1. Digital Pathology Early Adoption Douglas J
Digital Pathology Early Adoption Douglas J. Hartman, MD Pathology Informatics Summit May 25, 2016

2. Background
Very few labs in the USA have gone entirely digital for primary diagnosis
UPMC has started their conversion to a digital pathology platform for primary diagnosis sign out

3. Clinical Use Cases Primary diagnosis Incremental workload increase
Stepwise subspecialty rollout plan
Surgical pathology (first small biopsies, fewer parts)
Internal (UPMC) & external consults
IHC core lab (centralization)
Breast marker image analysis
PathXL education partnership
To do:
Archive outside consults, frozen section, tumor board, etc.

4. Omnyx Production Use Cases
Begin utilizing Omnyx for Clinical Use Cases:
Start Date – (8/24/2015)
Dermatopathology - 10 cases/day (~30 slides)
GI (quicks) - 10 cases/day (~30 slides)
Start Date - (9/21/2015)
Autopsy – 1 case/day (~15 slides)
Start Date - (10/13/2015)
Neuropathology – 1autopsy case/day
Start Date – (10/19/2015)
Pediatric Pathology (CHP) – 10 cases/day (max 3 parts) (~30 slides)
Start Date – (10/26/2015)
GYN/Breast biopsies (Magee) – 10 cases/day (~10 slides)
Start Date – (11/16/2015)
GU (prostate biopsies) – 2 cases/day
Start Date – (12/14/2015)
UPMC St. Margaret’s IHC Review
Start Date – (1/4/2016)
UPMC Horizon IHC Review
Start Date – (2/2/2016)
UPMC Passavant IHC Review
Start Date – (3/7/2016)
UPMC Magee Placenta

5. Technology VL120 Omnyx scanner
Digital Pathology System version integrated with Cerner CoPathPlus V
Scanned each slide at 40x
Slides viewed at Omnyx workstations

6. Workflow Process
Slides were selected within the histology lab and diverted to be scanned
Case Selection based on:
GI Quicks (biopsies)
Selected in the histology lab from the routine output
Cases with 3 or less parts
No STAT cases
Principally initial H&E stains only
Without impact on slide delivery

7. Core Histology Lab

8. First Case Signed Out!

9. Results 529 cases were reviewed prior to review of the glass slides
Diagnosis prior to reviewing glass slides was entered into sharepoint form

10. Sharepoint Form

11. Results: Digital vs Glass
470 cases (91%) were interpreted the same for the digital slides as the glass slides
No major discrepancies occurred
Of 54 cases with minor discrepancy, the majority (70%) involved evaluation of inflammation or lack of confidence in identifying helicobacter organisms

12. Inflammatory Cells

13. Helicobacter Organisms

14. Technical Issues Technical Issues related to integration
Stain info suppression
Query service delays
No broken slides during study period

15. Future Directions Improve workflow within the histology laboratory
Scanning specific specimens at higher mag or using a different technology (Helicobacter cases?)
Adjustment by pathologists

16. GI Pathologists Reet Pai, MD Jon Davison, MD Douglas J. Hartman
Shih-Fan Kuan MD, PhD
Michael Landau, MD
Changqing Ma, MD, PhD
Aatur Singhi, MD, PhD

17. ISD team Liron Pantanowtiz, MD Jeff McHugh Tony Piccoli
Matt O’Leary (Digital Pathology Team)
Chelsea Watkins
Brad Clifford
Ryan Mitchell

18. Histology Team Rachel Wall Jim Edwards
Keith Yester (Histology Lab at CLB)
Eric Ambrozic
Shaquayla Hill

19. Questions?

20. Office Workstation

21. Signout room of the future

22. Omnyx Numbers Per Site 29,000 total SLIDES scanned
65,000 total CASES in Omnyx

23. Resolved Issues Message queue bottlenecking Image streaming issue
Query service messages
CoPath messages
Image streaming issue
Error queue overflow
Slide handling scanner errors
Xylene level change
CoPath filtered stains
Blank stains