Practical Pathology Informatics

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Over the years, informatics has had multiple definitions. Medical informatics is the science of how to use data, information, and knowledge to improve human health and delivery of health care services. Experience and observation confirm that informatics training in pathology residency programs is often absent, or when offered, inconsistent from program to program and frequently lacking in depth, breadth, and structure, particularly in comparison to more traditional areas of pathology training. This work group, led by a core team of informatics and education leaders from the 3 organizations, developed and released the Pathology Informatics Essentials for Residents PIER , a novel and flexible curriculum for educating pathology residents in informatics.

PIER offers both a curriculum and instructional process for incorporating informatics training into pathology residency programs. The recognition of the importance of informatics to the specialty and practice of pathology has surged in recent years. The increasing role and recognition of informatics in contemporary pathology practice presents a strong argument that acquisition of a basic knowledge of informatics should be part of the preparation of future pathologists. In line with the observations above, expectations for pathology residency programs to train their residents in informatics are increasing.

Training residents in informatics has been a daunting task for most programs in the United States because of the absence of a standardized curriculum, the limited number of faculty with informatics expertise, numerous competing subject matter priorities and practical time constraints, and the rapid pace of change to the content due to both technologic advances and evolving regulatory needs.

These challenges notwithstanding, the pathology community recognizes the mandate for appropriate exposure and training in informatics to enable the advancement and transformation of the practice of pathology. The intent was to design a program that could be implemented in essentially any pathology residency program, whether or not that program had a local pathologist informaticist on the faculty. The work group researched and developed 38 peer-reviewed outcome statements identifying the knowledge and skills that all residents should have in pathology informatics to practice pathology upon completion of their residency program.

The group also reviewed core content for the new certifying Board Examination in Clinical Informatics, which is cosponsored by the American Board of Pathology. For training delivery purposes, the outcomes were organized into 4 groupings, named the PIER Essentials , presenting the recommended sequence for residents to build their pathology informatics knowledge and skills over time Figure 1. The work group identified key learning resources for the informatics topics in each of the PIER Essentials, such as book and journal references and online training modules.

The group also developed practical exercises aimed at reinforcing informatics knowledge with hands-on experience. The work group met regularly by conference calls from January to September A subset of the work group met in person to finalize the curriculum and instructional framework ie, PIER Essentials and curated list of associated resource options, and to determine the structure of the PIER Resource Toolkit. A core team of informatics and education leaders from CAP, APC, and API provided oversight and project management throughout the development process and continues to manage the initiative.

PIER Release 1 was made available to all residency programs on the APC Web site in September and was concurrently alpha tested by 12 residency programs Table 2 during that academic year. Preliminary alpha test findings indicate that PIER is effective.

Release 2 is currently in development and scheduled for release in the summer of The PIER Essentials present up-to-date pathology informatics training topics based on 38 peer-reviewed outcome statements Appendix. PIER Essentials also include aspects of laboratory information and systems in the greater health care information domain, including electronic health records Figure 1.

The PIER Essentials successively build on each other with increasing complexity, as indicated by the stated proficiency levels. Residency programs may control the timing by year to suit the scheduling availability of postgraduate year PGY 1 to PGY 4 residents; however, it is important that the order be followed because the knowledge and skills build in sequence. The estimated instructional hours for each PIER Essentials are based on the approximate time it takes to complete the recommended approach for each of the topics in each of the Essentials.

The number of instructional hours may be adjusted on the basis of the final number and type of resource options, and instructional strategies selected by the program director. PIER focuses on preparing all residents to achieve Levels 1 to 4 during residency and is an effective resource for aspiring informatics specialists to develop prerequisite pathology informatics knowledge and skills before advanced training or fellowships.

PIER is scoped and sequenced to achieve the outcomes, which are more specific and more directly aligned with practice needs than the high-level Milestone statements. It is expected that only a few exceptional residents will reach this level.

Pathology informatics

The Resource Toolkit provides 3 interactive tool templates that program directors and residents can use to plan, customize, implement, and manage the 4 PIER Essentials. These tools include 1 an Essentials Map that identifies the topics, topic rationale, key outcomes, topic content, rotation options, and delivery options for each of the Essentials Figure 3 ; 2 PIER Resource Options that include a recommended set of reference resources and practical training exercises for each topic Figure 4 ; and 3 an Essentials Outcomes Achievement Checklist that tracks accomplishment of each outcome statement; successful completion of each of the Essentials indicates achievement of the corresponding ACGME Milestone level Figure 5.

PIER provides the curriculum and process for residency programs to develop and customize their own self-study modules, lecture series, and blended learning units. Users can add and maintain their own tools and content in their Resource Toolkit electronic files. PIER is flexible and scalable for programs to best meet their local needs, philosophy, and circumstances.

The overarching goal of PIER is that residents build basic competency in pathology informatics. PIER recognizes that the GME pathology informatics space is growing with a variety of diverse topics, approaches, and materials, at varying costs and from multiple providers. Because programs have varied internal expertise, budgets, and education strategy preferences, PIER has built-in design agility, is free of charge, and includes only no-cost and relatively low-cost learning resources.

PIER also serves as a framework for other informatics training content. The curriculum can be supplemented with a variety of additional teaching resources and tools from internal and external providers as they become available. PIER is supported by a 4-phase, multiyear change management strategy designed to test and support delivery of GME informatics training across all US pathology residency programs. The change management strategy engages and supports residency programs in the successful implementation of PIER incrementally over time, recognizing that programs will have varying adoption types Table 3 and motivations.

As such, program directors can leverage the PIER curriculum and instructional process tools to guide the training decisions that are most appropriate to their program. The change management framework and associated terminology eg, early adopters, early majority, late majority, late minority developed for PIER is adapted from Diffusion of Innovations.

The communication and engagement methods for each phase are influenced by the adoption attributes of the residency programs in a given phase. The application of the model referenced above as related to the development of PIER is described below. As a result, key stakeholders were informed and educated about PIER and were invited to evaluate it for use at their own institutions. At the July APC Annual Meeting, more than 30 pathology residency programs expressed a desire to participate in an alpha test to validate PIER Release 1, initially released to all residency programs in September Twelve programs Table 2 participated in data collection events between November and October Data collection events included online surveys, phone interviews, and virtual focus groups.

Nine additional residency programs indicated that they used PIER Release 1 and participated in an online survey. Based on valuable feedback received from these 21 programs, PIER Release 2 is in development and will be available by summer of The communication and engagement plan will be developed in late , applying lessons learned from Phase 3 Deployment. Each phase of the change management strategy is specific to the adoption attributes of the program population.

Further to the latter point, PIER is not a commercial product and has no commercial ties. As early as , Aller et al 14 described the benefits of computerization for the pathology laboratory.

Practical pathology final SLIDES

Korpman 15 described how pathologists are well suited to play a leadership role as information managers in health care organizations. Friedman 16 first used the term pathology informatics in describing the need for a locus of responsibility and expertise in informatics within pathology departments. Sinard and Morrow 17 described a vision of the pathologist as an information integrator at the center of diagnostics in patient care.

Not surprisingly, a survey of pathology group leaders 18 cited informatics as one of the most important skill sets for newly hired pathologists. In the current era of information-rich medical practice, and with the development of new informatics-intensive laboratory technologies such as electronic health record—related meaningful use requirements, digital pathology, next-generation sequencing, and computational pathology, demand will increase on the pathology community to invest in informatics initiatives and resources, train more pathology informaticists, and educate all pathology residents about informatics.

There have been several recent initiatives highlighting the importance of effective education in informatics for pathology residents.

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While the new board certification does not relate to residency training per se, it does reflect an endorsement of the importance of informatics in medicine, and specifically in pathology practice. The core content for the certifying Board Examination in Clinical Informatics was previously published 11 ; this content was examined and analyzed during the preparation of PIER. While some programs have developed novel methods, such as virtual rotations and wikis, to expose their residents to informatics, 19 , 20 most programs in the United States are not teaching their pathology residents adequately.

During the past 25 years, there have been multiple proposals for elements of a curriculum in informatics for pathology residents. In , a comprehensive curriculum that detailed learning objectives and skill sets in informatics for pathology residents was published. Harrison 28 described in detail questions and methods for evaluating informatics training in a pathology residency program. None of these training proposals has been widely implemented, at least partly because other priorities compete with informatics for time during residency training, there is a perceived lack of informatics resources and training materials, and pathology faculty generally lack informatics expertise.

Program directors can reference the PIER curriculum to determine which instructional materials they want to make or buy, using the instructional process tools to document and track their decisions. Identifying reasonable subject management scope for residents in pathology informatics training was challenging. The field of informatics is broad and encompasses many diverse topics, and these topics continue to evolve and to expand rapidly as a result of advancing technology and emerging regulations.

Informatics has been incorporated into residency training in other medical specialties.

For example, because residents did not find detailed background in information technology to be of immediate clinical value, more attention was directed toward teaching practical skills and reinforcing these during clinical residency. The working group made decisions about the scope of informatics topics suitable to include in general resident training. Many topics that might be considered by some to be pathology informatics topics, such as computer programming, database administration, advanced statistics, and bioinformatics, were identified to be out of scope for PIER.

The working group had difficulty deciding how best to position and cover the field that has been termed computational pathology. That said, many of the other topics within PIER are expected to help prepare pathology residents to eventually use computational pathology in their future practice, should the need arise.

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The primary target audience for PIER is pathology residency program directors and administrators who have responsibility for training residents and preparing them generally for practice. Secondary audiences may include undergraduate medical education directors and students interested in knowing or understanding what is required in pathology informatics for a resident. Although practicing pathologists may also use PIER as a resource for continuing education in informatics, it was not designed specifically for this purpose.

To date, PIER has been well received by the pathology community and the alpha test programs. Most alpha test program representatives report that they would be willing to recommend PIER to other programs. Although program directors who participated in the PIER alpha test report satisfaction with PIER, they continue to raise the same implementation concerns reported in the literature to date. Start on. Show related SlideShares at end. WordPress Shortcode.

[PDF Download] Practical Pathology Informatics: Demystifying informatics for the practicing

Full Name Comment goes here. Are you sure you want to Yes No. Salah Ghany , assistant lecturer at al azher university plastic and reconstructive surgeon at al azher university. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. Pathology informatics 1. Current vs. Data stored in a protected database which can be accessed remotely with correct authorization Standardized Nomenclatures ICD Information System Organization 1. Surgical pathology 2.

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Cytology 3. Document Type: Book review.