1. Digital Imaging: Value Added, Finally Mike Isaacs Director of Information Technology John Pfeifer, MD, PhD Professor of Pathology Department of Pathology Washington University School of Medicine

2. Perspective for this talk Senior member of an academic department responsible for day-to-day operations of a busy surgical pathology practice

3. Practice Environment Academic tertiary care medical center Academic department High volume of high complexity cases Large number of surgical pathologists Large number of consult cases More than one sign-out area Large number of trainees

4. Characteristics of a useful digital imaging system Operational: easy to use Low cost: direct costs (hardware and software) and indirect costs (support personnel) Value added

5. Our approach has been to focus on the “value added” component “Value added” is defined broadly by operational measures (CTA) Cost Cost Time Time Accuracy Accuracy “Value added” can enhance Patient care Patient care Educational activities Educational activities Research Research

6. “Value added” in our patient care activities Availability (don’t need to go to the slide file; don’t need to request slides from outside institution again) Timeliness (get images in seconds) Portability (can access images from anywhere in the medical center) Permanence (save image of section that will be destroyed during ancillary testing)

7. “Value added” in our educational programs and research activities SearchabilityAvailabilityPortabilityPermanence

8. “Value added” applications we have identified that justify costs Current: Whole slide scanning of selected slides from cases sent to us in consultation Whole slide scanning of selected slides from selected cases for educational purposes Whole slide scanning of selected slides from selected cases for research purposes Whole slide scanning of slides that will be destroyed during ancillary testing Anticipated: Whole slide scanning of slides from cases that will be sent out Whole slide scanning of legal cases

9. To capture the “value added” opportunities, we needed to develop an interface between the imaging software and our LIS because… Our surgical pathology group is comprised of 35 lone wolves The lone wolves are not all equally tech savvy It turns out that you can’t teach old lone wolves new tricks

10. Things we currently anticipate will add even more value Access from remote sites, e.g., via the web via CITRIX Search results linked to images HIPPA compliant natural language search results (EPHI is suppressed) Incorporation of other image file types

11. Things we currently do not anticipate will add even more value Digital sign-out No identified CTA advantages No identified CTA advantages Remote sign-out No identified CTA advantages No identified CTA advantages Billing issues Billing issues