1. Telepathology Applications in VISN 12 Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov

2. Clinical Need for Telepathology In VISN 12 Retirement of pathologists at Iron Mountain, Tomah and North Chicago VA Medical Centers between 1996 and 1998. Functions to be replaced: –Surgical pathology –Frozen sections –Autopsies –Clinical pathology –Administrative

3. Applications of Telepathology in VISN 12 Surgical pathology –Primary diagnosis or consultation –Documentation of gross pathology –Consultation with clinicians Autopsy pathology Clinical pathology –Microbiology –Protein electrophoresis and immunofixation Continuing education

4. Applications of Telepathology in VISN 12 Surgical Pathology Primary diagnosis or consultation Documentation of gross pathology Consultation with clinicians at remote sites Clinical conferences

5. Applications of Telepathology in VISN 12 Autopsy Pathology Send key images electronically to attending along with preliminary autopsy diagnosis (PAD) Submit tissue sections from a distance Documentation of sections Autopsy conference presentations VistA Imaging as permanent record

6. Applications of Telepathology in VISN 12 Microbiology Culture, diagnosis and susceptibility testing have been migrated to Core Labs (Plate, incubate and send specimens in portable incubators) Telepathology to view gram stains and early culture growth - primary lab Telepathology to view gram stains and show cultures to clinicians - core lab

7. Applications of Telepathology in VISN 12 Protein Electrophoresis Electrophoresis has been centralized to the two Core Labs Images are sent to credentialed pathologists in VISN 12 for sign out, as needed (pathologists need not be at the Core Lab)

8. Applications of Telepathology in VISN 12 Continuing Education Static or dynamic images in every discipline within pathology can be shared as CE

9. Conclusions Telepathology can be extended to all areas of anatomic and clinical pathology Multiple capabilities available Must balance access, diagnostic accuracy and cost Users must be flexible, but do not have to be computer experts Strong support of telecommunications network is essential