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

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

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.

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

Technology VL120 Omnyx scanner Digital Pathology System version 1.3.1 integrated with Cerner CoPathPlus V2014.01.1.106 Scanned each slide at 40x Slides viewed at Omnyx workstations

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

Core Histology Lab

First Case Signed Out!

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

Sharepoint Form

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

Inflammatory Cells

Helicobacter Organisms

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

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

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

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

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

Questions?

Office Workstation

Signout room of the future

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

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