[Histonet] Specimen Tracking Systems

Fri Nov 1 11:47:09 CDT 2013

Just a quick thought....

If you scan your requisition into the LIS after accessioning, it might not
be a bad idea to have your grossing personnel review the requisition at
grossing to confirm that the patient name/specimen on the paperwork matches
what's in the LIS.   Yes, with barcodes this shouldn't happen, but it's a
nice double check.

Michael Mihalik
PathView Systems | cell: 214.733.7688 | 800.798.3540 | fax: 952.241.7369

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Morken,
Timothy
Sent: Friday, November 01, 2013 9:23 AM
To: 'Bauer, Karen L.'; 'Jesus Ellin'; 'WILLIAM DESALVO'; 'Matthew D. Roark';
'histonet'
Subject: RE: [Histonet] Specimen Tracking Systems

Karen, we are going to move to a system as you describe. At accessioning all
paperwork will be scanned and none will follow the specimen. The critical
trick is getting residents and pathologists to look at screens rather than
hard copies. We spend way too much time printing and collating hard copies
of reports ever day.

Tim Morken
Pathology
UC San Francisco Medical Center
San Francisco, CA

-----Original Message-----
From: Bauer, Karen L. [mailto:Bauer.Karen <@t> mayo.edu] 
Sent: Friday, November 01, 2013 9:03 AM
To: Morken, Timothy; 'Jesus Ellin'; 'WILLIAM DESALVO'; 'Matthew D. Roark';
'histonet'
Subject: RE: [Histonet] Specimen Tracking Systems
Importance: Low

Jesus, Tim, and Bill...  Wonderful communication about specimen tracking,
bi-directional capabilities, and creating a histology lab that will be
effective in the years to come!!  I loved reading your information!

We also have the Vantage system and it's helped us decrease our slide
labeling error rate to 0%!  It's wonderful and I'm so glad we finally had it
implemented last April.  Our workflow seems much more efficient, since we no
longer have to perform all of those manual reconciliation steps.

Yes, the bi-directionality of the systems (we have Sunquest CoPath) is a
downfall of the software, but the pros of Vantage outweighed that flaw.  I'm
hoping that in the years to come, that will be fixed.

A new question for the Histo group... 

We are trying to get away from printed grossing working drafts that are
submitted with the slides and delivered to the pathologists.  We would like
the docs to scan the slide at their microscope and have the patient
information show up on their computer.  The pathologists still want the
paper requisition from the specimen, so I suggested to have the requisition
scanned and attached in the digital format.  This way, when the doc scans
the slide, the CoPath working draft, the patient clinical hx, and the
scanned req slip can be viewed.

Is anyone doing this in their lab right now?  If so, I would really like to
hear more about how you and your LIS made that happen.  

Thanks so much and Happy Friday!!!!!    :)

Karen

Karen L. Bauer HTL/HT (ASCP) | Histology Supervisor | Pathology | MOHS Lab
Supervisor | Dermatology | Phone: 715-838-3205 | bauer.karen <@t> mayo.edu | Mayo
Clinic Health System | 1221 Whipple Street | Eau Claire, WI 54702 |
mayoclinichealthsystem.org

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Morken,
Timothy
Sent: Friday, November 01, 2013 10:06 AM
To: 'Jesus Ellin'; 'WILLIAM DESALVO'; Matthew D. Roark; histonet
Subject: RE: [Histonet] Specimen Tracking Systems

Jesus, the topic of bi-directional interfaces is fraught with both technical
and political issues. Technically it is certainly possible (As a software
developer colleague of mine always told us - 'don't ask if I can do it, just
tell me what you want. It's just software'). The issue is who pays for it,
and who wants it. As I see it, the large LIS companies got caught
flat-footed by the desire of histology labs to move to barcoding. Indeed,
when I worked for a company that manufactured immunostainers we approached
several large LIS companies about integrating our bar-code-driven instrument
with their systems (we had already prototyped it in our lab with our own
mockup of an LIS). I kid you not, the response of each and every one of them
was "Why would you want to do that?" Next, they said they could do it if we
had a customer that would pay for it. Here in Silicon Valley, where products
are developed on the premise that people don't know what they want until you
give it to them, that's like admitting you are clueless.

Most of these LIS companies are not very proactive and are largely
unimaginative in their outlook. That is why Ventana, Leica and others were
able to step into that gap and develop their own systems. And at places like
U of W they developed their own tracking systems and fully integrated it to
their LIS because their LIS did not have anything even planned for
barcoding.

But now these same LIS companies have finally figured out that that the
barcoding ship is leaving the dock and they are scrambling to develop their
own systems to compete with the stand-alone systems like Vantage and
Cerebro. Due to that competition these LIS companies may not be willing to
allow true bi-directional communication - it totally undercuts anything they
may develop. They are already  at least 5 years behind the curve and can't
allow the other companies to gain any further advantage. 

Tim Morken

-----Original Message-----
From: Jesus Ellin [mailto:JEllin <@t> yumaregional.org]
Sent: Friday, November 01, 2013 6:54 AM
To: Morken, Timothy; 'WILLIAM DESALVO'; Matthew D. Roark; histonet
Subject: RE: [Histonet] Specimen Tracking Systems

I would like to chime in on this Bill and Tim both gave great examples of
what it takes to move in this direction.  But I would also like to
understand why there are so many challenges in getting the data back into
the APLIS with updates and orders.   I would tell people the biggest concern
that I have the data being produced by a system should be accessible across
all gradients of the workflow and not just the unique tracking system.  Not
only is this tracking system positioned to help out histology with what is
being explained below, but it is the foundation work in taking steps to get
to the next level when talking Digital Pathology, molecular, Personalized
medicine,  Pathologist cockpit, and algorithm analysis.    

With the looming cuts coming down the pike, we have to make sure the vendors
understand we cannot have barriers when it comes to interface and
interoperability with our system.  At the same token we cannot be charges an
arm, leg and torso for interfacing what is rightfully ours and that is the
patients data we produce.

Bill and Tim excellent job in giving a crash course in Tracking system 101,,
I do believe we should see more of this explained at professional societies
meeting and also what the new environments we are going to be working in
because of this technology.  

Just my two cents

Jesus Ellin

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Morken,
Timothy
Sent: Thursday, October 31, 2013 3:45 PM
To: 'WILLIAM DESALVO'; Matthew D. Roark; histonet
Subject: RE: [Histonet] Specimen Tracking Systems

I agree with Bill on this. We have Cerner Copath Plus and looked at Cerebro,
Vantage and Omnitrax. Only Cerebro and Vantage were capable of working with
Copath. But the problem is that Copath requires you purchase their tracking
system to use as an HL-7 interface to any third party system. AND there is
not two-way communication between the systems. You MUST enter orders (cases,
blocks, stains) in copath and it ports orders to the other system. The only
feedback is status updates to copath - you cannot add items in the other
system and expect them to show up in copath. That requirement effectively
doubled the price of the system. So we are using only the Copath AB&T
system, which we are starting to implement now. They will finally have touch
screen capability in the spring so we were satisfied with that. Touch
screens were a primary spec we demanded. 

The key to tracking is how the tracking system works with your current LIS.
Can it communicate in a true bi-directional fashion? Is it just an add on
and all the tracking info is in the tracking component, not the LIS? There
are tradeoffs and you need to figure out which you want to live with.

We spent two years investigating all these systems, doing site visits, and
going through a 6-month total LEAN evaluation. The one thing every
institution told us was: LEAN your system BEFORE adding barcoding.
Barcoding will NOT fix any inefficiencies you have. And you are pretty much
stuck with what ever system you barcode - warts and all. So do all the hard
work up front. 

We thought we were prepared but are daily finding all kinds of little
details that have to be worked out. Detail out every single little thing
about all your workflows before starting anything. Streamline everything.

Cassette printing is the heart of barcoding. The barcoded (actually usually
2D matrix codes) on the cassette drive grossing, tracking through
processing, embedding and cutting. If that does not work reliably your
system will not work. 

We went with Leica cassette printers. They are huge, but fast (5 sec per
cass). We were going to use thermo, but they had their printhead problem and
we dropped the order. They are 20+ seconds per cassttes, tho have a very
compact footprint. You will find there are tradeoffs to everything.

Slide labeling is the other half of the equation. They must be reliable and
survive all histology procedures. 

We will use thermal transfer label printers rather than direct slide (too
expensive- we will have a printer at each microtome- and cumbersome to
change out slide types). Slide labeling is a HUGE deal - you have to be sure
it works for everything and can be used in your immuno stainers and
coverslipping machines. We are using either Brady StainerBondz labels or
LabTags Xylituff labels. These were the only ones that had the size we
wanted (23 x 19 mm) and survived all processes. General data StainerShield
are also good, but only come in 22 x 22 size. Plus are the most expensive.

You will find it much easier if you use labels and ribbons from one
manufacturer, designed to use with specific printers. That simplifies a lot
of the effort. We have tried to mix and match but it is very difficult
because all manufacturers do not make matching labels and ribbons for all
printers. 

Tim Morken
Supervisor, Electron Microscopy and Neuromuscular Special Studies UC San
Francisco Medical Center San Francisco, CA

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of WILLIAM
DESALVO
Sent: Thursday, October 31, 2013 3:01 PM
To: Matthew D. Roark; histonet
Subject: RE: [Histonet] Specimen Tracking Systems

My lab chose the Ventana Vantage System w/ Thermo PrintMate cassette
printers. We are a multi-location system and Vantage works well for us. We
wanted a robust tracking and flexible quality assurance system and Ventana
provided what we needed and wanted.

I suggest you look at the big four to start your evaluation:
Ventana - Vantage
Leica- Cerebro
Thermo- OmniTrax
General Data - HTS

The larger companies have more interfaces built for the different LIS used
in Histology. There are many smaller companies that offer tracking systems,
but make sure they can connect w/ your LIS.  After product selection,
support is critical.

Sunquest and Cerner Millennium now offer tracking and quality assurance
modules. And I imagine there are other tracking systems built into more LIS.

You will also want to evaluate multiple printers for your cassettes. Always
keep in mind the amount of information you will be adding to the cassette a
this will reduce the number of cassettes/ minute. Start w/ the tracking
system vendor and see what the have validated. Consider the upkeep and
maintenance of the printer. We choose heat transfer, but there are Laser and
Ink-jet that work really well. We chose to point of generation and wanted a
very small footprint to place the printers in the grossing stations.

We also choose not to use a slide printing system and decided the bar coded
labels at microtomy was the best solution for us. We wanted less maintenance
and steady throughput. Easier to load a roll of labels than keeping a
printer up and running.

Last, but certainly not least, support. You will need a ton of support to
work through this project: interfaces, IT upgrades, software adjustments,
WORKFLOW changes and training. Plan and re-plan before you make your
selection. And negotiate hard, the pricing is all over the place for the
systems.   

William DeSalvo, BS HTL(ASCP)
Production Manager-Anatomic Pathology
Chair, NSH Quality Management Committee
Board Member, Digital Pathology Association Owner/Consultant, Collaborative
Advantage Consulting

> From: mroark <@t> sfmc.net
> To: histonet <@t> lists.utsouthwestern.edu
> Date: Thu, 31 Oct 2013 20:21:47 +0000
> Subject: [Histonet] Specimen Tracking Systems
> 
> What systems are people using for specimen tracking?  I'm looking for the
whole package of cassette printers, work station slide printers, tracking
software, etc...
> 
> Any help and recommendations would be appreciated!
> 
> 
> 
> Matthew Roark- HT/HTL(ASCP)CM
> Histology Specialist
> Saint Francis Medical Center
> 211 Saint Francis Drive
> Cape Girardeau, MO 63703
> 573-331-3982
> mroark <@t> sfmc.net<mailto:mroark <@t> sfmc.net>
> http://www.sfmc.net<http://www.sfmc.net/>
> 
> _______________________________________________
> Histonet mailing list
> Histonet <@t> lists.utsouthwestern.edu
> http://lists.utsouthwestern.edu/mailman/listinfo/histonet

_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet

_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet

______________________________________________________________________
This message is confidential, intended only for the named
recipient(s) and may contain information that is privileged or exempt from
disclosure under applicable law.  If you are not the intended recipient(s),
you are notified that the dissemination, distribution, or copying of this
message is strictly prohibited.  If you receive this message in error, or
are not the named recipient(s), please notify the sender at either the
e-mail, fax, address, or telephone number listed above and delete this
e-mail from your computer. 
Thank You.
______________________________________________________________________

_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet

_______________________________________________
Histonet mailing list
Histonet <@t> lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet