Bar Code Specified Surgical Pathology Workflow

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Bar Code Specified Surgical Pathology Workflow

• Joy J Mammen MD Richard Zarbo MD Adrian Ormsby
  MD J. Mark Tuthill MD
• Henry Ford Health System
• Detroit, Michigan

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ContextIntroduction

• Automation of histopathology laboratory process
  have been difficult due to the variability
• specimen types
• the expression of disease in a given patient
• laboratory procedures required to arrive at
  pathologic diagnosis.
• A key challenge has been to automate specimen
  labeling
• Manual labeling is tedious, error prone, and
  inefficient.

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ContextFocus

• Revolutionary changes in materials available for
  use in the histopathology laboratory have allowed
  us to address this problem, automating cassette
  and slide label generation
• This decreases intra-lab identification errors
  and improves efficiency by driving workflow using
  bar code technology.

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Patient Sample Identification
Biopsy/Label
Transport
Accession
Tissue Gross Exam
Processing
Embedding
Cutting/ Slide Label
Staining/Cover
Case Collation
Delivery
Microscopic Exam
Stain/Recut Order
Dictation
Transciption
Report Signout
SP processes at risk of mis-identification error
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TechnologyCassette Creation

• Misys CopathPlus MHv 2.4 (Misys Healthcare,
  Raleigh, NC) LIS
• Custom interface to laser cassette etchers that
  use Labelase software, both from General Data
  (General Data, Cincinnati, OH).
• 2 Dimensional barcodes etched on the cassettes
• Cassettes are read at the microtomy stations
  using Dell Optiplex 745 PC (Dell, Roundrock, TX)
  and Symbol barcode scanners (Motorola Inc.,
  Holtsville, NY)

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TechnologyLabel Generation

• Stain-resistant slide labels (Stainershield ,
  General Data) on Intermec C4 (Intermec Inc.,
  Everett, WA) direct thermal printers
• A report was developed in CoPathPlus that
  retrieves stain orders for each block.

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DesignPrior to automation

• Tissue cassettes were printed with human-readable
  identification details using the
• Leica cassette printers (Leica Microsystems,
  Bannockburn, IL)
• Required re-entering demographic and case data
  into dedicated software
• After processing, sections were cut and mounted
  onto slides manually labeled with the case
  accession number and part number
• Stains were performed based on electronic
  requests that were available at the histology
  department through the LIS
• After staining, labels were batch printed from
  the LIS and affixed onto the corresponding
  slides.

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DesignAutomation

• Two General Data laser cassette etchers
  interfaced to CoPathPlus were placed at the
  accessioning stations.
• During accession, cassettes are etched with the
  case number, patient name, part type
  abbreviation, and a 2D barcode.
• Once the block arrives at the microtomy station
  equipped with a PC, barcode scanner and label
  printer, the 2D barcode is scanned printing all
  slide labels for that particular blocks stain
  orders from the LIS.

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DesignAutomation

• Labels are printed on Stainershield label
  stock, applied to the glass slide and tissue
  sections are cut and placed
• Blocks are positively identified and slides
  definitively labeled prior to staining.
• Manual labeling is eliminated (reduced)
• Cross matching slides with labels is eliminated
• Slide labels include all relevant data as well as
  a bar code (code 128C).

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Accession Station U-shaped Cell
CoPath terminal Barcode label printer -Lab tag
-Specimen containers Lab tag scanner, bar code
reader Cassette etcher- 2D barcode
Microtome Station U-shaped Cell
CoPath terminal 2D Barcode reader -Individual
cassettes Slide label printer -Chemical
resistant slide labels -Print 1 cassette not
batch
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Barcode Specified Surgical Pathology Workflow
1
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Create Lab Tag Specimen Container Barcodes
Gross Tissue Cutting
Scan container barcode to open case in CoPath
CoPath
Scantron Lab Tag Imager
Accession
Specimens
2
Tray
CoPath
3
Cassette Etcher Create cassette barcode
Verify created container barcode with CoPath and
cassette ID
Verify original Lab Tag created barcode ID
Histology
Scan cassette barcode
Pathologist Signout
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- Scan slide barcode to open case in CoPath -
View scanned lab tag in ThumbsPlus
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Microtome
4
Create chemical resistant slide labels by
cassette barcode
1
Verify on cassette slide SP and pt. name with
CoPath
Verify patient name, SP on Lab tag, slide and
in CoPath
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Patient Sample Identification
Biopsy/Label
Transport
Accession
Tissue Gross Exam
Processing
Embedding
Cutting/ Slide Label
Staining/Cover
Case Collation
Delivery
Microscopic Exam
Stain/Recut Order
Dictation
Transciption
Report Signout
SP processes targeted by barcode to reduce human
labor and mis-identification error
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Results

• Most specimens received in the lab are currently
  being processed using this system with slide
  labels printed on demand at the microtomy
  station.
• Paper labels are still utilized for slides that
  requiring microwave processing since the
  StainerShiel labels undergo degradation
• Time required for labeling prostate biopsies
  having 36 slides was reduced from 20 minutes to
  30-45 seconds

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Results

• The CoPath interfaces saves time and eliminates
  data entry errors related to re-keying data
• This saves about two minutes per case.
• Thus this technology has
• saved time and effort as well as
• eliminating labeling errors

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Results Post Bar Coding
All Surg Path Case Mis-identifications
62 reduction all misidentifications
45
85 reduction Block slide mis-ID
1.67
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0.62
4 Pre-analytic derived
Barcode
2694 cases
2877 cases
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Conclusions

• Integration of the barcode technology into the
  histopathology labeling process has resulted in
  process improvement, by saving time and reducing
  errors.