1 Foundation.cap.org Automation and Asset Tracking in Surgical Pathology: Barcoding, Tracking, Chain of Custody in a Small System Edward P. Fody, MD, Chief of Pathology, Holland Hospital Holland, Michigan

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Advanced Materials Processing (AMP) throughout the pathology lab Accessioning Gross Examination Histology Microscopic Examination 3

Accessioning Specimen labels and cassettes are printed with barcodes 4

Specimen label on container 5

Accessioning Specimen labels and cassettes are printed with barcodes Label is placed on specimen container(s) and requisition 6

Accessioning Specimen labels and cassettes are printed with barcodes Label is placed on specimen container(s) and requisition Cassettes go with container in their own bin compartment 7

Specimen bins, individual compartments for each case 8

Gross examination Bar code on container is scanned and case opens up in Powerpath 9

Gross examination Bar code on container is scanned and case opens up in Powerpath Using Voicebrook dictation system, case is dictated and sections are submitted within barcoded cassettes 10

Gross examination Bar code on container is scanned and case opens up in Powerpath Using Voicebrook dictation system, case is dictated and sections are submitted within barcoded cassettes If additional orders are produced (e.g. special stains, frozen sections), the barcode will now have this information attached 11

Histology Embedding –Computer at embedding station for embedder to easily mark each case as completed 12

Histology Embedding Microtomy –Cassette is scanned at the bench and slide labels automatically print Each station has its own computer, barcode scanner and label printer AMP system automatically marks each cassette as “completed” and each slide as “in process” 13

Histology Embedding Microtomy Slide check out –Each slide is scanned at our check out station and the AMP system marks it as “completed” in Powerpath 14

Microscopic examination The pathologist scans a slide and the correct case opens up in Powerpath Case is dictated using Voicebrook dictation system Case is either signed out or additional tests can be ordered –If additional tests are ordered, a new order appears in histology worklist and the histotech can rescan the block; all new labels will now print 15

16 Pathologist orders additional stains Ordering Special Stains/Immunohistochemical stains –Ventana stainer is interfaced with Powerpath –Case is highlighted in Ventana and labels are printed –Histotech sees order in Powerpath worklist, scans block for Powerpath labels (which are placed over Ventana label after staining)

Advantages to barcoding and AMP Barcoded specimen containers ensure correct case is being dictated No need to handwrite slides/cassettes, eliminates human error of mislabeling and smudging Each slide label individually prints and each case is handled separately, thus no mislabeling amongst cases Cassettes and slides can be followed through histology with AMP; simply look into a case to see what step they are at and where to find a case if needed 17

Internet Module Clinicians and their staff can easily view patients’ results via our internet module –Website is customized: 18

Internet Module Clinicians and/or their staff can easily view patients’ results via our internet module With a protected user ID and password, this site can be accessed anywhere internet access is available. 19

Internet Module Summary The internet module allows a physician to quickly and easily access patients’ pathology results from any computer and to view the photographs in color and enlarged 20

21 Additional features of AMP since we went live with our system Grossing station Embedding station Diagnostician station Specimen Discard Station Slide/Block Storage Station

Grossing Station Scan cassettes to verify info matches with container Order/print additional cassettes; remove unused extras Add number of pieces and special embedding instructions to a cassette 22

Embedding Station Track cassettes arriving at embedding Verify number of pieces in cassettes View embedding instructions 23

Diagnostician Station Scan a slide to receive all slides for case Auto load case in Powerpath 24

Specimen Discard Station Scan a container to check if specimen can be discarded 25

Storage File blocks and slides Check for availability from file storage Check out/Check in materials 26

Barcodes and Patient Safety Right Patient Right Test Right Time

What’s Next For Barcoding? Wristbands Lab Tests Blood Bank Pharmacy

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30 Advanced Materials Processing (AMP) at Holland Hospital Edward P. Fody, M.D. Chief of Pathology Holland Hospital 602 Michigan Ave Holland, MI (616)

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