Journal:Improving the creation and reporting of structured findings during digital pathology review

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Full article title Improving the creation and reporting of structured findings during digital pathology review
Journal Journal of Pathology Informatics
Author(s) Cervin, Ida; Molin, Jesper; Lundstrom, Claes
Author affiliation(s) Chalmers University of Technology, Linköping University
Primary contact Email: Available w/ login
Year published 2016
Volume and issue 7
Page(s) 32
DOI 10.4103/2153-3539.186917
ISSN 2153-3539
Distribution license Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported
Website http://www.jpathinformatics.org
Download http://www.jpathinformatics.org/temp/JPatholInform7132-492631_134103.pdf (PDF)

Abstract

Background: Today, pathology reporting consists of many separate tasks, carried out by multiple people. Common tasks include dictation during case review, transcription, verification of the transcription, report distribution, and reporting the key findings to follow-up registries. Introduction of digital workstations makes it possible to remove some of these tasks and simplify others. This study describes the work presented at the Nordic Symposium on Digital Pathology 2015, in Linköping, Sweden.

Methods: We explored the possibility of having a digital tool that simplifies image review by assisting note-taking, and with minimal extra effort, populates a structured report. Thus, our prototype sees reporting as an activity interleaved with image review rather than a separate final step. We created an interface to collect, sort, and display findings for the most common reporting needs, such as tumor size, grading, and scoring.

Results: The interface was designed to reduce the need to retain partial findings in the head or on paper, while at the same time be structured enough to support automatic extraction of key findings for follow-up registry reporting. The final prototype was evaluated with two pathologists, diagnosing complicated partial mastectomy cases. The pathologists experienced that the prototype aided them during the review and that it created a better overall workflow.

Conclusions: These results show that it is feasible to simplify the reporting tasks in a way that is not distracting, while at the same time being able to automatically extract the key findings. This simplification is possible due to the realization that the structured format needed for automatic extraction of data can be used to offload the pathologists' working memory during the diagnostic review.

Keywords: Digital pathology, structured reporting, usability, workflow

Background

The pathologist's review process with a microscope involves many activities such as reviewing the glass slides, taking notes, dictating the report, or referring to a colleague for advice.[1] Slide review is the most common activity during a session, but a considerable amount of time is spent on the other activities.[2] The main result of the review is distributed as a pathology report with the referring physician as the primary audience.[3] However, the result is also disseminated at multidisciplinary conferences, and certain parameters are reported to national registries for systematic follow-up. Structured (or synoptic) reports have been used successfully to improve this communication with external parties. The structure can act as a checklist and in that way improve the completeness of reporting or can be used as an electronic form to reduce the turn-around time since the additional dictation and transcription steps can be avoided.[4][5] The usability of structured reporting within pathology has, however, not been evaluated. Within radiology, the same benefits have been observed, but with regards to usability, structured reports have been associated with inappropriate interfaces for the reporting needs, and it has been questioned whether the structured format interferes with the image interpretation process.[6] Hence, it is important to take these issues into consideration when developing similar systems. On the other hand, the above studies see the reporting as a separate task alongside the review, and it is therefore only systems of that type that have been evaluated.

With digital pathology, it is instead possible to merge the reporting with the image review since the tasks are performed within the same system. This new possibility has so far received little attention, whereas the focus instead has been on new capabilities in terms of added features such as remote slide interpretation, digital image analysis, improved teleconferencing tools, and improved teaching capabilities.[7]

However, workflow improvements in terms of better integration between systems could be just as important. To improve these aspects, existing working patterns and assumptions need to be challenged. A few viewpoint papers and editorials present different visions of the future of digital pathology by employing this point of view: Krupinski[8] describes the future workstation as the pathologist's cockpit, where all the data needed to produce pathology reports are gathered in one interface including important workflow metrics in a digital dashboard to monitor the overall workflow. Fine[9] outlines a future scenario where digital image analysis algorithms are used to triage cases before review. The pathologist is then chauffeured between the most relevant areas of a case, where measurements are automatically performed. The pathologist can then select which measurements to accept and include into the final report. Hipp et al.[10] compared digital pathology to computational chess, and hypothesized that the best performing computer-aided diagnostic systems will be those that are best able to combine their performance with the pathologists, rather than the systems having best stand-alone performance.

The above visionary descriptions of future systems are clearly valuable for the development of the digital pathology field. In our work, we share their objective to redefine and improve the pathology workflows by removing assumptions that stem from the traditional use of microscopes, but no longer are necessary in a digital environment. Our work goes beyond theoretical visions as we conducted a design-based research study: A task analysis leading to a prototype development and finally a user evaluation of the prototype. The main assumption we challenged was that with microscopic review, the image review and the reporting in the form of dictation are considered to be separate tasks. Instead, we explored the possibilities that arise when building a reporting system that assists the pathologist during the review, as well as prepopulating a large part of the pathology report with structured items generated during the review.

References

  1. Randell, R.; Ruddle, R.A.; Thomas, R.; Treanor, D. (2012). "Diagnosis at the microscope: A workplace study of histopathology". Cognition, Technology & Work 14 (14): 319–335. doi:10.1007/s10111-011-0182-7. 
  2. Randell, R.; Ruddle, R.A.; Quirke, P.; Rhomas, R.G.; Treanor, D. (2012). "Working at the microscope: analysis of the activities involved in diagnostic pathology". Histopathology 60 (3): 504–510. doi:10.1111/j.1365-2559.2011.04090.x. PMID 22176210. 
  3. Mossanen, M.; True, L.D.; Wright, J.L. et al. (2014). "Surgical pathology and the patient: A systematic review evaluating the primary audience of pathology reports". Human Pathology 45 (11): 2192-2201. doi:10.1016/j.humpath.2014.07.008. PMID 25149550. 
  4. Casati, B.; Bjugn, R. (2012). "Structured electronic template for histopathology reporting on colorectal carcinoma resections: Five-year follow-up shows sustainable long-term quality improvement". Archives of Pathology & Laboratory Medicine 136 (6): 652–6. doi:10.5858/arpa.2011-0370-OA. PMID 22646273. 
  5. Bjugn, R.; Casati, B.; Norstein, J. (2008). "Structured electronic template for histopathology reports on colorectal carcinomas: A joint project by the Cancer Registry of Norway and the Norwegian Society for Pathology". Human Pathology 39 (3): 359-67. doi:10.1016/j.humpath.2007.06.019. PMID 18187180. 
  6. Weiss, D.L.; Langlotz, C.P. (2008). "Structured reporting: Patient care enhancement or productivity nightmare?". Radiology 249 (3): 739-47. doi:10.1148/radiol.2493080988. PMID 19011178. 
  7. Farahani, N.; Parwani, A.V.; Pantanowitz, L. (2015). "Whole slide imaging in pathology: Advantages, limitations, and emerging perspectives". Pathology and Laboratory Medicine International 2015 (7): 23–33. doi:10.2147/PLMI.S59826. 
  8. Krupinski, E.A. (2010). "Optimizing the pathology workstation "cockpit": Challenges and solutions". Journal of Pathology Informatics 1: 19. doi:10.4103/2153-3539.70708. PMC PMC2956171. PMID 21031008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956171. 
  9. Fine, J.L. (2014). "21(st) century workflow: A proposal". Journal of Pathology Informatics 5 (1): 44. doi:10.4103/2153-3539.145733. PMC PMC4260324. PMID 25535592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260324. 
  10. Hipp, J.; Flotte, T.; Monaco, J. et al. (2011). "Computer aided diagnostic tools aim to empower rather than replace pathologists: Lessons learned from computational chess". Journal of Pathology Informatics 2: 25. doi:10.4103/2153-3539.82050. PMC PMC3132993. PMID 21773056. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132993. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. In some cases important information was missing from the references, and that information was added.