[Histonet] Specimen Tracking Systems

Fri Nov 1 11:49:58 CDT 2013

Michael, yes that is the sort of workflow item that has to be considered. We plan to use the scanned image at the gross bench to double check. 

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

-----Original Message-----
From: Michael Mihalik [mailto:mike <@t> pathview.com] 
Sent: Friday, November 01, 2013 9:47 AM
To: Morken, Timothy; 'Bauer, Karen L.'; 'Jesus Ellin'; 'WILLIAM DESALVO'; 'Matthew D. Roark'; 'histonet'
Subject: RE: [Histonet] Specimen Tracking Systems

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

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