CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Raymond D. Aller, MD, and Hal Weiner
Fellowship blends clinical informatics and pathology
University research team develops virtual human
Sunquest parent company to buy Atlas Medical, CliniSys
Illumina to release two cloud-based genomics systems
Fellowship blends clinical informatics and pathology
Ask Rebecca Johnson, MD, and her colleague Bruce Levy, MD, about a newly approved fellowship program that allows fellows to train concurrently in clinical informatics and any other of the pathology subspecialties, and they’ll give you a similar answer: This has been in the works for a long time.
For Dr. Johnson, CEO of the American Board of Pathology, the story started in 2011, when the American Board of Medical Specialties approved a proposal from the ABP and the American Board of Preventive Medicine for a subspecialty certification in clinical informatics. The ABP, according to Dr. Johnson, discussed creating a clinical informatics subspecialty as early as the 1990s. After ABMS approved the subspecialty, the Accreditation Council for Graduate Medical Education drafted fellowship program requirements, including a requirement that clinical informatics be a two-year training program, unlike all other ABP subspecialties, which require one year of training.
“Many pathologists and pathology organizations opposed the 24-month requirement for a number of very good reasons, including that the two-year requirement would be prohibitive for pathology departments due to cost and a lack of interest in committing two years solely to informatics,” says Dr. Johnson. “ACGME received a multitude of comments and letters opposing the two-year requirement; however, the final program requirement required 24 months.”
“The American Medical Informatics Association felt the CI fellowship should be two years because they envisioned fellows becoming chief information officers,” Dr. Johnson adds. “However, that’s not really the way it works in pathology because few pathologists solely practice informatics.”
Armed with this knowledge, Dr. Johnson had a conversation with Dr. Levy at the 2013 Association of Pathology Chairs meeting. She was intrigued to hear about the fellowship program he was implementing at the University of Illinois at Chicago and the potential solution it offered.
Dr. Levy, director of pathology informatics and associate chief health information officer at UIC, graduated from a unique fellowship program at Massachusetts General Hospital. The program, a nonaccredited fellowship in pathology informatics, allowed fellows to complete a two-year training program that covered informatics and a pathology subspecialty. Although one year of the fellowship focused on informatics and the other on the pathology subspecialty, the curriculum integrated the topics, with fellows completing informatics projects during the pathology subspecialty year and getting clinical practice in pathology during the informatics year.
“We found [this program structure at Mass General] worked really well,” says Dr. Levy. “It seemed to suit the interest of the fellows, and it fit the needs of the field both today and looking forward.”
When Dr. Levy came to UIC in 2012, he anticipated building a similar program. After ACGME’s approval of the clinical informatics subspecialty, however, he recognized an optimal moment to do something slightly different: “Initially we thought [the fellowship at UIC] would be a pathology informatics program, but it rapidly became obvious that CI was finally gaining traction and it was going to be an accredited fellowship, so we decided to go in that direction.” Dr. Levy suggested to Dr. Johnson that she propose a similar program to the ABP.
“I told her this was something we should explore because it would be really good for the field; it would attract our top residents and the best medical students to pathology,” Dr. Levy explains. “She and I discussed some of the potential issues—for instance, how to fit three years of training [two for clinical informatics and one for a pathology subspecialty] into two. And I talked about the experiences I had at MGH and how you can structure the program in a way that works.” The outcome of their conversation: a proposal to offer 24 months of clinical informatics training with simultaneous completion of a one-year pathology subspecialty fellowship stretched over the same two years.
Dr. Johnson subsequently proposed the idea to the ABP Board of Trustees, which approved it in September. (Because the program requirements for the fellowships are remaining the same, the accreditation council and the ABMS did not have to be involved in the approval process.)
As is sometimes the case with new training programs, a grandfather period, in which candidates may qualify to become certified in clinical informatics by experience rather than a fellowship, will continue until the fall of 2017. One issue: ACGME will accredit only one clinical informatics fellowship per institution. “For instance, a pathology department could not have an accredited CI fellowship if the pediatrics department already has one,” Dr. Johnson clarifies. “However, I think the [new dual-track fellowship] will encourage more pathology departments to develop clinical informatics programs.”
Dr. Levy hopes the new program will spur pathologists to up their ownership of the clinical informatics field. “I believe that as pathologists, we have an incredibly important role to play in CI, not just within pathology but throughout the health care system. We need to show our leadership in that area and be responsible for more than just pathology itself.”
Accordingly, the clinical informatics portion of the new fellowship will take a comprehensive approach to hospital information systems. “I think many informatics programs in pathology have been focused on pathology informatics,” Dr. Johnson explains. “The CI training requires fellows to have experience in health care informatics at large.” (Program requirements for the clinical informatics subspecialty can be found at www.acgme.org.)
“What we do as pathologists touches so much throughout the entire health care enterprise,” says Dr. Levy. “A majority of the data in the EHR today was generated by pathology. As we move towards digital whole slide imaging and genomics, that’s only going to grow larger. We need to understand that the borders of our data do not end at the doors of our department.” —Charna Albert
University research team develops virtual human
A team of engineering students and faculty at the private research university Worcester Polytechnic Institute have created a virtual human by digitizing and combining high-resolution images of thin slices of a cadaver.
The digital model, which was created using proprietary software developed at Worcester, Mass.-based WPI, can be used to conduct virtual medical procedures and medical experiments to determine how the body will respond to specific treatments. The researchers hope to use it to help diagnose diseases, as well.
The digital body, four years in the making, was developed by combining high-resolution color photographs of 5,000 cross-sectional .33 mm-thick slices of a human cadaver. The development team used a variety of image-processing techniques to align the images, which were created for the National Library of Medicine but made available to the team, and digitally stitch them into a three-dimensional virtual human body. The virtual body was then transformed into a model that contains detailed information about the location and characteristics of the tissues that make up organs and systems.
“There are many cases where doctors need to investigate what is happening in the human body, but it would be too difficult to do the corresponding experiments [in humans],” says team leader Sergey Makarov, professor of electrical and computer engineering at WPI. For example, Makarov explains, his team has used the model to explore how tissues surrounding metal implants, including replacement joints and rods or nails used to repair fractures, would respond when a patient undergoes magnetic resonance imaging.
“This approach allows you to model things beforehand, whether that means exploring how a body would react in an MRI machine or how certain diseases may react differently to a device or diagnostic modality,” adds Ara Nazarian, assistant professor of orthopedic surgery at Harvard Medical School. (The WPI researchers teamed up with faculty at Harvard Medical School for assistance in determining how the digital model may be used in clinical applications.) Virtual experiments, Nazarian continues, can be much easier to conduct and are far less costly than clinical trials.
Makarov and Nazarian are seeking to license the virtual human software and make it available to research universities and other medical groups.
Sunquest parent company to buy Atlas Medical, CliniSys
Sunquest Information Systems’ parent company, Roper Technologies, has entered into definitive agreements to acquire Atlas Medical, a marketer of clinical process integration and connectivity solutions, and CliniSys Group Ltd., a European supplier of laboratory information-management systems. The acquisitions are intended to expand Roper’s portfolio of companies focused on diagnostics solutions, which includes the middleware vendor Data Innovations.
“Similar to Sunquest’s relationship with Data Innovations, Atlas Medical will report its financial results through Sunquest, while CliniSys will remain as a separate company under Roper Technologies,” says Matthew Hawkins, president of Sunquest Information Systems. Collaboration between Sunquest and CliniSys is dependent upon formal approval from the proper authorities in Germany and the United Kingdom.
“All Sunquest, Data Innovations, Atlas, and CliniSys solutions will continue to be marketed, developed, and supported,” Hawkins adds.
Sunquest Information Systems, 877-239-6337
Illumina to release two cloud-based genomics systems
Illumina has added to its BaseSpace cloud-based genomics analysis and storage platform the BaseSpace Professional and Enterprise integrated laboratory information-management systems. Both offerings are slated for commercial availability next month and will come with bioinformatics support.
“Customers will have the speed and flexibility to manage their sequencing workflow on the cloud, reducing infrastructure cost, while accelerating basic and translational research,” says Sanjay Chikarmane, senior vice president and general manager of Illumina Enterprise Informatics. BaseSpace integrates sample set-up, instrument and sequencing run monitoring, and genomics data storage, analysis, and sharing.
BaseSpace Professional provides multi-user access and automated launching of apps. BaseSpace Enterprise offers individual domains, multiple users and groups, and single sign-on. The Enterprise edition can also be integrated with GenoLogics’ LIMSs. GenoLogics was acquired by Illumina in August.
Illumina, 858-202-4500
Visiun launches module for blood use analysis
The business intelligence and analytics firm Visiun has released a blood bank utilization module for laboratories and transfusion services.
The system, a component of the company’s Performance Insight product for monitoring key performance indicators, is intended to enhance patient blood management. It allows blood banks to identify how well hospital physicians comply with transfusion service protocols; review the cross-matched-to-transfused ratios of units and determine transfusion probabilities; monitor which units were taken out of circulation; determine the source and financial impact of wastage; and compare transfusion patterns among physicians.
Visiun, 786-351-4805
Free urinalysis mobile app
Quantimetrix has launched a free mobile app for iPhones and iPads.
The app, Urinalysis Made Simple, was originally a laboratory reference poster and is intended for educational purposes only. It addresses such topics as quality control products, physical appearance of urine, chemical and microscopic properties of urine, and confirmatory tests.
The app can be downloaded from the Apple App Store.
Quantimetrix, 310-536-0006
[hr]Dr. Aller is director of informatics and clinical professor in the Department of Pathology, University of Southern California, Los Angeles. He can be reached at raller@usc.edu. Hal Weiner is president of Weiner Consulting Services, LLC, Eugene, Ore. He can be reached at hal@weinerconsulting.com.