1. John H. Sinard, MD, PhD Neil Mutnick Peter Gershkovich, MD, MHA Pathology Informatics Yale University School of Medicine Histology Asset Tracking Dashboard: Real-time monitoring and dynamic work lists Pathology Informatics 2010

2. Tracking Software “Complexity” Level I: AuditingLevel I: Auditing Post events for each asset (what, when, who)Post events for each asset (what, when, who) Allows auditing and workflow analysisAllows auditing and workflow analysis Level II: Constrained Status ProgressionLevel II: Constrained Status Progression Assures appropriate asset used at appropriate timeAssures appropriate asset used at appropriate time Promotes patient safetyPromotes patient safety Level III: Drive WorkflowLevel III: Drive Workflow Dynamic to-do listsDynamic to-do lists Identify assets which are falling behind real-timeIdentify assets which are falling behind real-time John H. Sinard, MD, PhD

3. Barcodes in Tracking Software Barcodes are not magicalBarcodes are not magical Simply allow easy and accurate entrySimply allow easy and accurate entry Makes it feasible to “enter” asset location at many time pointsMakes it feasible to “enter” asset location at many time points “Entry” can be accompanied by checks / constraints“Entry” can be accompanied by checks / constraints Human readable ID vs an internal key?Human readable ID vs an internal key? Usability outside of the system holding the keyUsability outside of the system holding the key Resistance to damage of the barcodeResistance to damage of the barcode Backward compatibility with unlabeled assetsBackward compatibility with unlabeled assets Conversion from one LIS to anotherConversion from one LIS to another Length of identifier (and thus size of the barcode)Length of identifier (and thus size of the barcode) John H. Sinard, MD, PhD

4. Prerequisites for Successful Tracking Individually identify each assetIndividually identify each asset Blocks already doneBlocks already done Slides: block and stain not sufficientSlides: block and stain not sufficient Assure accurate asset labelingAssure accurate asset labeling Just-in-time labeling: generate label at same time as assetJust-in-time labeling: generate label at same time as asset One piece workflow – no batchingOne piece workflow – no batching Validate labeling if asset and label generated asynchronouslyValidate labeling if asset and label generated asynchronously Compatibility with workflow and resourcesCompatibility with workflow and resources Clever people will find a way to circumvent constraintsClever people will find a way to circumvent constraints John H. Sinard, MD, PhD

5. Slide Number Sequentially number slides as they are cut from the blockSequentially number slides as they are cut from the block Can follow lesions through successive levelsCan follow lesions through successive levels When ordering a stain on an unstained slide, can specify the level to be usedWhen ordering a stain on an unstained slide, can specify the level to be used Places additional constraints on tracking systemPlaces additional constraints on tracking system Have to assign slide number at the time of slide cutting, not orderingHave to assign slide number at the time of slide cutting, not ordering Using an existing slide (eg unstained) requires modifying the information about that slide; can’t add a new stain with a comment of “use level 5”Using an existing slide (eg unstained) requires modifying the information about that slide; can’t add a new stain with a comment of “use level 5” John H. Sinard, MD, PhD

6. Assuring Accuracy of Asset Labeling Blocks:Blocks: Pre-make cassettes with unique block numbersPre-make cassettes with unique block numbers Enter blocks into LIS by scanningEnter blocks into LIS by scanning Assures correct case number (patient safety)Assures correct case number (patient safety) Confirms uniqueness of block numberConfirms uniqueness of block number Slides:Slides: Scan block at microtome: print labels for slidesScan block at microtome: print labels for slides Tentative slide numbers locked in by scanning the cut, labeled slide to confirm successful cuttingTentative slide numbers locked in by scanning the cut, labeled slide to confirm successful cutting Just because a label prints doesn’t mean there is a slideJust because a label prints doesn’t mean there is a slide John H. Sinard, MD, PhD

7. Ordering Blocks in LIS after Preprinting John H. Sinard, MD, PhD

8. Barcoded Block Wizard John H. Sinard, MD, PhD S10-5010 01-01

9. Asset Status Progression Control WorkflowControl Workflow Only allow assets to progress to a new status from an appropriate old status(es), and in the correct contextOnly allow assets to progress to a new status from an appropriate old status(es), and in the correct context Need additional statuses to accommodate alternative workflow pathwaysNeed additional statuses to accommodate alternative workflow pathways Drive WorkflowDrive Workflow Use asset status to determine not where it has been but rather where it is goingUse asset status to determine not where it has been but rather where it is going Status of asset (and perhaps associated assets) should determine next process, independent of asset historyStatus of asset (and perhaps associated assets) should determine next process, independent of asset history John H. Sinard, MD, PhD

10. Block Status Progression John H. Sinard, MD, PhD Printed Cassette Ordered Received OnBatch Embeded Filed Block Missing Cancelled ReEmbed ReProcess CheckedIn CheckedOut

11. Block Status Progression John H. Sinard, MD, PhD Ordered Received OnBatch Embeded Filed ReEmbed ReProcess CheckedIn CheckedOut Processor batch not yet started Processor batch marked finished Processor batch started; not marked finished At least one slide for this block has a status of “Ordered” No slide for this block has a status of “Ordered”

12. John H. Sinard, MD, PhD

14. Slide Status Progression John H. Sinard, MD, PhD Ordered Cut Collected Stained Verified Ordered On Unst. Ordered On Unst. Relabeled For Unstained Slides for H&E

15. Slide Status Progression John H. Sinard, MD, PhD Block not yet embedded Block Embedded or Checked in Block Filed or Checked out Ordered Cut Collected Stained Verified Ordered On Unst. Ordered On Unst. Relabeled

16. John H. Sinard, MD, PhD

17. Effect on Overtime in Histology John H. Sinard, MD, PhD

18. Block/Slide Tracking Errors John H. Sinard, MD, PhD

19. Block/Slide Tracking Errors John H. Sinard, MD, PhD

20. Take Home Messages There are different degrees to which an asset tracking system can be implementedThere are different degrees to which an asset tracking system can be implemented Know what it is you want to achieveKnow what it is you want to achieve Dashboards can be a useful tool for...Dashboards can be a useful tool for......monitoring and driving workflow...generating real-time to-do lists John H. Sinard, MD, PhD