Improving Pathology Workflow with an EMR Interface

Precise and punctual communication between dermatology clinics and pathology labs is essential to provide patients with accurate results and swift turnaround times. Because over 90 percent of all tumors are confirmed by pathologists, physicians that utilize an EMR are increasingly interfacing with pathology laboratories to relay case results.

Integrating an EMR interface between your practice EHR and the lab can help increase operational efficiency, streamline staff workloads, and improve the quality of patient care and satisfaction.

Operational Efficiency 

Your patients expect an organized and efficient experience every time they interact with your clinic, and you can hold your laboratory to those same standards. Relying on a laboratory with outdated means of communication can negatively impact the quality of your experience, as well as impact patient care. 

Today, three out of five dermatologists have adopted an EMR into their practices. Interfacing with your laboratory’s information system takes full advantage of this record-keeping technology, creating a communication portal that instantly organizes and shares case data results. Integration into pathology reporting means clinics can use their existing EMR systems to automatically receive, review, search, and sort results on demand without additional clinic support staff involvement.

In Utah, Allen-Taintor Dermatology was used to sometimes waiting up to two weeks to receive results from the lab, which sometimes failed to send slides. Because the clinic wanted to review the slides before calling patients, this consistent issue was a concern. Once they began using PathologyWatch, Allen-Taintor Dermatology saw improved staff workflow efficiency, including a 75 percent reduction in dermatologist review time, which further improved efficiency. Patient satisfaction likewise improved because the physicians could review the results with their patients on digital slides.

System Setup

For those using an EMR in clinic, the advantages of an interface are clear. Building an interface between your EMR and the laboratory in a way that optimizes workflow efficiencies is not always straightforward and requires an experienced IT professional.

By partnering with a trusted full-service dermatopathology laboratory like PathologyWatch, clinics can rely on experienced engineers to architect their interfaces in a way that optimizes their EHR capabilities to maximize internal clinic efficiencies.  

Streamline Workloads

For many clinics, paper continues to be the gold standard for documenting and sharing records. For clinics that have moved to an EHR, however, additional benefits can be realized if your laboratory is fully integrated. For example, a well-designed interface can make handwriting requisition forms and physically making carbon copies a thing of the past. You can also reduce the probability of errors by digitally sending that information to the laboratory, as clinic data must be re-entered into the LIS and attached to the sample when received on paper forms. 

Patient Satisfaction

Delivering reliable and timely results to your patients should be a high priority for every dermatology clinic and dermatopathology laboratory. After patients have a biopsy taken, many experience an uneasy suspense while waiting for their results. This was the case for Allen-Taintor Dermatology. Once they were able to utilize digital biopsy images to show patients their pathology during visits, their high patient satisfaction increased even more. EMR interfaces and optimal laboratory processes can reduce the turnaround time from when a biopsy is taken to when a result is received, resulting in a better quality of care and patient satisfaction.

An additional benefit to patient safety and satisfaction is that interfaces can also improve data integrity and results delivery, decreasing the risk of a data entry error in both the clinic and laboratory.

In summary, building and utilizing a well-developed interface between the clinic EMR and laboratory system can help to improve operational efficiency, simplify staff workloads, and improve the quality of patient care and satisfaction.

FAQ Interview with PathologyWatch CEO Dan Lambert

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.

Integration with Pathology Reporting

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. 

Meet April Larson, MD, FAAD, Director of Clinical Implementation and Advisory Board at PathologyWatch

April Larson received her medical degree from the University of Utah and completed a research fellowship at the Tom C. Mathews Familial Melanoma Research Clinic at the Huntsman Cancer Institute. Since completing a dermatology residency at Dartmouth-Hitchcock Medical Center over ten years ago, she has devoted herself to patient care. 

April, who is currently director of the clinical advisory board and clinical implementation at PathologyWatch, always had a desire to pursue medicine; both her father and older brother are plastic surgeons. While she was itching for a career in medicine, her first choice was family practice. It wasn’t until she met an intern during her first rotation in her third year of medical school that she changed her mind about dermatology—and the connection was instantaneous. 

Can you describe that defining moment when you knew dermatology was the right choice?

I heard a lecture by Sancy Leachman, MD, PhD—this charismatic, amazing physician-scientist—as she described how the first melanoma gene was identified. She told this compelling story of everyday events and interactions that led to an advance in the understanding of melanoma cancer genomics. The impact of that discovery struck me. It was my first encounter with academic medicine. I eventually worked as a research fellow for Dr. Leachman in her melanoma clinic. 

How did that experience impact your work with PathologyWatch?

This opportunity is helping me get back to my roots in academic medicine: to use science to improve our diagnosis and treatment of patients. When we are talking about patients’ lives, can we be satisfied with 75, 80, or even 95 percent success? In medicine, we will always be searching for better ways of taking care of patients. That’s the idea: trying to push forward the knowledge we have to improve patient care. It’s how you can have a more significant impact on people. As the director of the clinical advisory board and clinical implementation at PathologyWatch, I am focused on advancing patient care and access by using technological solutions to enhance the laboratory services offered to dermatologists and their patients, both nationally and globally.

Based on your experience as a former client, how do you believe PathologyWatch is instrumental in helping dermatologists improve patient care?

We achieve this in two ways. First, I see digital pathology as a key to improving dermatology diagnostics through the enhanced correlation of microscopic and clinical skin findings. We provide digital slide images that are easily reviewed in real-time as dermatologists are making critical decisions for their patients. 

Second, we help improve dermatology processes by integrating with many EMRs, which streamlines the clinical workflow. Sometimes, the technology that is supposed to help us ends up slowing us down or gets in the way of patient interaction. I understand the stresses and pressures that regularly happen in these dermatology clinics. And I know dermatologists and their staff are trying to provide the best care in a fast-paced environment. I want to help my specialty get it right 100 percent of the time. 

This ultimately translates to providing optimized care and spending more time with patients, where we feel the most joy and connection in our jobs. This is what drives me.

My favorite part of being a dermatologist is the relationship I develop with my patients. You learn to trust each other. It’s a unique relationship as you help them make decisions for their care.

As a dermatologist, what are the rewards of working at PathologyWatch? 

I feel fortunate to be a part of this fantastic team and to be surrounded by intelligent, kind, hard-working individuals, each using his or her expertise toward a common goal. I am learning so much about all these different aspects of medicine and business and computer science. It’s exciting to see what the combination of technological advances and human intelligence can do for medicine, which before was just science fiction. I also love interacting with other dermatologists, helping them find what works for them and improves their practice, which I hope leads to more success and joy in their work lives.

What do you do when you are not working? 

I live with my husband and four children in southern Utah. My family spends a lot of time boating and playing outdoors.

From Microscope to Monitor: 3 Ways Digital Pathology Is Improving Dermatology Practices

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

Is your dermatology practice ready for digital pathology? Most physicians feel the need to create a more efficient patient care process, but many don’t realize the far-reaching advantages of using a digital pathology workflow. 

According to a 2018 survey of US healthcare consumers and physicians, up to 69 percent of physicians, including dermatologists, are interested in increasing the use of digital tools to improve patient care, among other purposes. Due to recent advances in digital pathology, there is an alternative for dermatology clinics that typically rely on microscopy and glass slides: the online access of digital slides and reads from academic-level dermatopathologists. Companies like PathologyWatch, which offers whole-slide imaging to dermatologists, are helping digital pathology quicken its pace to the forefront of dermatology patient care. 

As complications like COVID-19 force healthcare providers to consider alternative options to traditional office visits, dermatologists must find a way to abide by HIPAA guidelines while remaining profitable. Experts agree that a digital system can be cost neutral and even save money for medical practices. 

Three critical factors contribute to a successful dermatology practice: efficiency, accessibility, and customer satisfaction. Each of these can improve with the adoption of a digital pathology platform.

1. Digital pathology is the solution for a more efficient and profitable pathology process. 

According to experts, current trends in the traditional pathology model were already facing transformation. Based on data collected by DARK Daily, between 2007 and 2017, the pathologist workforce reduced its numbers by almost 18 percent, while the pathologist’s diagnostic workload rose by 41.7 percent. 

Such imbalance is a formula for potential disaster as technicians scramble to meet lab work demands while using manual processes to prepare slides, mail specimens, collect and organize test results, and input data for each patient’s specimen slide. 

Those who work in labs recognize that a digital pathology system may help to reduce errors and create efficiency, even while the workload increases. Fortunately, adopting a digital workflow and imaging system reduces the risk of mistakes while inputting data, eliminates redundancy in handling slides, and speeds up the process for issuing test results. Laboratories that provide digital images of the glass slides can also result in 24/7 access to slides by clinicians.

2. Digitized slides enable collaboration among specialists. 

With whole-slide images digitally cataloged, doctors can easily access a patient’s specimen themselves and securely share it anywhere and anytime with fellow pathologists. Such collaborative practices heighten the quality of care at all participating facilities rather than limiting expertise to one or two locations. “We place a lot of value in consulting, case sharing, and communicating in our practice so that each hospital receives the benefit of our combined knowledge and experience,” says Nicolas G. Cacciabeve, MD, a managing member at Advanced Pathology Associates. 

Cacciabeve adds that incorporating whole-slide imaging into their practice workflow has led to an improvement in the way they do things. “It drives efficiency and improves access to expertise,” he says. 

The ability to extend patient care to those who often face challenges accessing specialized care is an exciting feature of digital technology. For healthcare professionals, providing treatment to the most vulnerable communities, particularly those in rural communities, is a constant challenge. 

According to the Office of Disease Prevention and Health Promotion, almost 25 percent of Americans living in rural areas do not have a primary care provider (PCP) or health center where they can receive regular medical services. And with skin cancer ranking as the most common form of cancer in the US, people living in rural, agricultural areas could particularly benefit from access to dermatopathologists, who can examine a digitalized specimen and work with a local physician to design a treatment plan. Such services wouldn’t be possible without digital pathology technology.

3. Improve customer confidence with a digital platform.

The expanded access and collaboration available with the adoption of digital pathology also results in equivalent or improved patient outcomes. Zoltan Laszik, MD, PhD, professor of clinical pathology at the University of California San Francisco School of Medicine, directed a team to collect results between 30 pathologists and 800 test slides distributed among three hospitals. “There was not a single case that was misdiagnosed because of the digital technology, and the benefits were immediate from hospital to hospital,” Laszik says. By improving access to expertise and facilitating collaboration, Laszik and Cacciabeve see digital pathology as a vehicle to increase the speed and accuracy of diagnosis while innovating the modern standard of patient care. 

While digital technology isn’t new, the possibilities digital pathology creates for the dermatopathology field to streamline lab processes, expand patient access to specialized care, and improve customer satisfaction are exciting and work together to ultimately help physicians take better care of their patients.

Meet Greg Osmond, MD, Chief Medical Officer and Co-Founder of PathologyWatch 

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

For over 15 years, Greg Osmond has been studying the growing field of dermatopathology and accompanying forms of cancer. He is a board-certified pathologist and dermatopathologist and an expert on cutaneous disease. 

During his residency at Duke University, Greg participated in the Health Policy Law and Ethics concentration track, where he focused on novel business models surrounding the implementation of digital pathology with an emphasis on dermatology. Following his residency, he completed a fellowship in dermatopathology in the combined Harvard program, rotating between Beth Israel Deaconess, Brigham & Women’s, and Massachusetts General Hospitals. 

While Pathology Watch currently focuses its laboratory services to dermatologists within the United States, Greg is looking forward to expanding the capabilities and accessibility of specialized diagnoses and treatment through the use of digital pathology and supervised artificial intelligence in underdeveloped settings.

We sat down with Greg to learn more about his connection with digital pathology as well as his vision for PathologyWatch and its influence on the dermatology field. 

At what point in your education did you realize you wanted to pursue a career in dermatopathology?

I spent my third year of medical school at Duke in dermatology clinics and performing melanoma research. As part of those endeavors, I worked extensively with the staff dermatopathologists and discovered that I enjoyed my time at the microscope more than my time in clinic, though I have always enjoyed both.

What is the most rewarding aspect of working in dermatopathology?

I find the most satisfaction when I take a deep dive into unusual cases in order to come up with the best answer and most helpful results to the clinician and patient. Sometimes, answers aren’t clear-cut on the pathology slides, and more involved correlation with clinical findings and the literature are needed to issue a report that is helpful. Generating a concise but clinically helpful report in these instances is the most rewarding.

What made you want to develop PathologyWatch

I have been privileged to train under, work in, and consult with some of the best hospital systems and pathology departments in the country. However, within each center, there is a noticeable disconnect between the technology being used in other industries and systems commonly employed in the healthcare settings. At the same time, health systems and providers are also looking for ways to enhance efficiencies in providing care while simultaneously noticeably improving quality. We have created PathologyWatch to solve these issues simultaneously within anatomic pathology using cutting-edge digital technologies as the foundation. 

What is it about your experience and/or background that helps you bring something unique to PathologyWatch?

I think my strongest asset for PathologyWatch has been to help gather outstanding people to work with. I would say that goes for my co-founders Dan and Michael as well. We’ve gathered excellent, dedicated people with incredible skill sets that are focused on the problem, but also have a high level of integrity and character; these are people that I genuinely enjoy interacting with.

When it comes to serving dermatologists, what matters most to you?

I believe the best way to serve dermatologists is to set up and optimize our systems and services so they are focused on the patient experience. Patients come first at PathologyWatch, and we develop our systems to be optimally efficient for them. The beautiful thing is that what improves care for patients also seems to serve dermatologists best. This includes

  1. the quality of the diagnosis and report format,
  2. optimal interfacing to minimize patient errors and get results to the provider in their EMR faster,
  3. enhancing the dermatologist’s ability to easily correlate pathology with clinical findings via immediate 24/7 access to diagnostic slides that have been digitized,
  4. 24/48-hour turnaround time on routine specimens, as well as on cases when additional consultation may be needed,
  5. having dermpaths available to view digital slides with dermatologists as needed,
  6. having comprehensive insurance coverage, and
  7. reasonable cash pay prices.

Focusing on what we would want if we were the patient has been the guiding principle for us. Patients get a better answer when derms work with digital tech. This also includes the underdeveloped world. When you learn that 45 percent of the world doesn’t currently have access to diagnostics, largely due to the cost of care, you want to do something to change that. Optimally developed algorithms working in tandem with an expert pathology service model will hopefully not only improve the quality of care but also allow for the cost of care to drop to an affordable price point for all patients, both domestically and internationally. That’s our goal. 

What’s an interesting fun fact about Greg Osmond? 

I lived in rural Honduras for a few years during college. I enjoy music production and downhill skiing, so living in Utah has been great. But I spend most of my free time exploring the red rocks of Southern Utah with my wife and five kids. We had twins a few years ago, and that definitely keeps us busy.