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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.