Wednesday, July 20, 2011

So What is Pathology Informatics?

Imagine my chagrin when, after my last post, my father informs me that he found my blog.


It is a good thing that my dad has a sense of humor. He then took the opportunity to inform me that after whining poetical about how no one understands what I do for a living, I still managed not to explain what I do for a living.


So, dad, this beer, I mean blog, is for you.

Let's start with informatics. The American Medical Informatics Association (AMIA) defines informatics as “A general term used to refer to biomedical informatics and its many areas of application and practice (e.g., bioinformatics, clinical informatics, public health informatics).” They subsequently go on to define biomedical informatics as “the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health.” Additional definitions can be found on AMIA’s glossary page.

Pathology Informatics is essentially biomedical informatics practiced by pathologists within the scope of pathology practice.  Unknown to many in the non-medical profession, the scope of pathology practice is huge. Surgical pathology, cytopathology, chemistry, transfusion, microbiology, hematology, molecular diagnostics, immunology, transplant immunology and autopsy medicine all fall within our purview.

Laboratories generate enormous amounts of discrete data on patients every hour of every day. Providing faculty oversight for the acquisition, management, storage and retrieval of this data in our laboratories is my job. In order to get an idea of the weight of the responsibility that I feel, let’s review how much data we are talking about…

If you work in a hospital, think about the numbers of lab results that you use to manage your patients on an hourly basis. Now multiply that across all patients in all of our facilities 24 hours a day, 7 days a week. Now, just to make it more fun and to complicate matters, let’s tweak, change out or add new computer systems (a.k.a. information systems) here and there constantly to improve the care we deliver to patients. Existing care cannot stop during these changes, and our patients’ data have to be delivered on the right patient at the right time to the right provider. We have hundreds of systems running at my multi-facility institution, and most of them are tied to one another via interfaces. Information is flowing at super-speeds between these systems. The laboratory alone has numerous systems humming with data being brought in, updated, and sent back out to the tune of billions of data elements each year. Ensuring that a patient’s data is transferred accurately and quickly from one system to another is a very complex task in this environment, especially when some but not all of the systems may be undergoing changes which could affect the transfer of the data. Checking and rechecking systems before changes are released into production can be very tedious and requires immaculate attention to detail. Fortunately for me, I work with a group of laboratory information system support personnel who are very good at doing this.

So, if I have personnel to do the checking, what is my role? As a physician who specializes in pathology and a techno-nerd with knowledge of healthcare computing, I review the design and implementation of new and updated systems using my hybrid experiences in pathology and information technology in these and other areas:
  • Hardware infrastructure
  • Data models
  • Network design and security
  • Software design, display and security
  • Result reporting
  • Interfaces
  • Barcoding
  • Digital imaging and image analysis
It also includes other not-so-fun but necessary things such as:
  • Reviewing information technology contracts
  • Trying to explain to various individuals that yes, we really do have to comply with local, state and federal laws such as HIPAA, HITECH, CLIA and others and what that means for application X that they want to install
  • Ensuring that our laboratory information practices meet or exceed the standards put forth by the aforesaid regulations as well as by the College of American Pathologists Laboratory Accreditation Program, the Joint Commission and other programs.
  • Preventing medical errors due to poor data management or design before they happen.
However, there are a lot of truly fun things that I get to do:
  1. Improve patient care and prevent errors that can hurt people
  2. Help develop new tools to improve data retrieval and management so that our work is safer and easier
  3. Teach residents and fellows
  4. Give talks at meetings about my activities with #1 and #2
  5. Collaborate with my pathology informatics colleagues
  6. Travel lots of places to see and learn new things
At some point, when Emory finishes overhauling massive laboratory information systems, I hope to inspire a new generation of pathology informaticists/informaticians, some of whom I hope will share my admittedly wacky sense of humor.