Jul 28, 2020 | Digital Dermatopathology
Maren Chan, MD, MS, is a board-certified dermatopathologist. She completed her residency and dermatopathology fellowship at Beth Israel Deaconess Medical Center/Harvard Medical School. Her early career was spent as an active-duty Army dermatopathologist at San Antonio Military Medical Center.
Thereafter, Maren was the medical director of Aurora Diagnostics, an established, primarily dermatology-trained dermatopathology laboratory in South Texas. She received her BS in chemical engineering from Montana State University and MS in chemical engineering from the University of Washington, with an interest in mathematical modeling of airway gas exchange.
Combining her experiences in laboratory operations, engineering, medical research, and high-volume dermatopathology interpretation, she is focused on large-scale implementation of digital pathology and other technological advances in medicine.
We sat down with Maren to talk about her experiences at Harvard Medical School, her work with PathologyWatch, and her choice of the pathology field.
At what point did you decide to go into pathology?
I was doing a research fellowship in general surgery at the Dana Farber Cancer Institute in Boston. While studying mammary tumors in mice, I became interested in histology and pathology.
What is it about PathologyWatch that appeals to you?
My life has typically been a search for opportunities, not necessarily a preplanned path. Even as a young teenager, I was always in pursuit of something that I felt passionate about. Since then, when an opportunity has presented itself, I’ve taken it. Pathology was like that, and I feel so fortunate to be a part of it. I felt an instant connection with dermatopathology, and once I made that decision, I ran into people by chance who helped me move forward in that field. That is how I met Greg Osmond and April Larson at PathologyWatch. These connections just fell into place at the ideal time.
I truly believe the future of pathology is digital pathology. As this technology expands, I plan to devote the rest of my career to this field. I am a visual person, and it’s extremely satisfying to have a job where I can make diagnoses entirely by what I see.
What do you bring to PathologyWatch?
I really thrive on process management, quality control, and unifying all aspects of this business. I enjoy making sure we have a great product at all levels. At this moment, we have a product that is truly fabulous, but I always like to ask myself, “How can we make it better?” That’s what I find exciting. I like to focus on the physical operational functionality of our company to ensure it is both compliant and efficient and that we give the clinician and patient the best that healthcare can provide.
When it comes to serving dermatologists, what matters most to you?
I’m an efficient person. I have a propensity for that, but I also had to learn to manage my time better and work quickly because I was raising a family while going to school and having a busy career. I recognize the need for efficiency in the dermatology clinic where dermatologists expect a careful, well-thought-out, rapid diagnosis with clear communication. I think it’s important to provide that combination of diagnostic expertise, efficiency, and safe operational quality control. It’s essential in dermatology—more so than any other field—and I know digital technology will be instrumental in supporting that.
How is PathologyWatch impacting patient care?
Digital pathology tremendously improves the accuracy of pathologic diagnoses. A key to a good pathologic diagnosis is clinical correlation and histologic expertise. This technology makes it easier for pathologists to collaborate between themselves and clinicians, which provides better patient care. It’s accessible at home or in the clinic—anywhere and anytime. I believe digital technology is going to change the entire field of pathology.
What do you do in your free time?
I don’t have a lot of free time. My focus is on PathologyWatch—I spend a lot of time doing that and enjoy it. But I also enjoy spending time with my boys. My kids partake in various sports, and watching them grow and become their own unique human beings is something I cherish. We split our time between Utah and San Antonio, TX—two very different and wonderful places to live.
Jul 22, 2020 | Digital Dermatopathology, Digital Pathology
What is the single most innovative technology you are currently delivering to health systems or medical groups?
We deliver digital pathology services and EMR integration solutions to dermatology clinics in many locations. Dermatologists are able to discuss cases with expert pathologists from many different locations in a way that has never been done before. We’re also developing AI tools that are specific to dermatopathology. Ultimately, humans and the AI working together in pathology will mean lives saved, and we’re at the beginning of this process.
How is your product or service innovating the work being done in these organizations to provide care or make systems run more smoothly?
PathologyWatch greatly reduces the amount of time spent on duplicating data between systems—the reports are accurately and automatically entered into the dermatologist systems. We’re eliminating the faxed reports and walled-garden report access. Digital pathology and EMR integration alone have streamlined clinical workflows and improved the quality of care within dermatology clinics.
What is the primary need fulfilled by the product or service?
The primary need is improved quality of care with decreased cost. We are attacking this problem in the narrow field of dermatology/dermatopathology, but the principles and technology can be expanded well outside of that area. We plan to expand from dermatology to other fields of outpatient medicine within the next two years.
What is the ROI of said product or service?
Our clients have seen up to 75 percent decrease in sample turnaround time, as well as up to 75 percent decrease in the time it takes for physicians to review pathology reports (per internal case study reports).
What are some examples of implementation and outcomes use cases?
- Improved operational efficiency with digital workflows
- Improved patient satisfaction as the physician and patient review pathology together
- Improved patient outcomes because of faster turnaround times
- Improved staff efficiency
(For more information, see the Allen-Taintor and Prairie Lakes Healthcare case studies.)
Who are some of the clients and organizations served by the company?
How has innovation advanced the field of healthcare or the practice of care?
- Increased availability to high-quality care in underserved areas: Geography is no longer a limiting factor, providing opportunities for underserved areas to receive academic-level dermatopathology reads.
- Improved speed and availability of samples for improved patient outcomes: Dermatologists are able to view their slides 24/7 digitally with a web browser (on-demand ability to correlate with pathologic findings).
- Expanded access: Forty-five percent of the world does not have access to cancer diagnostics. AI has the potential to solve this problem.
How is innovation changing lives specifically?
Through patient education, patients are now able to better understand why they do or do not need surgery, because physicians can display the digital pathology images for them. Patient diagnoses are improved, as dermatologists can more quickly and easily correlate pathologic findings with clinical features. Patients are more satisfied with their care, as they are receiving answers more quickly, especially in difficult cases where consultations would normally take additional days or sometimes weeks.
What is the company’s go-forward strategy? What’s next? Which problem is the organization working on now and in the future?
We’re focused on optimizing workflows and technology specific to dermatology and dermatopathology. We plan to expand into other areas of pathology in the future, as well as work to solve the lack of access to pathology globally through the utilization of AI. Ultimately, our goal is to provide affordable, available, and accurate diagnoses to the world’s population.
What are the most significant lessons learned by delivering the innovation, product, and/or service to health systems and/or medical groups?
- Healthcare systems are extremely difficult to work with, as they sometimes employ outdated systems with limited ability to quickly and easily adapt to current technological changes.
- Very few successful healthcare companies are “just software.” You can’t build it and expect they will come. It takes making the right relationships with payers and providers.
- As the healthcare industry continues its digital transformation, significant opportunities exist to improve patient outcomes and improve the efficiency and effectiveness of the overall healthcare system.
- There are many ways to build algorithms. Think long and hard about your end-use case when architecting it and deciding whether to take a supervised or unsupervised approach to building out your algorithms.
Jul 20, 2020 | Digital Dermatopathology
Dermatopathology turnaround time is a critical quality indicator that every lab should continuously strive to improve. Laboratories are responsible for 60 percent of the vital information on a patient’s record and play a pivotal role in helping your dermatology practice maintain high patient satisfaction.
Achieving an acceptable pathology turnaround time depends on many factors. By considering patient expectations, the transportation process, laboratory workflow, and the differences between paper and digital pathology, your clinic can be sure to partner with a dermatopathology lab that delivers timely results.
Patient Expectations
When it comes to receiving pathology results, many patients want to know the diagnoses as soon as possible. Relaying a timely diagnosis can help to reduce hours, days, or weeks of distressing uncertainty.
With this in mind, the College of American Pathologists (CAP) indicates 90 percent of routine pathology cases should meet the standard two business day turnaround time. The 48-hour turnaround does not begin until the specimen is received, or accessioned, by the lab. The process ends when the lab’s results are finalized in the laboratory—the lab documents this transaction as the report date. However, the overall turnaround time for a clinic can be much longer, due to factors affecting specimen transport, laboratory workflow, and report delivery.
Specimen Transport
Transporting specimens from the dermatology clinic is a significant factor that affects turnaround time. Working with a local lab requires the use of couriers to transport biopsy specimens. Partnering with a lab outside of your region can be relatively painless thanks to overnight shipping, though some rural locations may require additional time. Delays in transport can add significant delays in getting a report on time.
Laboratory Workflow
Once a specimen reaches the lab, staffing, experience, and workflow play a significant role in turnaround time. While many labs offer traditional weekday hours between 8 and 5, some offer night shifts or even 24/7 service. It’s also vital to confirm the dermatopathologists have the bandwidth and know-how to serve your patients properly, as turnaround time can increase by over 20 percent in complex cases. Digital pathology can save considerable time by enabling multiple remote pathologists to consult on a specimen simultaneously, which can give an accurate and expert diagnosis quicker than traditional laboratories.
Report Delivery
The lab shares the final pathology report with the requesting provider via fax, courier, or electronic interfaces. Since three out of five dermatologists have already adopted EMR technology, interfaces are the next logical step to take advantage of digital time savings.
Relying on physical paper to transfer information takes longer and opens up the possibility of human error. Going paperless with an EMR interface means that labs can instantly transfer results directly into a patient’s digital records. Clinics can also filter the digital lab results, so urgent cases appear at the top of the stack.
Digital pathology service providers like PathologyWatch manage the entire EMR interface process, leaving you with the satisfaction of instant electronic reporting from academic-level dermatopathologists.
Patient satisfaction and health outcomes can be impacted by long turnaround times, which can be ameliorated by an efficient laboratory system. When you acknowledge the patient’s expectations and recognize transportation and report delivery options, you and your lab partner can find ways to improve dermatopathology turnaround time.
Jul 17, 2020 | Digital Dermatopathology
Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.
Providing your patients with definitive diagnoses requires clear and thorough dermatopathology reports. Many clinics and healthcare groups are permitting patients to log in and view these reports. However, a recent survey indicates patients are nearly three times as likely to misinterpret a dermatopathology report and conclude they have an incorrect diagnosis over the correct diagnosis.
“As patient access to pathologic test result reports increases, it is important to consider best practices to minimize potential negative consequences for patients and clinicians,” notes Hannah Shucard, MS. With patient satisfaction as the number one priority, you want to make sure your reports are complete and easy for everyone to interpret, in addition to meeting the standard of care.
There are several sections in a dermatopathology report. Below, we’ll review the purpose of the final diagnosis, microscopic descriptions, gross descriptions, clinical information, changes and corrections, and compliance to ensure your dermatopathology reports are understandable for you and your patients.
Final Diagnosis
As the most important part of a dermatopathology report, the final diagnosis should designate the results of the disease process seen in the biopsy or tissue. Sometimes, there is a comment section that describes further clinically relevant information, such as margin status, treatment recommendations, or other studies’ results. Diagnoses should be definitive in the vast majority of cases.
Microscopic Description
In this section, we find descriptions of the morphological features of the disease process seen under the microscope. Many pathologists use standardized text descriptions that elaborate on the key features that are unique to that disease. The Microscopic Description also describes the results of stains used to assist in making the diagnosis.
Gross Description
This section describes the size, color, and texture of the tissue that was received in the laboratory. This is an important section that is used by the submitting clinic and provider to ensure that the correct specimen is being examined. The laboratory also describes any inking or cutting that was done to the tissue prior to processing it to make glass slides. Specimen orientation with inking is also included in this section.
Clinical Information/Impression
The Clinical Information provided by the clinic and provider on the pathology order form is some of the most critical data that a laboratory and pathologist can receive to generate an accurate report. The information includes clinical differential diagnosis or clinical history. The Clinical Information section is also used for quality assurance by the dermatologist to ensure that the Final Diagnosis section correlates with clinical findings.
Changes and Corrections
Sometimes, additional clinical information or discussion can lead to a revised report. If the information does not significantly affect the Final Diagnosis, the laboratory will issue an “Addendum,” a secondary report that includes the new information. Rarely, corrections need to be made to a finalized report. In this instance, an “Amendment” report is issued, outlining the corrections that have been made. Common causes for amended reports include correcting the specimen site or demographic information. However, these should be rare occurrences.
Compliance
There are several other components to a laboratory report which are necessary to comply with laboratory licensing standards outlined by CLIA (Clinical Laboratory Improvement Amendments of 1988 (CLIA 493.1291)). These include patient identifiers, the testing laboratory’s location, test report date, and specimen source. A Billing section is sometimes added for auditing purposes.
Dermatology clinics carry an essential responsibility to make sure their patients receive accurate and organized diagnoses. Ensuring that the dermatopathology laboratory provides clear and precise reports that meet the industry standards is crucial to delivering the highest quality of clinical care possible.
Jul 15, 2020 | Digital Dermatopathology
Darren Whittemore didn’t always want to be a dermatopathologist. As a child, he wanted to be an astronaut.
His education took flight at San Diego State University, where he earned a BS in aerospace, aeronautical, and astronautical/space engineering. But as his interest in medicine grew, his role serving in the US Air Force took him to Texas to complete his education.
Darren completed his anatomic and clinical pathology residency at the combined US Air Force Wilford Hall Medical Center/Brooke Army Medical Center program. He then completed his fellowship in dermatopathology at the University of Texas Health Science Center in Houston under the nationally renowned Dr. Ron Rapini. Today, Darren is US board-certified in anatomic and clinical pathology and dermatopathology.
We sat down with Darren Whittemore to learn more about his pathway to dermatopathology and what he brings to the PathologyWatch team. Here are some of the highlights of that interview.
Was there a defining moment in your professional career when you knew pathology was the right choice?
While some people experience a single defining moment that changes their course, I experienced more of a series of moments that lead me to dermatopathology. It was while I was doing my third or fourth year of medical school end-of-rotation lectures that I realized I was fascinated by the pathogenesis of disease. Through those experiences, I knew I would be happier and feel more fulfilled by understanding the disease processes and educating peers in these areas.
While part of the aerospace engineering program as an undergraduate, I came to appreciate the completion of a project, which doesn’t always happen in the real engineering market. I was drawn to watching a project come full-circle. That’s what helped me decide to move more toward a career in medicine. Those plans were confirmed when I got an Air Force scholarship for pathology at one of the biggest AF academic centers at the time.
What is the most rewarding aspect of working in pathology?
Since separating from the Air Force, I have really enjoyed the private practice and business side of dermatopathology. This environment is surrounded by exploring new ways of helping patients and finding better ways to deliver patient care. There is so much to learn and do in this field. It’s an exciting environment in which to work.
I served in the US Air Force as a general pathologist and dermatopathologist for 12 years, separating as a lieutenant colonel. Since then, I have enjoyed establishing independent roots and building a reputation in various areas of expertise. The innovation emerging from this field has a global impact, and it’s rewarding to see international opportunities and assess the needs of the dermatopathology world.
What made you want to work with PathologyWatch?
I’m drawn to the innovation of digital pathology enabling dermatopathologists at multiple locations to be linked together nationally and internationally by viewing shared images at the same time. I love how that technology brings us together as if we are all in the same room.
This is also an exciting platform for teaching. There are plenty of volume-scaled opportunities for dermatopathologists and students since we have access to experts who can direct more learning by sharing their experiences and expertise. Personally, I believe having access to these leaders heightens the capabilities of the field.
Finally, the services provided by PathologyWatch means clinicians never have to work alone with this technology. We are connecting smaller clinics in all kinds of rural areas with remote work capabilities. For example, it’s often the case that a client is one of only a few clinicians in the area, yet that client has access to people all over the world with an enormous amount of experience.
You have over a decade of dermatopathology experience. What is it about your experience and/or background that helps you bring something unique to PathologyWatch?
I think my leadership roles, both in the academic and business sectors, have helped prepare me for this opportunity. But I think my directorship experiences from serving in the military at multiple laboratory sites will also be a big contribution. It’s given me confidence in my abilities.
I hope to bring my subspecialty experience and abilities in diagnosing alopecia cases to the PathologyWatch team so that they can be an even stronger comprehensive group of highly-trained and skilled dermatopathologists.
After a long day, what are your favorite things to do?
My wife and I have nine children, so I enjoy primarily wonderful family activities. We now live in a beautiful area in Northern Idaho, so there are plenty of outdoor activities to do on the weekends. I also enjoy fitness and strength training.
Music is a big part of my family as well. Eight of my children are training in Suzuki violin. I’ve played the clarinet and saxophone since high school, playing in various bands. Even now, you’ll still catch me playing my soprano saxophone to unwind.
Jul 13, 2020 | Digital Dermatopathology, Digital Pathology
Dermatology patients rely on their physicians to provide accurate diagnoses and effective treatment plans. With three out of four providers indicating electronic medical/health (EMR/EHR) systems enhance patient care, integration with pathology reporting is a valuable transition every clinic should consider.
You want the most cost-effective and reliable method to link information between your dermatology clinic and the laboratory’s lab information system (LIS). By breaking down the limitations of traditional paper communication, learning about interfaces, examining the two types of integration, and understanding the interface challenges, we’ll cover all of the basics you need to know about integrating an electronic interface to elevate your practice and improve patient care.
Traditional Paper
Many dermatology clinics continue to rely on traditional paper when it comes to lab correspondence. When ordering tests, these practices handwrite requisition forms and manually create carbon copies, so a record stays in the office. Once received by the lab, the requisition information is typed into the LIS and matched to the biopsy. When the lab completes the patient report, the paper is attached and sent back to the clinic via fax, mail, or courier.
The exchange of paper between clinics and labs is tried and true for many; however, it does open the door to certain errors that can impact patient care, such as the amount of time it takes to write out forms and re-enter the same data into the LIS. The longer it takes to process and receive information, the longer it will take a patient to receive a diagnosis. It also increases the chance for errors to occur during user translation. Repeatedly entering the same data into patient records invites opportunities for human error. Despite these drawbacks, many clinics continue to use paper as a standard, especially if an efficient electronic health record is not being utilized.
Interface Benefits
While working with paper can lead to inaccuracies or delays, an electronic interface can decrease turnaround times and errors. These benefits appeal to tech-savvy dermatologists, who have a 63 percent adoption rate of EHR technology.
A significant benefit of integrating the clinic EHR with pathology reporting is that fields and data entered into one system can communicate with an entirely different system. As a result, users from the clinic and the lab can search the same patient data or perform quality lookbacks through their EMR using their current systems. This reduces data entry errors and can also allow for identification of improperly labeled specimens, reducing patient risk.
Types of Interfaces
Choosing the right electronic interface can help increase a lab’s efficiency and workflow.
There are two types of interface for you to consider: unidirectional and bidirectional. A unidirectional interface can only transmit information one way. It can either send orders from the clinic to the lab or receive results from the lab to the clinic. The latter requires clinics to continue to submit paper orders.
Using a bidirectional interface provides a convenient two-way line of communication between the clinic and the lab. Sending and receiving digital orders can reduce time and mistakes, though a bidirectional interface requires programming for both locations. Both types of interfaces are utilized with success, depending on the unique workflow of each practice.
System Setup
Once an electronic interface is selected, real work is required before it can be activated. As more than half of dermatologists see over 50 patients per day, the initial investment of time and effort will pay off in the long run with productivity and dependability.
Interfaces are not simple plug-and-play systems. Individually coded, they require IT support to set up a secure line using a unique virtual private network (VPN) or other similar structure. Programmers use health language 7 (HL7) to reliably transfer patient records and study orders between the clinic and the lab. Full-service dermpath labs like PathologyWatch are designed to shoulder the burden of integrating an electronic interface into your practice.
Today’s EMR systems are full of complexities and functionality, with one leading vendor providing 3,100 automated treatment plans and procedures for dermatologists. By looking at the differences between a paper and digital workflow, exploring different types of integration, and understanding installation, you can assess whether integration with pathology reporting can help you get the most out of your EMR and your practice.
