Fifth generation telepathology systems. Workflow analysis of the robotic dynamic telepathology Component

Abstract

SUMMARY:BACKGROUND:Telepathology is the practice of pathology over distances using video-imaging equipment and a telecommunications network. Two workflow paradigms for telepathology practice are a subspecialty pathology practice (SPP) model and a case triage practice (CTP) model. With the CTP model, developed at the University of Arizona, the telepathologist on call can render a diagnosis independently or, regardless of its subspecialty category, has the option of referring the case to a subspecialty pathologist as needed.FINDINGS:Surgical pathology teleconsultations providing real-time quality assurance (QA) services were established between the University Medical Center (UMC) in Tucson, Arizona, and the Havasu Regional Medical Center (HRMC) in rural Lake Havasu City, Arizona, 300 miles away. HRMC had a single on-site pathologist. From 2005 to 2009, 1815 cases were reviewed by one of ten UMC case triage telepathologists. Each faculty pathologist had an area of surgical subspecialty expertise. 90.9% of cases were signed out directly by the on-service triage pathologist, without consultation with a subspecialty pathologist. The majority of cases were outside of the triage pathologists areas of subspecialty expertise. The diagnostic concordance of the telepathologist's diagnosis with the original pathologist's diagnosis was 94.3%. Major and minor discrepancies were 2.90% and 2.83% respectively. The discordant cases were re-reviewed by light microscopy at the UMC daily QA conference.CONCLUSIONS:This study supports the use of the CTP workflow model for a telepathology QA service. Subspecialty surgical pathologists can efficiently and accurately render QA second opinions outside their areas of subspecialty expertise by telepathology. This workflow model will be applicable to practices using fifth generation telepathology systems.