The Importance of Radiology and Pathology Communication in the Diagnosis and Staging of Cancer: Mammography as a Case Study. 5.3 Limitations to current workflows

11/01/2010

Current attempts to address the radiology-pathology workflow needs are being carried out in isolation by some institutions but there is no unified approach to addressing these recommendations. There are multiple issues that need to be addressed and resolved before a unified workflow can be adopted. First, there are numerous different, unique information systems used by the two disciplines. Even within pathology, anatomical pathology and laboratory medicine (clinical pathology) might have separate information systems that need to interoperate with each other as well as with other systems such as Hospital Information System (HIS) and Electronic Medical Records (EMR). Also, a separate pathology system may be needed to view and possibly store pathology images. Similarly, radiologists typically use a Picture Archiving and Communication System (PACS) to communicate and archive images, a separate Radiology Information System (RIS) for textual reports, and often a third system for speech recognition. In addition, a separate system is often used in radiology for only mammography studies [*] (Mammography Information System (MIS)). For most intra-institutional communications between radiology and pathology to occur, the radiology and pathology systems need to communicate with the main HIS.

Second, there is lack of standardization related to the exchange of information between the various pathology and radiology information systems and where an exchange has been developed implementation is typically incomplete. Both pathology and radiology information systems may use a messaging standard such as Health Level Seven (HL7) for orders and results. However, current implementations do not support the advanced HL7 features needed to support ordering or reporting functions for standardized interfacing between radiology and pathology information systems. There is also a lack of commercially available information systems that allow a unified view of a patient’s records without querying across multiple systems to obtain relevant information from a radiology or pathology system. This situation is even more complicated in settings where the pathologist and radiologist do not share a common host institution and/or HIS.

Third, while there may be general mechanisms for standard communication of specimen-associated data from the biopsy environment to the Laboratory Information System (LIS), there is no national standardized electronic specimen requisition form. Instead, a paper requisition form accompanies the physical specimen sent to the pathology laboratory from radiology and is used to communicate clinical and specimen information.

Finally, while there are standardized protocols (such as the College of American Pathologists Cancer Protocols) to report malignant findings, there is no national consensus or guideline for the reporting of benign or negative pathology results. This can be problematic, especially if benign pathology results are discordant with radiology findings and may potentially be missed malignancies. Practice guidelines are needed for these types of cases to assist in the identification of possible discordant pathology/radiology results. By using standardized data elements, biopsy-imaging correlation may improve and the process may be automated if the data elements can be captured in a structured, machine-readable manner.

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