Division of Pathology Informatics

Since its inception sixteen years ago, the Division of Pathology Informatics has grown to a nationally recognized informatics organization. The Division has core faculty from the Department of Pathology who direct staff and technical personnel from the UPMC Information Services Division (ISD), as well as the University of Pittsburgh Cancer Institute (UPCI). Dr. Liron Pantanowitz is the Director of Pathology Informatics who has worked closely with ISD as well as the Department of Pathology to continue the activities which support clinical services, translational research, and basic research. Last year, the subdivision of Advanced Pathology Imaging was created under the leadership of Dr. Jeffrey Fine. Drs. Jonhan Ho, Doug Hartman, and Zoltan Oltvai serve as additional faculty.

Division Clinical Activities

The Division maintains and develops cutting-edge clinical information systems to support anatomic pathology, clinical pathology, hematopathology, and molecular diagnostics. Over seventy percent of all the information generated in an academic or community hospital is derived from the activities of clinical and anatomic pathology. The Pathology Informatics Division manages this enormous flow of information and turns it into accessible knowledge for use by clinicians. The Division provides support to all clinical areas of the Department and many other hospital functions as well. In relation to Anatomic Pathology, this Division managed the installation and maintenance of CoPathPlus, highly integrated Lab System software that provides electronics sign-out, imaging and organization of reports from all areas of Anatomic Pathology and feeds them into all of the UPMC Electronic Health Records, including MARS and Power Chart. Gross images of tissue samples entering into the Anatomic Pathology laboratory information system (APLIS) generate recorded images that become available as needed during the final sign-out under the microscope. Microscopic images are also recorded and become available as part of the patient record. These images are retrievable and are routinely used as background information on the signing-out of cases from patients who have had previous hospitalizations.

For Clinical Pathology, the Division supervises the maintenance of Misys Sunquest, a highly sophisticated piece of software that coordinates the electronic data generated by a large number of machines and feeds them into the MARS, Cerner EHR, Emtek and EPIC databases. This data, in turn, is available for clinicians and researchers throughout UPMC. The Division serves as a beta-testing site for both CoPathPlus and Misys.

Anatomic Pathology Laboratory Information System (APLIS) Clinical Activities

The APLIS staff supports, maintains, integrates and develops tools for use within the Division of Anatomic Pathology at all of the UPMC Health System Hospitals. In the past year, many tools were enhanced or added to CoPathPlus. These include, but are not limited to, voice recognition in the gross room, synoptic templates as data points, pathologist sign-out tool enhancements and integration of laboratory devices such as slide printers and external image conversion. CoPathPlus has been successfully installed at all of the major UPMC network hospitals with support from a central help desk.

Examples of some of the initiatives that were successfully completed included the complete integration of synoptic templates as data points within the CoPathPlus Database, an upgrade of CoPathPlus to version 3.2, HPV reporting at MWH, and related pending case alert tools. Many new enhancements were done to the APLIS website (restricted access), including creation of all Anatomic Pathology IT project updates, CoPath reports library, ongoing request for reports, online requisitions for APLIS issues, a Centers of Excellence Website, and over 60 online videos created by the APLIS team for ongoing CoPathPlus training and APLIS activities updates.

Research Activities

The Pathology Informatics Division is actively involved in informatics, workflow and imaging research projects. Several modules used by CoPathPlus throughout the entire country have been generated by the activities of this Division. Current projects include developing Internet-based telepathology consultations, automation in the labs including bar coding in the anatomic pathology labs, supporting UPMC's multimedia Electronic Medical Record effort, extended epidemiology applications, patient isolation facilities for infection control, and developing state-of-the-art thin client systems for use in patient reporting over the Web.

The research programs of the Division are focused on next generation pathology reporting methods, imaging, and bioinformatics. The division continues to foster research and collaboration in informatics and has a prominent presence in the premier pathology and informatics organizations including APIII, CAP and USCAP. The APLIS team in the Department has provided multiple presentations on a national and local venue.

Telepathology offers multisite web conferencing systems for UPMC in Pennsylvania, five live and archived weekly web cast conferences, two live and archived monthly conferences, robotic microscopy systems (both dynamic and static), and many different imaging research options. These options include research in wireless WAN/LAN, IP telephony, whole slide imaging and automated image analysis.

The Imaging Program consists of the Whole Slide Imaging Lab and the Telepathology Lab. All systems utilize image enhancement, image analysis and telepathology software which were custom-developed at UPMC. Some of the major initiatives in the clinical imaging arena have been the use of whole slide imaging for clinical activities such as quality assurance and primary diagnosis. Major clinical trials were conducted in the last five years to evaluate the use of whole slide imaging and these trials are ongoing. We have successfully created large collection of whole slide images with annotations for resident and medical student teaching and training. Significant strides have also been made to deliver pathology gross images via Stentor. A department wide initiative for the last five years included the addition of remote robotic pathology and whole slide imaging stations at the major UPMC academic hospitals including Presbytarian, Shadyside, MWH, Children’s and VA hospitals. This is an exciting era in digital imaging and we at UPMC have the resources and direction to continue to be the national leaders in this technology. Last year, telepathology was extended to UPMC East, Passavant and Horizon Hospitals.

Some of the current tools under deployment include Bar Coding, Telepathology, Whole Slide Imaging and Automated Image Analysis. Current research efforts include collaboration with Omnyx, a joint General Electric and UPMC venture, to incorporate digital imaging with whole slide imaging into the workflow of pathologist with the overall goal to digitize pathology. Enhancements in the lab information system (CoPathPlus) are underway to interface with digital pathology solutions that the new venture will produce. Several UPMC pathologists serve on the clinical teams of Omnyx. Other new informatics initiatives underway include development of customized digital pathology consultation portals. Last year, these portals were launched successfully to get consults from China from within the USA.

The Division is working with the Health Sciences Tissue Bank for the development and deployment of a customizable inventory system for tracking specimens, being developed at UPMC. This tool allows the HSTB to be able to track what tissues are banked at an institutional level rather than tracking them locally at each site. Work with continue with HSTB to install this application at all of their sites and integrating the inventory data with the organ-specific databases to further annotate the banked tissues. The division is also working with the ISD teams to deploy tissue banking informatics tools in the local environment included the newly developed Biospecimen Inventory and Operating System (BIOS).

Training Activities

Dr. Liron Pantanowitz directed the Pathology Informatics course with participation from seven trainees and many faculty and staff from the Informatics Division. We will continue to work with the Department to further implement the many requests for enhancements and additions to the UPMC model of CoPathPlus so that it continues to meet all departmental user needs and to enhance productivity. The fellowship in Pathology Informatics continues to be successful with many high quality candidates applying for this fellowship. The faculty has presented workshops in informatics at major national and international pathology meetings. Dr. Pantanowitz is involved in teaching and administrative activities of the Association for Pathology Informatics (API), whose mission is to promote the field of pathology informatics as an academic and a clinical subspecialty of pathology. Both of them also serve as the Chief Editors of the Journal of Pathology Informatics.

National Organization Support

The Division coordinates and hosts the Pathology Informatics annual conference. This conference is designed for academic and practicing pathologists and oncologists, researchers in biomedical informatics, residents, fellows, graduate students, computer support personnel and lab managers who are interested in learning how informatics is impacting and transforming pathology and oncology. Prior knowledge of informatics is not required.

The Division for Pathology Informatics maintains formal, active associations with the Pittsburgh Supercomputing Center, the UPMC Information Services Division, the University of Pittsburgh's Department for Biomedical Informatics, the University of Pittsburgh School of Information Sciences, the University of Pittsburgh Cancer Institute and leading companies in medical informatics. The Division's faculty members have produced a significant body of work in pathology informatics and medical bioinformatics, including journal articles, invited presentations, and abstracts.

Selected Publications by Division Faculty in Informatics

Drogowski LM, Martina J, Parwani AV. Clinical examination and validation of primary diagnosis in anatomic pathology using whole slide digital images. Arch Pathol Lab Med. 2011 Mar;135(3):372-8.

Wiley CA, Murdoch G, Parwani AV, Cudahy T, Wilson D, Payner T, Springer K, Lewis T. Interinstitutional and interstate teleneuropathology J Pathol Inform. 2011;2:21 Singh R, Chubb L, Pantanowitz L, Parwani AV Standardization in digital pathology: Supplement 145 of the DICOM standards. J Pathol Inform. 2011;2:23. Epub 2011 May 11.

Pantanowitz L, Parwani AV, Khalbuss W. Digital imaging for cytopathology: are we there yet? Cytopathology. 2011; 22:71-72.

Smith MA, Roy S, Nestler R, Augustine B, Miller D, Parwani AV, Nichols L. University of Pittsburgh Medical Center Remains Tracker: A novel application for tracking decedents and improving the autopsy workflow. J Pathol Inform. 2011;2:30. Epub 2011 Jun 14.

Khalbuss WE, Pantanowitz L, Parwani AV. Digital imaging in cytopathology. Patholog Res Int. 2011;2011:264683. Epub 2011 Jul 19.

Kamat S, Parwani AV, Khalbuss WE, Monaco SE, Kelly SM, Wiehagen LT, Piccoli AL, Lassige KM, Pantanowitz L. Use of a laboratory information system driven tool for pre-signout quality assurance of random cytopathology reports. J Pathol Inform. 2011;2:42. Epub 2011 Aug 27. PMID: 21969923.

Park SL, Pantanowitz L, Sharma G, Parwani AV. Anatomic pathology laboratory information systems: a review. Adv Anat Pathol. 2012 Mar;19(2):81-96. PMID: 22313836.

Amin M, Sharma G, Parwani AV, Anderson R, Kolowitz BJ, Piccoli A, Shrestha RB, Lauro GR, Pantanowitz L. Integration of digital gross pathology images for enterprise-wide access. J Pathol Inform. 2012;3:10. Epub 2012 Mar 16.

Park S, Parwani AV, Satyanarayanan M, Pantanowitz L. Handheld Computing in Pathology. J Pathol Inform. 2012;3:15. Epub 2012 Apr 18.

Chen Y, Liang CP, Liu Y, Fischer AH, Parwani AV, Pantanowitz L. Review of Advanced Imaging Techniques. J Pathol Inform. 2012;3:22. Epub 2012 May 28. PMID: 22754737.