[Histonet] Specimen Tracking Systems

Fri Nov 1 11:28:30 CDT 2013

I pretty much agree with everything that has been already stated, but I
thought I would add the perspective of an LIS vendor to the conversation.
If anyone wishes to further discuss any of statements, publicly or
privately, I'm more than willing to do so.

1.  Tracking systems can work with minimal to no interfaces, but though
effective, they can be less than optimal and limited in scope.  It's all
about the workflow (how easy it is to do something because if it's
difficult, it won't happen) and it all depends on your objective.  For
instance, if all you want to do is gather statistics on personnel and
turnaround times for points tracked within your tracking system, then
interfaces, especially 'data back to the LIS' are not as necessary.  On the
other hand, if that is your sole objective, I would counter that there are
many more benefits to be gained from a tracking system.  Think of this
scenario:  A tech has found a problem or suspects a problem with a block or
slide.  She/he documents it in the tracking system, but how does that
information get to the pathologist when she/he is looking at the slide?  The
tracking system has the quality comment and can therefore report out
statistics, but that doesn't help the pathologist during the analysis of the
slide.

2.  Why is it so hard to communicate this data from the LIS to a middleware
tracking system and vice versa?   In a lot of ways, we've already read the
answer.  There is no technical reason for this.  It's just more software.
On the other hand, look at the complexity involved.  It's not just a matter
of sending information to and from the tracking system, it's a matter of
where and how the LIS displays and interacts with the data.  By the time, a
vendor has truly worked this out in their own system, they have essentially
written a tracking system themselves.  Furthermore, to truly write a tightly
coupled interface means that the LIS vendor is constantly expending effort
to match the changes of the tracking system vendor.  With this much effort
involved, why not build a tracking system within the LIS?

3.  To answer my last question, to truly a build a good tracking system, you
have to rewrite your LIS from the ground up because tracking and quality can
and should permeate all aspects of the workflow process.  If a vendor has a
certain amount of money to spend on either  marketing /sales or on
development, what will they do?  I would propose that most vendors are now
trying to reach some compromise.  The vendor won't rewrite extensive parts
of their system because that's too expensive, but they will patch some
'piece of software' on to the existing LIS and then use the remaining monies
to market/sell their solution.    Remember, this is just my opinion.  I
don't really know what other vendors do.

...but back to the original email.  The 30 second bit of advice is this:
Define your objectives and then pursue a solution that will help you meet
your objectives.  If I were in your shoes, I'd prepare my list of objectives
by
  a.   looking at the problems in my lab that I'm trying to solve,
  b.  looking at the problems and benefits other people have dealt with
(like you're doing now via histonet (thank you again histonet)), and 
  c.  looking  at the 'features/benefits' that various vendors talk about.

Distill a list and go from there, but and this is a big but, try to find
some way to factor in the support and relationship you will have with the
vendor.  Purchasing a computer solution today is truly like being married.
Divorces are expensive and an unbalanced or incompatible relationship is
painful on a day in, day out basis.

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 Jesus Ellin
Sent: Friday, November 01, 2013 8:36 AM
To: 'WILLIAM DESALVO'; 'Morken, Timothy'; Matthew D. Roark; histonet
Subject: RE: [Histonet] Specimen Tracking Systems

Amen to Both Bill and Tim,, I have fought this battle for years and as to
put it in Tim's words " The Ship has left the DOCK"  but now we MUST demand
this,, to stay a float and to move forward this is no longer an option, but
rather a integral part of the ship

From: WILLIAM DESALVO [mailto:wdesalvo.cac <@t> outlook.com]
Sent: Friday, November 01, 2013 8:18 AM
To: Jesus Ellin; 'Morken, Timothy'; Matthew D. Roark; histonet
Subject: RE: [Histonet] Specimen Tracking Systems

I completely agree w/ Jesus and Tim. It is way to difficult to connect our
data and move Anatomic Pathology to a level plane w/ the rest of Healthcare.
We need to demand from our vendors systems that will to allow us seamless
integration and communication of our data. Too often, the solutions for AP
are piecemealed together, proprietary and just not up to standard. We need
tracking and quality systems that will work with all our equipment and we
need equipment that will integrate into all information systems.

As we move to delivery of personalized medicine, AP will become one of the
major centers of data and information and we cannot afford to spend the time
and effort to recreate the wheel every time a lab wants to connect. The
technology upgrade we need in AP is tried and true, even old, technology. We
need this upgrade now. We need an overhaul of the equipment and processes in
AP and we must demand new and useful innovation if we are to meet the
demands of the ever changing Healthcare market.

I also hope more individuals share their experiences at all the professional
societies. We need the vendors to hear of the need from the technical,
professional and patient perspectives. We will need to engage w/ our vendors
to help them understand our needs.

William DeSalvo, BS HTL(ASCP)
> From: JEllin <@t> yumaregional.org
> To: Timothy.Morken <@t> ucsfmedctr.org; wdesalvo.cac <@t> outlook.com; 
> mroark <@t> sfmc.net; histonet <@t> lists.utsouthwestern.edu
> Subject: RE: [Histonet] Specimen Tracking Systems
> Date: Fri, 1 Nov 2013 13:54:16 +0000
>
> 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> list
> s.utsouthwestern.edu> 
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu]<mailto:[mailto:hist
> onet-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> list
> s.utsouthwestern.edu> 
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu]<mailto:[mailto:hist
> onet-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<mailto:mroark <@t> sfmc.net>
> > To: 
> > histonet <@t> lists.utsouthwestern.edu<mailto:histonet <@t> lists.utsouthweste
> > rn.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<mailto:mroark <@t> sfmc.net%3cmail
> > to:mroark <@t> sfmc.net>> 
> > http://www.sfmc.net<http://www.sfmc.net/<http://www.sfmc.net%3chttp:
> > /www.sfmc.net/>>
> >
> > _______________________________________________
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