Introduction to Pathology Informatics

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Introduction to Pathology Informatics

• Practical Informatics Course
• APIII 2008

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What is Pathology Informatics?

• The term has been defined largely by its usage,
  and its meaning is evolving (expanding)
• For many, informatics the use of computers (or
  any and all technology) in the practice of a
  discipline
• Shifts focus to the tools themselves rather than
  how the tools are used
• e.g., laboratory medicine is not simply the use
  of instruments to analyze blood
• e.g., molecular biology is not the use of
  bacteria in biology
• Dilutes the intent of defining an academic
  discipline

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Informatics vs Computer Science ?

• Computer Science, among many other things,
  addresses how data is stored and organized in a
  computer.
• For the most part, however, computer scientists
  focus on the storage of the data itself, often
  without consideration for what the data
  represents in terms of real-life concepts
• Knowledge of the real-life concepts represented
  by the data, including the inherent and implicit
  relationships these concepts impose, is critical
  to proper management of that information. This
  domain layer is an important part of what
  separates informatics from computer science

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Informatics

• The study and practice of data acquisition,
  storage, processing, retrieval, analysis, and
  presentation to facilitate workflow and increase
  the accuracy and value of the information
  contained within the data
• Computer not part of the definition discipline
  could have existed a century ago
• Information explosion, plus demands to make
  greater use of that information
• Manual management becomes inefficient and
  impractical
• Computer becomes an indispensable tool for the
  discipline of informatics
• Knowledge of the real-life concepts represented
  by the data, including the inherent and implicit
  relationships these concepts impose, is critical
  to proper management of that information. This
  domain layer is an important part of what
  separates informatics from computer science

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Informatics is a Process

• Productivity Tools
• Knowledge Management Tools
• Decision Support Tools

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Overlapping Scope of Informatics
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The Role of the Pathologist in Patient Care

• Pathologists do not simply attach names to pieces
  of tissue or report numbers measured by a
  machine we provide an assessment which directs
  the clinical care of the patient
• The final interpretation is based not solely
  upon the tissue and/or the results of analysis,
  but rather is tempered by the clinical setting
• We choose the wording of our interpretive reports
  to trigger the appropriate clinical response
• Tools
• The histologic image is one of the richest data
  streams in medicine, and the ability of the
  pathologist to synthesize and interpret this
  information is unlikely to be duplicated
  electronically for some time
• Other techniques immunohistochemistry, flow
  cytometry, gene rearrangement studies, molecular
  tests

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PathologyToday
Electronic Data Layer

• Information systems used predominantly to manage
  practices and workflow
• Limited use to access external data sources
• No direct feedback from patient outcome

Dx
Rx
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Controlling the Flow of Information

• Vast amounts of data need to be assimilated,
  filtered, and presented in such a way as to
  convert it into usable information
• Informatics tools will be needed to assist in the
  data integration process
• The decision making role in medicine will go to
  whoever can most effectively mobilize,
  capitalize, and leverage the informatics
  resources necessary to make this a reality
• Two views of the future

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Pathologist as Data Provider
Electronic Data Layer

• Pathologist limits evaluation to tissue or fluids
  submitted
• Pathology output is a data element in treating
  clinicians decision support system
• As treating clinicians draw on other data
  sources, relative contribution of pathologist
  decreases

Electronic Data Layer
Decision Support
Dx Rx
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Pathologist as Diagnostic Specialist
Electronic Data Layer

• Pathology moves aggressively to develop and adopt
  informatics tools to leverage data from emerging
  technologies
• Pathologist remains a diagnostic consultant,
  providing outcomes based treatment
  recommendations to treating clinicians

Decision Support
Dx
Rx
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Choosing our Future

• Pathologist as a Data Provider
• Easier steady-as-she-goes result
• Pathology is protected from the new diagnostic
  modalities
• As new diagnostic modalities proliferate, the
  relative contribution of the pathology decreases
• Pathologist as the Diagnostic Specialist
• Pathologists, largely freed from details of
  day-to-day patient management, are better
  positioned for data integration
• More in keeping with the current roles and
  interests/personalities of the respective
  players,
• Pathologists and pathology departments must move
  aggressively to develop the skills and the
  informatics infrastructure necessary to leverage
  the information explosion

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Practical Informatics Course

• Introduction to Pathology Informatics (Sinard)
• Databases and Data Storage (Sinard)
• Data, Messaging Standards, and Interfaces
  (Gilbertson)
• Break
• Digital Imaging Basics (Sinard)
• Telepathology and Whole Slide Imaging (Parwani)
• Introduction to Bioinformatics (Chandran)