Journal of Pathology Informatics Journal of Pathology Informatics
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RESEARCH ARTICLE
Year : 2013  |  Volume : 4  |  Issue : 1  |  Page : 32

Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service


1 Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
2 Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
3 Department of Pathology, San Antonio Military Medical Center, Joint Base San Antonio, San Antonio, Texas, USA
4 Department of Radiation Medicine, Air Force Institute of Technology, University California, San Diego, La Jolla, California, USA
5 Institute of Gastrointestinal Pathology and Digestive Disease, AmeriPath, Inc., Cleveland, Ohio, USA
6 Department of Pathology, Auburn Memorial Hospital, Auburn, New York, USA
7 Department of Pathology, 96th Medical Group, Eglin Air Force Base, Fort Walton Beach, Florida, USA
8 Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Correspondence Address:
Jonhan Ho
Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2153-3539.122388

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Background: Advances in digital pathology are accelerating integration of this technology into anatomic pathology (AP). To optimize implementation and adoption of digital pathology systems within a large healthcare organization, initial assessment of both end user (pathologist) needs and organizational infrastructure are required. Contextual inquiry is a qualitative, user-centered tool for collecting, interpreting, and aggregating such detailed data about work practices that can be employed to help identify specific needs and requirements. Aim: Using contextual inquiry, the objective of this study was to identify the unique work practices and requirements in AP for the United States (US) Air Force Medical Service (AFMS) that had to be targeted in order to support their transition to digital pathology. Subjects and Methods: A pathology-centered observer team conducted 1.5 h interviews with a total of 24 AFMS pathologists and histology lab personnel at three large regional centers and one smaller peripheral AFMS pathology center using contextual inquiry guidelines. Findings were documented as notes and arranged into a hierarchal organization of common themes based on user-provided data, defined as an affinity diagram. These data were also organized into consolidated graphic models that characterized AFMS pathology work practices, structure, and requirements. Results: Over 1,200 recorded notes were grouped into an affinity diagram composed of 27 third-level, 10 second-level, and five main-level (workflow and workload distribution, quality, communication, military culture, and technology) categories. When combined with workflow and cultural models, the findings revealed that AFMS pathologists had needs that were unique to their military setting, when compared to civilian pathologists. These unique needs included having to serve a globally distributed patient population, transient staff, but a uniform information technology (IT) structure. Conclusions: The contextual inquiry method helped reveal similarities and key differences with civilian pathologists. Such an analysis helped identify specific instances that would benefit from implementing digital pathology in a military environment. Employing digital pathology to facilitate workload distribution, secondary consultations, and quality assurance (over-reads) could help the AFMS deliver more accurate, efficient, and timely AP services at a global level.


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