Maximize Your Staff’s Time to Work Smarter, Not Harder

Oct 20, 2020 | Pathology Business

As medical reimbursement continues to fluctuate, practicing smarter instead of harder or longer becomes even more critical for dermatologists. Running a thriving dermatology practice demands that business owners continually examine ways to increase staff efficiency and maintain patient satisfaction. The average staff-to-dermatologist FTE ratio is between 5:1 and 6:1—but, when they are seeing 40 to 50 patients a day, dermatologists still often take work home with them.

Meanwhile, a recent study indicates that only 30 percent of Gen X dermatology patients are “completely satisfied” with their provider. By cross-training your staff, maximizing your EMR, being prepared, and partnering with the right dermatopathology lab, you can discover ways to maximize your staff’s time to work smarter while maintaining or improving patient satisfaction.

Cross-Train Your Staff

Traditionally, clinic staffing has included front-office staff focused on checking patients in and out of the clinic, collecting payments, and scheduling appointments. Selecting composed and capable individuals to fill these positions is critical since customer service is the source of over 95 percent of patient complaints. Medical assistants and back-office personnel are trained to assist in patient rooms, handle clinical questions, call back biopsy and lab results, and manage clinical supplies.

However, many clinics now find it more useful to train staff to perform both front- and back-office tasks. That way, if someone is out sick, needs to take time off, or requires a helping hand, any staff member can step in to assist. Some clinics have a dedicated float person who can call in prescriptions, answer phones to schedule appointments, or triage patient questions. Having someone who is clinically savvy cover the front desk can increase efficiency by knowing when to add or overbook patients without requiring other staff or the physicians to make the right call.

Maximize Your EMR

It can be hard to invest the extra time setting up an EMR effectively with templates and favorites with a busy schedule. Since up to 80 percent of dermatologists use EMR systems, talk to colleagues to get their suggestions. While you’re at it, see if they have any electronic templates or lists of commonly used medications that your staff can enter as favorites. If no one you know is using an EMR, try joining a dermatology Facebook group—such as The Board Certified Dermatologists or Business of Dermatology—where you can ask questions or search old posts.

Some clinics have both a dedicated scribe and medical assistant in the room during patient visits. This way, the scribe can accurately document the appointment, allowing you to bill appropriately for the service level. Meanwhile, the MA can make biopsy preparations, take photographs, or fill out paperwork for you. Consider having staff start patient notes before the patient arrives so they can ask directed follow-up questions and give a more useful summary before you see the patient.

Some EMRs now offer the ability to print requisitions and labels. Taking advantage of this feature can save staff from handwriting forms and labels, which is slow and prone to error.

Time invested up front can save hours of time for the clinical staff, who have to do less manual input and can spend more time counseling the patient than charting. Suppose your templates or patient handouts contain all the prompts for counseling. In that case, the MA has a template to follow, so patients consistently receive all necessary information instead of relying on their memory to counsel them. By allowing them this one-on-one time with patients, medical assistants often find more meaning in their job and create better relationships with them, leaving you time to catch up on notes or fit in an urgent visit.

Be Prepared

If a patient needs a biopsy, rescheduling the patient will cost staff time setting up a new appointment, checking in again, and rooming the patient. With no-show rates as high as 30 percent in the United States, it’s essential to promptly ensure your patients receive the care they require. 

Suppose your biopsy tray is already set up and ready for a shave biopsy, with appropriate tools and paperwork ready to go. In that case, you can perform the biopsy while the patient is already in the room and disrobed. Consider having your rooms organized with easily accessible supplies grouped by types of procedures. If appropriate, preprinted patient labels can help save time during a busy clinic. You can also slap a label on patient paperwork rather than handwriting the label.

Having tear-off sheets printed for follow-up appointments or frequently recommended over-the-counter treatments can also save staff time and money. Printing in bulk at your local copy store or an online resource can help you save on supply costs like paper and ink, preserve staff time, and become more organized with frequently used handouts at your disposal.

Find the Right Dermatopathology Lab

Fast turnaround times combined with quality reporting will save you and your staff time. Receiving timely reports helps patients get results and treatments more quickly, decreasing patient calls and increasing patient satisfaction by up to 8 percent.

Partnering with a lab that offers an EMR interface speeds up the process even more. Reports automatically interface with the specific patient’s chart, eliminating the need to scan in paper faxes or sort through pages of e-faxes, providing the staff time to address other tasks. Providers can review photographs and results simultaneously and process clinical decisions more quickly.

In addition, having access to your digital biopsy slides can improve your clinicopathologic correlation on the case and result in the most appropriate clinical diagnosis and subsequent treatment.* It also allows the dermatologist to review the slide in real-time with the dermatopathologist. When needed, expert consults can be processed in-network, saving time in the long run by delivering precise diagnoses and reduced billing issues. Also, by allowing your dermatopathologist to contact you directly, they can more easily reach out when additional correlation is needed on a case or notify you about melanoma diagnoses.

With 12 million skin lesions biopsied in the United States every year, the demand has never been greater for labs to demonstrate competence and value to the dermatologists they serve. Joining forces with a full-service dermpath lab like PathologyWatch provides all these benefits by giving quality reporting, fast turnaround times, digital access to your slides, and clinicians who care about each case.

Increasing staff efficiency while maintaining patient satisfaction is key to the long-term success of dermatologists. Take proactive measures to cross-train your staff, make full use of your EMR, prepare for every case, and partner with a capable dermatopathology lab to maximize your staff’s time and get the most productivity out of your clinic. 

*Images are not intended to be used for the diagnosis or treatment of a disease or condition.

What Is an HL7 Interface, and Why Should I Want One?

Oct 14, 2020 | Digital Pathology

You May Save FTE Time by Switching to an EMR Interface

By April Larson

In an increasingly digital world, where digital devices make us more efficient (except for time spent playing Candy Crush), we often find that digital healthcare solutions cost us time and efficiency. While we anticipate technology will improve efficiencies, we often find we are trading one inefficiency for another. Why does my iPhone seem to solve my every problem (“Hey Siri, where is the closest gas station?”), yet I’m still spending my evenings feeding my kids Top Ramen while I catch up on my clinic notes? Ironically, in the increasingly sophisticated digital age, healthcare technology feels outdated and less robust than we experience in competitive arenas like entertainment or business.

In this article, we will discuss ways to save FTE time and simplify clinic workloads by examining some of the obstacles created by new technology, defining what an HL7 interface offers, looking at the challenges of paper, and digging into the advantages of digital pathology. 

What are the technological challenges?

  1. There is no universally accepted electronic medical record.
    One challenge with information sharing in healthcare is that there are many universally accepted electronic medical record systems. In fact, over 130 vendors produce EMR systems. Therefore, while healthcare is becoming increasingly digital, many of us are still disconnected and cannot share medical information—such as clinic notes, lab results, and pathology reports—as seamlessly as we would like. Dermatologists and staff spend lots of time tracking down reports and medical records, sending consult letters, or performing other necessary communication to provide the continuity of care patients need.
  2. Regulations can complicate the sharing of medical information.
    This is a crucial reason why the medical world is one of the few industries where old-school faxing is still widely embraced. Digital communications are complex and sometimes may not be compliant with HIPAA or HITECH requirements.
  3. Electronic documentation is often less specific.
    It can be beneficial to use templated descriptions for common diagnoses. However, when I biopsy a lesion, a more specific description is preferred. Manual entry of a lesion description can be cumbersome, especially when training a new medical assistant; either I accept a less detailed description or differential, which can limit the amount of information getting to my pathologist, or I spend my evening catching up on my notes rather than binge-watching Schitt’s Creek.

As digital technology makes its way into healthcare, perhaps Siri will one day be able to scribe and bill all my notes while my medical assistant and I happily engage with and educate our patients. In the meantime, the most exciting way to start sharing electronic information is through an HL7 interface. 

What is an HL7 interface?

HL7 stands for Health Level Seven, which refers to set standards for transferring healthcare data between healthcare providers. With a membership that includes 90 percent of healthcare system vendors, the organization establishes specifications to safely and accurately exchange sensitive healthcare data.

How do I get the LIS and EMR talking?

Laboratories, including dermatopathology laboratories, use an electronic system called the LIS (laboratory information system). The dermatopathology world’s EMA and EZDerms include an LIS such as PowerPath, Beaker, or WebPathLab.

While these systems are not designed to talk to your EMR, the HL7 interface enables EMRs and LIS programs to communicate the same language. This allows for the transfer of data between otherwise incompatible electronic medical records.

Why do I want an HL7 interface?

While 60 percent of clinics already have implemented EMRs in their practice, most have not experienced the game-changing capabilities that an interface provides. The exchange of information through this interface can simplify your daily workflow considerably. By way of an HL7 interface, the lab can send reports electronically directly to your patient chart and, in certain instances, populate the diagnosis and treatment, streamlining your review and signoff.

The adoption of technology can save the staff from menial, time-consuming tasks and allow them to participate more in patient care, which increases both staff and patient satisfaction.

What are the challenges of paper?

When a dermatology practice sees 40–50 patients per day, relying on paper to manage the workflow can create inefficiencies and impact the time to deliver results to patients. Consider the following weaknesses:

  1. Handwritten requisitions and labels take a lot of time, are redundant, and can be difficult to read.
    Pertinent information must be recorded both on the requisition and the label. Handwritten forms not only take time in the clinic, but labs must also use manual entry. When the dermatopathology lab receives the requisition, the lab tech must manually enter the requisition information into the LIS and match it to the biopsy. This process is prone to human error.
  2. Reports must be faxed and scanned.
    The dermatopathologist signs an electronic report, which is often faxed and then scanned into the dermatologist’s EMR. Papers also occasionally get lost or misplaced in a busy clinic.

What are the benefits of a digital pathology workflow?

To move beyond the challenges of paper, dermatopathology lab services like PathlogyWatch can build an HL7 interface directly to the dermatology clinic’s EMR to optimize margins of error and turnaround times, preserving precious staff and provider time.

  1. There are fewer redundancies and room for mistakes with electronic requisitions and labels.
    When you document a lesion in the electronic chart, you can use this description and diagnosis to generate electronic requisitions and labels rather than write down the same information in multiple places, like the location or date of birth. Patient information is also easier to read, more accurate, and simple to double-check with the patient.
  2. Reports automatically upload to the patient’s chart.
    When dermatopathology reports are signed out, the reports are uploaded directly into the patient’s EMR.
  3. Automatic data entry is also possible.
    In some instances, the diagnosis and treatment options autopopulate for the dermatologist’s quick review and signoff.
  4. A digital pathology log can be easily shared amongst providers and staff.
    Providers can quickly sign off on a report, and a reminder is automatically sent to the electronic pathology log, where multiple staff members can work simultaneously.

The pressure is on dermatopathology laboratories to simplify the way information is shared with their partner dermatology clinics while maintaining compliance. By assuming the many time-consuming, routine tasks involved in a traditional dermatopathology workflow, a secure and compliant HL7 interface allows both dermatologists and their support staff to spend more time in patient care areas that are more rewarding, such as patient interactions and education. We win by spending our time doing what we’re best at and most enjoy: seeing patients. 

And who knows? Maybe we’ll have time to get in an episode or two of that show we’re behind on.

Diagnostic Testing in Atypical Spitz Tumors

Oct 5, 2020 | Digital Dermatopathology, Digital Pathology

Dermatologists diagnose and treat various skin disorders, including eczema, psoriasis, infections, and skin cancers. The average dermatologist sees 40 to 50 cases per day and is exposed to uncommon conditions, such as atypical Spitz tumors.

Considered borderline lesions, atypical Spitz tumors can make it challenging to predict metastatic risk or biologic behavior. Because they can resemble malignant melanoma, it is essential to recognize atypical Spitzoid tumors, become familiar with associated diagnostic testing, and partner with dermatopathology experts that can provide your patients with accurate and efficient results. 

Understanding Atypical Spitzoid Tumors

Lesions designated as atypical Spitzoid tumors (AST) confusingly appear as both Spitzoid melanomas and wholly benign Spitz nevi. Most commonly found in females with an average age of 22 years, the enigmatic lesion lacks standardized histological benchmarks, making consensus difficult for pathologists. 

Because of the difficulty in defining the biologic potential using morphology alone, dermatopathologists will sometimes order additional ancillary testing to help characterize the lesion. 

Additional testing platforms

Two techniques sometimes utilized to help characterize atypical Spitz tumors include Flourescence in-situ hybridization (FISH) and Array-based comparative genomic hybridization (aCGH). Flourescence in-situ hybridization (FISH) tests for characteristic chromosomal changes seen in tumors. Using a fluorescence microscope, short DNA fragments known as “FISH probes” are examined as they hybridize to tumor cells. By counting the resulting fluorescent dots, dermatopathologists can detect a loss or duplication of chromosome fragments. The method, used in combinations of four and five-probe FISH assays, is sometimes preferred as the primary molecular test because it is quick and straightforward and allows histopathologic correlation. In atypical Spitz tumors, probes are performed for covering the chromosomal loci 6p25, 8q24, 11q13, centromere 9, and 9p21.

Array-based comparative genomic hybridization (aCGH) is used to establish areas of genomic imbalance. While few academic centers perform CGH due to the high cost and limited insurance reimbursement, the method produces higher resolution results, which enable the identification of genes related to Spitzoid melanocytic neoplasms. When a Spitzoid neoplasm has a genetic pattern similar to malignant melanoma, this can potentially result in a poorer prognosis and possibly a reclassification to Spitzoid melanoma.

There are additional ancillary testing modalities marketed in the dermatology community to aid in the diagnosis of melanoma. None of these tests, however, have been shown to be consistently reliable; therefore, many dermatopathologists do not utilize them except in very rare circumstances.

Finding Experts in Molecular Testing 

When a dermatology clinic encounters an unfamiliar lesion, they turn to their dermatopathology laboratory for a correct and timely diagnosis. Aligning with a lab that embraces digital pathology can decrease turnaround time by 20 percent to up to 75 percent. 

Partnering with expert dermatopathologists, like the team at PathologyWatch, means access to academic-level interpretations and judicious use of ancillary tests when indicated. In addition, utilizing a digital pathology workflow enables simultaneous corroborations on difficult lesions by multiple experts. Having a team of qualified pathologists on your side can be the difference between diagnosing a tissue sample as Spitz nevus or Spitzoid melanoma. 

Though uncommon, your dermatology clinic may come across borderline lesions from time to time. By learning more about atypical Spitz tumors, understanding diagnostic testing, and knowing what to look for in a dermatopathology lab partner, you can empower your practice and continue to provide your patients with optimal care.

Dan Lambert Shares How the Pandemic Has Upset Healthcare and Five Ways to Fix It

Sep 29, 2020 | Pathology Business

In a new article published by Forbes, Dan Lambert, CEO of PathologyWatch, examines how the pandemic is causing harm to particular functions of the healthcare industry.

While COVID-19 will have a long-lasting physical and economic impact worldwide, it has also exposed some troubling problems within the healthcare community. These include steep financial challenges facing hospitals and private practices, patients delaying medical procedures, overlooking pre-existing healthcare industry concerns, and bottlenecks in pathology lab workflow.

Dan explains, “When a pathology lab delays processing skin specimens or other biopsies to focus on COVID-19 cases, it unintentionally increases the patient’s level of risk.” He adds, “Some estimates claim these coronavirus postponements will lead to over 10,000 cancer fatalities in the next decade. By reducing the wait time for day-to-day lab results today, we can save lives tomorrow.”

Dan also shares five action items that could help the healthcare industry improve the situation before it’s too late. These include telehealth adoption, hospital bailouts, digital data transfer, alternative insurance options, and academic standards.

To read the full Forbes article, click here.

Diagnostic Markers for Melanocytic Lesions

Sep 18, 2020 | Digital Dermatopathology, Digital Pathology

Melanocytic lesions, commonly found in 23 percent of skin biopsies, can sometimes be challenging to diagnose based on morphologic criteria alone. However, utilizing diagnostic markers can make a significant difference in the accuracy of a melanocytic lesion diagnosis. 

As a dermatologist, you rely on your partnering dermatopathology laboratory to demonstrate expertise when it comes to diagnosing your melanocytic lesion cases. By understanding why diagnostic markers are ordered and examining the more prevalent types of immunohistochemical stains, you can play a greater role in providing your patients with optimal care.

Why are diagnostic markers ordered?

In a survey of 160 dermatopathologists, 99 percent indicated they ordered additional immunohistochemistry (IHC) or molecular tests out of concern for patient safety. Because melanocytic lesions can produce harmful results if a melanoma diagnosis is missed, laboratories often order diagnostic markers to make sure the results are as definitive as possible, utilizing the most reliable tests.

Medicare has released guidelines to cut costs, reduce overutilization, and ensure that orders for diagnostic markers meet medically necessary criteria. These directives indicate that “a pathologist must first review the H&E [hematoxylin and eosin] stain prior to ordering special stains or IHC.” They add that “the medical necessity for the special stain . . . must be documented in the surgical pathology report.”

The most proficient and ethical dermatopathologists avoid overbilling by ordering additional stains only when they are truly necessary. 

What are the different types of markers?

Immunohistochemical stains are used to help pathologists arrive at an accurate diagnosis. As a dermatologist, it’s essential to be familiar with the stains as they will eventually end up in your report.

These antibodies are the most familiar diagnostic markers: 

  • S100 – The S100 protein is found in 95 percent of primary cutaneous melanomas, making it a popular stain. Diagnostic challenges can occur if the tissue was formerly frozen, had a low fixation time, or underwent enzymatic pretreatment with trypsin. S100 protein detects melanocytes, as well as neoplasms of the nerve sheath such as schwannomas.
  • HMB45 – Human Melanoma Black-45 was derived from extracts of pigmented melanoma in lymph nodes. HMB-45 antibody is specific for melanocytes and exposes patterns of nevi maturation. It can also detect patchy gp100 patterns in primary cutaneous melanomas.
  • MART1 – Melanoma Antigen Recognized by T Cells 1 identifies most melanocytic lesions. It is a cytoplasmic stain and can highlight the dendritic cell processes of melanocytes. It is also known as Melan A.

These markers have been discovered recently:

  • MiTF – Microphthalmia Transcription Factor is a sensitive and specific marker for melanocytes. MiTF has superior sensitivity and specificity to S100 and HMB45. This is a nuclear stain and can be used to quantify pagetoid spread of melanocytes. However, other cells can express MiTF, such as macrophages, smooth muscle cells, and fibroblasts.
  • SOX10 – SRY-Related HMG-Box Gene 10 is a nuclear transcription factor seen in melanocytes with a similar staining pattern as MiTF. SOX10 is also seen in nerve sheath tumors. 
  • PRAME – Preferentially Expressed Antigen in Melanoma is a tumor-associated antigen expressed in cutaneous melanoma, ocular melanoma, and other nonmelanocytic malignant neoplasms such as lung and breast carcinoma. The PRAME immunohistochemical stain has been shown to be diffusely positive in the nuclei of most melanoma cells and negative in most benign nevi. In addition, its specificity for malignant cells has made it a candidate for targeted immunotherapy.

Because the diagnosis of melanoma can sometimes be difficult, additional stains or second opinions are sometimes utilized. 

A 2019 pathology study indicates “second opinions rendered by dermatopathologists improve reliability of melanocytic lesion diagnosis.” Utilizing digital slides from full-service dermpath labs like PathologyWatch enables multiple experts to collaborate on difficult cases simultaneously. When a dermatopathology group includes expert dermatopathologists that are trained and accustomed to a standardized laboratory process, there is no need to duplicate any ancillary staining, thereby reducing costs. Furthermore, seeking second opinions earlier in the process can help limit the number of stains required for definitive diagnosis. 

Performing biopsies on melanocytic lesions will be a constant cause of concern for patients and their dermatologists. With the high stakes of melanoma and the possibilities of missed diagnoses, it is critical to know why diagnostic markers are ordered while becoming familiar with the most popular immunohistochemical stains to keep your patients safe.