Digital - Drivers for Change - Tuthill Pathology ... · Molecular pathology Pathology Informatics Affiliated specialty labs: cytogenetics, bone and mineral Mohs Service etc " 12+

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Pathology Informatics in the USA Automating Anatomic Pathology

J. Mark Tuthill, MDDivision of Pathology Informatics,

Henry Ford HospitalDetroit, MI [email protected]

International Academy of Pathology and thePathological Society of Great Britain & Ireland

Belfast Pathology, June, 2017

Disclosures

• I have no financial disclosures• I am:

– A non paid member of the Sunquest Information Systems Strategic Advisory Board

• Current President of the Sunquest User Group– Member of the MSMS Board of Directors– Past Program Chair of the API– Conference Co-Director of the PI Summit

• Any vendors or productus mentioned during this presentation DO NOT represent an endorsement and are shared as examples– Your mileage may vary~

Objectives

• Understand Pathology Informatics as a medical subspecialty and it evolution in the USA

• Describe the structure of the Division of Pathology Informatics at Henry Ford Health System

• Innumerate areas of anatomic pathology that might be automated

• Enumerate some of the pre-requisites for anatomic pathology automation and LIS interfaces

• Present examples of evolving automation, their impact, and associated AP-LIS Requirements

Henry Ford Health System

Detroit, Michigan, USA

J. Mark Tuthill, MD, Henry Ford Health

About Pathology and Laboratory MedicineHenry Ford Health System

• HFH established 1915, by Henry Ford, who organized a closed staff of physicians and surgeons, many of whom came from Johns Hopkins– http://www.henryford.com/body_nologin.cfm?id=39484

• Laboratory grouped into divisions– Anatomic Pathology divisions

• Cytology, Surgical Pathology, Autopsy– Clinical Pathology divisions

• Blood bank, chemistry, microbiology, hematology etc– Molecular pathology– Pathology Informatics– Affiliated specialty labs: cytogenetics, bone and mineral Mohs Service etc

• 12+ million billable clinical laboratory tests and 200, 000 Anatomic Pathology Reports– 12th largest hospital based laboratory in the U.S.

• Operates as a single service line across– 5 hospitals– 36 medical centers– Single Integrated AP and CP LIS: Sunquest Clinical Lab and CoPathPlus

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Pathology Informatics

Patient Care One (Giga) Byte at a Time

Pathology InformaticsA Brave New World

• “The computer will be as important to future pathologists as the microscope has been to those of the past”

• Jeffery Ross, MD– Chair, Department of Pathology, Albany

Medical Center– Past commissioner for continuing education,

American Society of Clinical Pathologists» Circa 1993

Pathology InformaticsWhat Is It?

• The study of information technology and its application to the problems of pathology and laboratory medicine – What are information needs of pathology and

laboratory medicine?– What are the information needs of pathology and

laboratory medicine customers?– How can these needs be met?– Implementation of solutions (systems)– What new opportunities exist?– Keeping the lights on!

LIS Operations

Education Support

Strategic Planning

InternetTechnologySystems

Integration

Regulatory Compliance

Research andDevelopment

Imaging

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Board Exam for Clinical InformaticsIncludes Pathology Informaticists

• American Board of Preventive Health has created an board exam and credentialing program– This is jointly sponsored by American Board of

Pathology and includes pathology informatics• First exam was offered in 2013

– Four administration over 1500 certifications• Formalization of Clinical Pathology Informatics

fellowships by the ACGME has been achieved– CDC recently created a fellowship in public health

informatics

Where did we start at Henry Ford?

• Single operational system– Primary focus of LIS/LIT/System teams

• LIS on lab supported network– Housed in laboratory– Terminals and PC’s supported by laboratory

• Fragmented Internet services• Little standardization• Separate teams: LIS, LIT, System

Where are we now?(We’re getting there!)

• Integrated, system team approach– Pathology Informatics

• Suite of operational systems– AP LIS, CP-LIS, Imaging, Web Portal– LIS only part of focus, albeit, most significant!

• Increasing central support– Network, microcomputers, other services

• Integrated Laboratory information portal– Education, operation, research, administration,

communications• Application of data standards

– LOINC, SNOMED-CT, UML

System Teams

LIS LIT

Pathology InformaticsCP TeamAP Team

GK

RB BK*

LD*

Analytics

JMT

JWRZ

MC TC*RD

DA

HLDM

TBD

Academic Programs

Fellow Resident Med Tech

JR

Pathology Informatics Organization Structure

MA

EC

Cross DivisionalCross DepartmentalCross Institutional

Local Support•HFMH-Warren•HFMH: DM•WYH: BB•Cottage•WBH: LM•HFAH: MH

Central IT

MW

THSM

SD

Outreach Team

KCTBD

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Vision

The division of pathology informatics will continuously improve the efficiency and quality of patient care by applying information technology to the service, educational, and research missions of Pathology and Laboratory Medicine and its customers.

Mission

The division of pathology informatics will expand the use of laboratory information technology from a single systemthat primarily supports the operational aspects of the diagnostic laboratory to a suite of integrated applications and databases that generate information from analytic data, ensure quality and regulatory compliance, and provide pathology and laboratory information to those who need it, whenever, and wherever they are.

What is our Laboratory Information System (LIS)?

• Sunquest (formerly Misys Healthcare) Laboratory Information Systems– Clinical Pathology (blood and fluid testing) version 6.4

• Send it to “The Lab”• Sunquest Clinical Laboratory

– Single clinical pathology LIS for all medical centers and hospitals

– Anatomic Pathology (tissues; microscope based diagnosis

• Sunquest CoPath version 6.3– Single anatomic pathology LIS

Lab Information

System

TECHNICAL & SUPPORT STAFF

PATHOLOGISTS

Information Technology

Sunquest :

Lab and CoPath Histotrak HLAMAS POC

Aqueduct HematologyLane Faxing

LAB PORTAL Atlas

APOLLO Pathpacs

Scantron

LAB USER’S GUIDE

pathology.hfhs.org/lug

Digital PathologyRoche

MikroScanDigital Cameras

− Store AP Req Scans− Store Clin Path Req Scans− Integrate External AP Results− Telepath Integration− Associate Imaging to Reports− Interface to acquisition devices

Cameras (1-2 M records/yr)- Gels-Microbiology

− Surg Path Reqs− Cytopath Reqs− Clin Path Reqs− Outreach Documents

PathInformatics 032309

SCANNING

TISSUE BIOREPOSITORY

DOCUMENT CONTROL

Master Control

HEALTHSTREAMTraining (HFHS U)

Competency

Wired

Molecular Pathology and NGS

Epic

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Pathology Information Systems: Hardware

Each AIX computer contains: 8 CPUs, 16 gb memory Lab: PROD Lab: PROD

TEST TEST

Lab allocated: TESTUPG TESTUPG

6 CPUs, 12 gb memory

Integration Manager: SAM

CoPath allocated: CoPath PROD CoPath PROD 2 CPUs, 4 gb memory TEST TEST

Each VM server: 32 gb memory

Sunquest Lab Sunquest CoPath Other LIS / Application future state of standalone applications

Standalone Servers: RHDC & HFH K5

Virtual servers are defined by dynamic load balancing across all four servers dependant on

system resources

All servers running Windows2003 except, SIMs

running Linux

[ Histotrak HLA ]

Scantron

Lab Users Guide

PI-Tracks Change Control

Virtual Machine Server Cluster

Aqueduct Hematology Middleware

Lane Faxing

CoPath Inquiry

Macro-Scheduler

BTM : Tissue Biorepository

SMART (test)

Interfaces (prod)Report Writer

Histotrak HLA

Document Control

MAS RALS Point-of-Care

Integration

ePath (AP reports to

JFCC)

Sunquest AIX CPUs

Sunquest Lab Sunquest CoPath

SMART (prod) specimen labeling

sybase v12.5 sybase v12.5

Distribution1 / SNOMED

SIM (primary) Instruments Manager

Distribution3 SMART (upgrade)

[ PI-Tracks Change Control ]

[ Lab Users Guide ]

[Tissue Biorepository ]

ADMIN (SMART failover)

Atlas Gateway

Distribution2

[ ePath ]

Apollo PathPACS

[ Document Control ]

Interfaces (test)

SIM (failover) Instruments Manager

[ Scantron ]

[ CoPath Inquiry ]

VMserver #3 VMserver #4

AIX v5.3 AIX v5.3

VMserver #1 VMserver #2

cache v5.0 cache v5.0

SAM1SAM2

Clinical Pathology SystemsFunctional Areas Applications

• Chemistry• Hematology• Coagulation• Urinalysis• Blood Bank• Microbiology• Serology• Virology• HLA• Molecular• Genomic Pathology• Point of Care

– Glucometers >650– Coagulation clinics

• SunquestLab• SMART – barcoded specimen tracking,

management. and archiving

• >140 Instrument Interfaces via Sunquest Instrument Manager (SIM)

• Autovalidation• Macroscheduler automated jobs• Histotrac: HLA laboratory system

• MSQL Report Writer w/ Crystal• Results transmitted to EPIC

Anatomic Pathology SystemsFunctional Areas Applications

• Histology• Molecular Pathology• Cytology• Frozen Room• Autopsy• CP Integration

– Special Hematology– Flow Cytometry– Immunohistochemistry

• Sunquest CoPath• Telepathology: Mikroscan• Biomaterial tracking system (BTM)• Scantron: requisition scanning

• mTuitive: synoptic checklists

• JFCC reporting via ePath• Apollo Digital photography• Barcoded LEAN production• WSI: Ventana connect and Virtuoso• Dako Connect• Ventana Connect• Illumna NGS

Other LIS Applications and Operations Functions• Atlas Portal: Outreach EMR; order entry and result reporting

• Scantron: Document scanning for regulatory retention

• LUG: Laboratory Users Guide

• Lane Faxing: supports all Health system laboratory faxing

• BTM: Tissue Biorepository

• IT Service Now: Helpdesk; PI Change Control database for compliance

• Apollo PathPACS: image storage integrated with both Sunquest systems (Lab & CoPath)

Automating Anatomic Pathology

What Can We Envision Automating?The Big Picture

• Electronic order to AP-LIS• Biopsy/Label (sample procurement)• Transport including tracking and routing• Accession • Tissue Gross Exam • Processing, including fixation • Embedding • Cutting/ Slide Labeling • Routine Staining/Cover slipping• Case Collation • Delivery • Microscopic Exam • Special Stains/Re-cut Orders/materials retrieval • Diagnosis• Dictation • Transcription • Report Sign out • Materials filing and storage, tracking, routing

Imagine automating and integrating these process using computerization and advanced robotics!

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What Can We Envision Automating?The Big Picture

• Pre analytic– Prior to receiving or analyzing the sample– Preparing samples for analysis

• Analytic– The process of analyzing the tissue

• Post analytic– The reporting of diagnostic information– Preparing for additional analytic studies

Why has AP Automation Lagged Behind the Clinical Pathology Laboratory?

• The variability of specimens– Versus CP specimens which come in tubes, AP

sample vary with each surgery• Required manual processes (so far)

– Manual dissection, embedding, sectioning• A lack of interest?

– Do anatomic pathologists lack exposure to the ideas of automation used in the clinical laboratory?

– Why change what works?• The harsh environment

– Chemicals, paraffin, bloody tissue etc

Prerequisites for Anatomic Pathology Automation

• Sophisticated electronic medical records system– Electronic orders interface for Anatomic Pathology

• Bar code labeled assets with the laboratory– Assets with unique identifiers

• Development of robotic technologies– Grossing– Sectioning– Tissue transport– Storage systems: cassettes and slides– Sampling


• Sophisticated electronic medical records systems– Such systems will enable clinical orders to be sent to

the anatomic pathology information system as well as supporting:

• Decision support• Gathering of accurate and required information• Positive patient identification• Generation of laboratory ready labels to the point

of service• Tracking of samples to the laboratory including

monitoring of conditions


• Electronic orders interface to the Anatomic Pathology Laboratory Information System (AP-LIS)– Similar to the clinical laboratory, a flow of orders to the

LIS will enable:• Sample receipt• Tracking• Routing• Processing• Automation of several elements of case

accessioning– Decrease errors– Increased throughput


• Bar code labeled assets within the laboratory– This is most essential early prerequisite to achieve

automation within the laboratory– Bar coding of assets allows for:

• Bar code driven workflow• Identification error reduction due to mislabeling• Improved efficiency by reducing manual labeling• Automation of subsequent activities

– Integration whole slide imaging, interface devices

– This is the key requirement for all many automation requirement, and thus the AP-LIS

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• Bar code labeled assets within the laboratory– In addition to simple bar coding of assets with a accession

number or medical record number it will be critical for each asset to have an unique ID embedded in the bar code

– This will allow each block and each slide to be managed uniquely supporting

• Sophisticated routing• Tracking of assets • Digital Pathology (unique ID on slides will be essential!)• Systems interfaces

• Without uniquely identified assets the clinical laboratory could not have achieved the level of automation currently experienced

Examples of Anatomic Pathology Automation

Real World Examples and Status Updates

Examples of AP Automation

• Automation of histology orders (stain protocols)• Auto stainers and auto cover slippers• Interfaced immunostain orders to automated

immunostain platform• Bar code labeling automation

– Automated production of cassettes at accessioning– Cassette driven generation of labeled slides

• Tracking, routing and storage• Automated tissue embedding• Automated microtome's

Examples of AP Automation

• Automated block sampling• Automated slide sampling

– Laser capture micro dissection• Conveyor belt systems, tubes, roving robots• Slide collation robotics• Automatic diagnostics

– Whole slide imaging algorithms for immunostains quantification

– Automated pap smear readers for thin layer cytology

Examples of AP AutomationHistology Protocols

• Automated ordering histology protocols for different sample types at case accession– When a particular part is accession the appropriate blocks and

initial stain orders are generated– Initial billing fee codes are applied– Histology logs are electronic sent and printed providing early

notification of work• This has increases efficiency and allows for LEAN processes

– Work is standardized– Revenues were enhanced through better charge capture

• This is not easy and required iterative re-work and constant attention to defects to get the most satisfactory end result

Examples of AP AutomationBar Code Labeling

• Essential first step to widespread AP automation– Note the impact of re-labeling in the automated

staining platform• As previously stated the implications of bar code labeled

cassettes drives all other processes• By themselves, the impact of automation of cassette

labeling following by label generation are profound

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Examples of AP AutomationReal Time Labeling

• Bar code specified surgical pathology– 2D bar codes were not available so we created a

solution and integrated it using middleware• Interfaced to CoPath eliminating dual entry

– Cassettes are etched at the time of accession– Uses predefined protocols

• Provides nicely formatted cassettes with 2D bar codes• Bar coded cassettes are used to create slides labels

“just in time” at the cutting bench– “Stainer shield”

Historical Workflow

• After processing, sections were cut and mounted onto slides then hand labeled with the case accession number and part designation

• Stains were performed based on requests that were available at the histology department through the LIS– Or phone calls…– Or emails…– Or notes on scrap paper

Historical Workflow• After staining, paper labels were batch printed from the LIS and

affixed onto the corresponding slides

46

CoPath terminalBarcode label printer-Lab tag-Specimen containers

Lab tag scanner, bar code readerCassette etcher- 2D barcode

Accession Station U-shaped Cell

CoPath terminal2D Barcode reader-Individual cassettes

Slide label printer-Chemical resistant slide labels-Print 1 cassette not batch

Microtome Station U-shaped Cell

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Microtomy Station

48

This case is submitted in 3 specimen containers consisting of:part A - sigmoid colon biopsy, part B - transverse colon biopsy and part C - stomach biopsy with standing preorder

for Helicobacter pylori immunostain.

Protocol driven information is reflected in the slide labels dictating 2 levels cut for each part.

The stomach biopsy protocol, part C, calls for an additional 2 blanks slides to be cut, one for the immunostain & a 4th left unstained.

1

4

3

2

Barcode SpecifiedWork Processes

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Outcome• With 'real-time labeling' the batch printing process has

now been entirely eliminated

• Specimen misidentification rates have been reduced

• Workflow efficacy in the histology lab has increased as cassette reading defects have been eliminated– Barcode reading defects required the histotechnologist to

manually type in cases numbers, leading to increased risk of patient misidentification

Results: Misidentification Rates

Baseline Linear BarCodes(Jan.2007)

2D BarCodes(June2012)

45

18

10

5

10

15

20

25

30

35

40

45

Number Mis-IDDefectsPercent of Cases

1.67%

0.62%

0.02%

Interfacing Automated Immunostaining

• Perhaps the most commonly automated process in the current AP lab– Included automated cover slipping

• This saves hundreds of man hours per year• Has more consistent results versus manual staining and

cover slipping• Interfaces with AP LIS will further enhance productivity

and decrease errors

Examples of AP AutomationAutomated Staining Platforms

Automated ImmunostainingInterface Design

• An HL7 interface was created between CoPath and the Dako autostainer Link 48 platforms– Allowed IHC orders placed in CoPath to be directly

transmitted and received by the DakoLink instrument control software; used Dako labels

• Our CoPath LIS was upgraded to version 6.0 which provided the capability to uniquely identify and track each case assets – Assign unique identifiers to each and every case asset (i.e.

parts, blocks, and slides)– With this in place, unique slide IDs (linked to IHC orders in

the AP-LIS) were transmitted to Dako autostainer control software

– Dako autostainer instruments could then read and utilize native CoPath labels

CoPath – Dako New Workflow1. Stains are ordered in CoPathPlus.2. Stain orders are released to the interface on demand

or scheduled.3. Interface creates an HL7 message and delivers to

Dako 4. Message is routed to instrument. Slide labels print

from CoPath. 5. Slides are cut in the laboratory and Slide labels print

from CoPath and labels are applied to slides.6. Slides are placed into the instrument. Label is

scanned by instrument which indicates the reagent stain workup.

7. Slides are processed.

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New workflow after deployment of the automated stainer interface

Stains Ordered

Slide are cut & labeled

Creates HL7 message

Slides placed onto

instruments

Slide labels scanned

Slides processed

CoPath Interface

IHC

Special stains

From CoPath Printer to Slides to DakoBypassing Dako Relabeling

ResultsActivity Number of

Slides Time

Pick up and sort slides from histology 12.0 mins.

Look up patient name in CoPath and record on sheet 7.0 mins.

Daily QC sheet 11.0 mins

Program Stainer: Enter name, acc#, path. initials, stain orders

IHC Autostainer #1 44 slides 11.5 mins.

- Label slides and place in rack 7.0 mins.

IHC Autostainer #2 32 sildes 10.5 mins.

- Label slides and place on rack 5.5 mins.

IHC Autostainer #3 36 slides 10.0 mins.

- Label Slides and place on rack 5.5 mins.

Approximate time saved per run: 56.5 mins.

Assuming 2.0 runs per day X 56.5 minutes = 1.88 hours

Assuming 1.9 hours X 303 days worked per year = 575.7 Hrs/YR

Results

• With elimination of relabeling the slides and dual order entry through automation markedly decreases assay run time – This saves upward of ~700 hours of manual effort per

year while eliminating errors, improving patient safety and improving laboratory throughput

• Increases order accuracy by reducing keystroke errors.• Enhances operational efficiency by automating processes.• Enforces safe, consistent, efficient handling of specimen.

Electronic EMR Orders Interface

AP Orders Interface

• Project initiated to transmit AP orders from our EMR to CoPath

• This will solve several problems:– Elimination of unsolicited results as orders will be

fulfilled in the EMR– Proper encounter selection– Routing to provider inboxes– Better tracking or AP tissue– More efficient accessioning

• ADT, MD, Part Type, ICD, Clinical History and ask at order entry questions will be transmitted from EMR to CoPath

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AP Orders Interface

• Project initiated to transmit AP orders from our EMR to CoPath recently completed

• Impact based on time studies– 1.5 minute average decrease in case accession– 100,000 cases as a baseline for our math

• Savings of 2500 hours• Minimum of $50,000, direct cost savings

• Time savings doesn’t include elimination of the complexities of mis-accessioned cases and required resolution– Elimination of defect in encounter selection alone will

have huge impact

Deploying and Integrating Whole Slide Imaging

Evolution of WSI strategies at HFHS

WSI Drivers for HFHS Pathology2013-2016

• Maturity of the WSI technology platforms – Improved performance– Decreasing costs

• Increasing likelihood of FDA approval/acceptance for primary diagnosis

• The need for a distributed digital pathology workflow to support diagnostic studies– Move images not glass!

• Loss of support for our robotic telepathology platforms• The desire to adopt cISH and image analysis for

diagnostic panels

Prerequisites for Interfacing WSI

• Requisite hardware and software for WSI capable of using HL7 messaging– Network attached storage solution– Network bandwidth

• We had WSI in place since January 2016• An LIS capable of communicating with WSI systems via

HL7• Electronic histology orders used for all histology

processes• Bar code labeled assets with unique ID’s

Value of Interfacing WSI

• Immediate case annotation through interface– Elimination of labeling errors

• Significantly more data is populated – Part, Block, stain– Patients details: age, sex, DOB; – Assigned pathologist

• Leveraging bar code technology– Current 2D bar codes are read directly by the scanners

and match with the order information• Case available to pathologist immediately upon successful

scan– No need to annotate and release

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TECHNOLOGYFile mover services leveraged

Autopsy suite

Apollo EPMM

Specimen X-rays

Grossing stations

DocumentScanners

Autopsy suite

Whole Slide Imaging

LIS Integration

Decisions and Goals

• Select WSI partner for cISH analysis and distributed diagnostic imaging– Selected Ventana Roche as a partner

• Implement iScan Coreo and Coreo HT platforms• Interface these platforms with Sunquest CoPath• Validate the Ventana Ultra cISH platform• Harmonize bar code labeling symbologies so that

CoPath generate bar codes labels would be used• Integrate this technology into our CoPath and

Apollo workflow

Ventana Roche2015-2016

• Stand up iScan Coreo and iScan HT systems including servers, scanners, networking, and storage– Train pathologist and histology– Complete validation studies for images analysis on

iScan Coreo• Develop interfaces between iScan systems and

Sunquest CoPath– Ventana Connect– Virtuoso

• Harmonize labeling of slides so that copath labels could be used on all systems– Implement USID technology recently made available

• 11/1/2016 Roche Ventana iScan Coreo

Roche Ventana HT

Roche Ventana Virtuoso

CoPath

Dako

Apollo Imager

SAM

Stain orders

Stain status updates

Image ordersImage orders

Image results Image results

Past HL7 Setup

SAMSunquest Application Manager

CoPath

Dako

Apollo Imager

Dako stain ordersStain status updates

Image orders

Image orders

Image resultsImage results

Ventana Connect

Dako stain orders

Dako Stain status updates

Dako & Ventana stain orders

Ventana Stain status updatesVentana Image Results

Ventana stain orders

Current HL7 Setup

SAM

SAMSunquest Application Manager

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Benchmark Ultra

Virtuoso

Ventana Stain status updatesVentana Connect

Dako & Ventana stain orders Ventana images

Ventana stain orders from CoPath

Current HL7 Setup

Coreo PC

Ventana imagesHT PC

Ventana image results

Dako & Ventana stain orders

iScan HT Workflow

• Cases are created in CoPath at accession• HL7 message is sent to Ventana Connect and onto

Virtuoso• Slides cut, stained and placed on HT for scanning• Scanned images automatically associated with patient,

CoPath accession and pathologist• Scanned images available to be viewed through CoPath

interface• Select fields can be exported and integrated into the

CoPath report using Apollo EPMM

Conclusions

Conclusions

• More aspects of anatomic pathology can be automated than are typically envisioned

• Automation of AP process have significant cost savings• Automation of manual process eliminates defects,

improves efficiency, and frees up time for value added tasks

• Elimination of defects results in improved patient safety• Electronic orders interfaces to CoPath markedly impact

the accession process as well as clinical customer satisfaction and patient safety

• New “instruments” are coming for tissue pathology imaging; think of WSI as a tissue analyzer

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• Najmabadi P, Goldenberg AA, Emili A. Hardware flexibility of laboratory automation systems: analysis and new flexible automation architectures. Clin Lab Med. 2007;27:1-28.

• Pantanowitz L, Hornish M, Goulart RA. The impact of digital imaging in the field of cytopathology.Cytojournal. 2009;6:6.

• Sasaki M, Kageoka T, Ogura K, Kataoka H, Ueta T, Sugihara S. Total laboratory automation in Japan. Past, present, and the future. Clin Chim Acta. 1998;278:217-27.

• Zarbo RJ, Tuthill JM, D'Angelo R, Varney R, Mahar B, Neuman C, Ormsby A. The Henry Ford Production System: reduction of surgical pathology in-process misidentification defects by bar code-specified work process standardization. Am J Clin Pathol. 2009;131:468-77.

• College of American Pathologists system review series: Laboratory automation systems & workcells. CAP Today [www.CAP.org].

• Tissue-Tek® AutoTEC® Automated Embedder– http://www.sakura.eu/products/showitem.asp?cat=7&subcat=83

• Laser Capture Microdissection– http://www.appliedbiosystems.com/absite/us/en/home/applications-technologies/laser-

capture-microdissection/overview-of-arcturus-laser-capture-microdissection-process.html

Pathology Informatics in the USA Automating Anatomic Pathology

J. Mark Tuthill, MDDivision of Pathology Informatics,

Henry Ford HospitalDetroit, MI [email protected]

International Academy of Pathology and thePathological Society of Great Britain & Ireland

Belfast Pathology, June, 2017

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Pathology Informatics 2018Monday, May 21–Thursday, May 24, 2018, Pittsburgh, PA

Pathology Informatics 2019Monday, May 6-Thursday,May 9, 2019, Pittsburgh, PA