[Histonet] Histology Workflow Solutions

Michael Mihalik mike <@t> pathview.com
Mon Feb 28 11:35:01 CST 2011

As many as you know this is a topic that is near and dear to my heart so I'd
like to expound on this subject if you'll permit me.  For those of you who
already have solutions, or perhaps have more favored topics, please feel to
move on to the next subject.

First off, while I have some knowledge of both products, I am a user of
neither.  In fact I am a competitor of both, to some degree.  Both products
offer advantages and disadvantages.  You really need to think about how they
fit in your lab.  When I say 'in your lab', I mean not only the histology
area, but everyone, including the accessioning clerks, secretaries,
pathologists, and even cytotechnologists.

To me, one of the items that is more relevant to your situation is whether
you want an integrated solution (IMPAC) or a standalone/interfaced solution.
For instance,

1.  How will information get into Vantage?  Will it have to be manually
accessioned/entered or will there be an interface?  In the IMPAC solution
this is a non issue.  Also, keep in mind that there may be an interface cost
from BOTH vendors should you decide an interface is in order.

2.  How will information get OUT of Vantage or put another way, does the
pathologist or secretary need to see information gathered/stored by Vantage?
This may be resolved by another interface, but it may also be resolved by
putting Vantage on more and more PCs.

3.  Who is going to configure, manage and maintain Vantage?  This is going
to be a whole other computer system in your lab.  Will your IT department
support it, maintain it, administer it, etc.  Who will understand and set up
the files, etc.?  You have the same issue with IMPAC, but I bet someone is
already handling all these issues.

4.  Can you use barcodes generated from Ventana on IMPAC?  I don't know the
answer to this question.  It's not that each system can't read the barcode.
It's a matter of whether IMPAC calls their slide, slide X and Vantage calls
it 'y'.  For instance, maybe IMPAC calls it case#.spnid.blockid.slideid and
maybe Vantage calls it slideidNN.  That means whenever the pathologist scans
the slide at his IMPAC workstation, IMPAC won't recognize it.  Perhaps this
is not an issue, but I thought I would bring it up.

5.  Management Reports:  I know IMPAC supports Crystal Reports and at least
theoretically you can build your own management reports.  I don't what the
situation with Vantage is.  Are they canned reports or can you add more?
Does this matter to you?  I don't know enough about the details of either
reporting module.  Perhaps, the Vantage report subsystem generates
everything you could possibly need and therefore why deal with Crystal
Reports to generate unneeded reports.  On the other hand, I note that in a
response, Christie mentioned that Vantage tracked quality issues 'anywhere
in the process'.  I would wonder how Vantage could track quality issues at
specimen receipt or at the pathologists PC if Vantage was not installed at
those two areas.  Perhaps as long as it's tracked somewhere, who cares what
system contains the data.

These are some serious issues to consider and as you might conclude, the
analysis leans towards an integrated solution.  However, that's not the
whole story.  

There is really no magic to printing and scanning barcodes.  The real
science/magic lies in how those barcoded identifiers are used.  You want
them to make misidentification errors go away and you want them to
constantly provide who/what/where information for any and all material.
...but again, HOW do the two sets of software do that?

You might want to consider the following questions:

1.  Do you HAVE to use PCs for each grossing, embedding, cutting station?
This is important because more PCs cost money and more PCs take up precious
space.  On the other hand, more PCs allow more ease of data entry.
2.  At grossing do you need to see the requisition?  Are the requisitions
scanned into IMPAC?   That would make it difficult for IMPAC to display
those images.  What about patient history?  Do you need to see that at
3.  Do ALL slides print automatically when a block is scanned or do they
have to be selected?  You may have a preference here, but notice that I said
'slides for a block'.  I can see both answers being 'correct'.
4.  If you already have a Benchmark or Ultra, you have a built in motivation
to use Vantage.  With Vantage, you can use only ONE slide label to label
slides going to those instruments.  With IMPAC, you have to hand write or
double label.  This is because those 2 instruments require the use of
Ventana's own label.   Also, once the order for the benchmark or Ultra is in
Vantage, I 'imagine' that this data would be sent to those instruments
automatically.  Please confirm this as I do not know if this is an
additional cost.
5.  Again, if you use either the Ultra or Benchmark, the anticipated slide
completion date is available.  This date/time is not available via an
interface to IMPAC or any other vendor.
6.  At grossing do you need to see the requisition?  Are the requisitions
scanned into IMPAC?   That would make it difficult for Vantage to display
those images.  What about patient history?  Do you need to see that at

There are certainly other issues, and please don't get me wrong.  I think
that Vantage is a very sexy product.  It looks very nice and it provides the
positive ID everyone should really have.  As you read the literature and get
responses from others keep in mind that you have a choice a lot of people
don't have.  You can choose a system that is supported by your current
vendor.  A LOT of other people don't have that choice.  It's either Vantage,
a competitor to Vantage or a new LIS.  You can get a lot of 'bang for the
buck' with just Vantage.

...but if you're looking for a new LIS, well that's where my company comes
in.... but that's a subject for a private email.

P.S.  The purpose of this email is to neither endorse one or the other
product.  My intention was to simply get people thinking about the issues
involved, especially as tracking solutions and LIS's have evolved over the
last few years.

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 CHRISTIE
Sent: Monday, February 28, 2011 7:05 AM
To: dana.spencer <@t> pcmh.com; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Histology Workflow Solutions

Hi Dana,
I can't speak to the Elekta module but I have used the Vantage system for
over a year now. We generate a bar code at accessioning that is used
throughout the entire process to make cassettes, gross, embed, section,
stain and turn out. We do not batch during any of the process other than the
20 slides we put in our staining tray. We scan each block at microtomy as we
section which prints a label that we affix to the slide when we pick up the
section. We have virtually eliminated errors at all stations. We were able
to see quite an improvement in turn around times as well as tracking our
specimens. This system also allows us to track quality issues anywhere in
the process. Please feel free to contact me if you have further questions.
Christie Gowan
University of Alabama at Birmingham
Surgical Pathology
205 934 4991
> Date: Mon, 28 Feb 2011 09:41:02 -0500
> From: Dana.Spencer <@t> PCMH.COM
> To: histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] Histology Workflow Solutions
> I am currently investigating workflow solutions for our Histology Lab
incorporating bar code labeling. We use the PowerPath/ Elekta AP System. I
am looking into Elekta's AMP Module vs Ventana's Vantage system. I would
welcome any comments on these systems and how they work in your lab or if
you use something else. I would also welcome any suggestions or comments on
how you label slides...Do you batch print and scan barcodes of the blocks
and slides at the microtome? Do you scan blocks at the microtome and print
labels there for the slides? Do you scan blocks at the microtome and print
slides at the microtome? You may email directly if you prefer. Please share!
Thanks in advance for your help and feedback!
> Dana
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