A Time amp Motion Study Pathology Visions October 26 2011 Curtis Stratman MBA 1 Laura Drogowski BS 2 Jonhan Ho MD 23 1 Omnyx LLC Pittsburgh PA 2 University of Pittsburgh Department of Pathology Pittsburgh PA ID: 934147
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Digital Pathology in the Clinical Workflow:A Time & Motion StudyPathology VisionsOctober 26, 2011
Curtis Stratman, MBA1Laura Drogowski, BS2Jonhan Ho, MD2,3
1Omnyx, LLC, Pittsburgh, PA2University of Pittsburgh, Department of Pathology, Pittsburgh, PA3University of Pittsburgh, Department of Dermatology, Pittsburgh, PA
Slide2Stratman – Employee of OmnyxHo – Research Grant from OmnyxDisclosures
Slide3Goal of the StudiesHow would the migration to an all-digital workflow impact staffing across an organization, including both pathologists and the histology lab?Understanding this impact is significant for evaluating digital pathology solutions for high-volume uses.3
Slide4Histology Lab Time and Motion Study
Slide5Histology Lab T&M Study ContextPhysical Workflow
Slide6Histology Lab T&M Study ContextDigital Workflow – Standalone Imaging Solution
Slide7Histology Lab T&M Study ContextDigital Workflow – Standalone Imaging Solution
NEW TASKS
EQUIVALENT TASKSDUP TASKS
Slide8Histology Lab T&M Study ContextDigital Workflow – APLIS Integrated
NEW TASKS
EQUIVALENT TASKSDUP TASKS
Eliminate
Slide9Histology Lab T&M Study Context Digital Workflow – APLIS & Barcode Integrated
NEW TASKS
EQUIVALENT TASKSDUP TASKS
Eliminate
Eliminate
Slide10Study Case Entry time to: understand incremental staff costs for standalone implementationquantify value of APLIS interfaceStudy Case Assembly time to: understand opportunity to offset increment staff costs from imagingquantify value of barcoding interfaceHistology Lab T&M Study Goals
Case EntryImagingImaging
ImagingCase Assembly
+ Tasks
- Tasks
Standalone
APLIS Integrated
APLIS & Barcode Integrated
Slide11Entered 17 randomly selected cases into Omnyx applicationRecorded time to enter Patient, Case, and Histology informationPerformed regression to model component timesAverage Case (1 Part, 10 Slides) = 2:03 minutes / caseSupport Average Pathologist (3500 cases / year) = 119.6 hours / year
Average Lab FTE (2000 hrs / year) = 6.0% FTE / pathologist = ~1 FTE / 16 pathologistsHistology Lab T&M Study MethodologyCase Entry Time
Data ComponentAverage Time (Each)Patient & Case
68 seconds
Histology Part(s)
25 seconds
Histology Slide(s)
3 seconds
Slide12Analyzing total impact requires additional study of actual time for imaging tasksHighly variable with scanner designAPLIS Integration avoids actual incremental 6% lab FTE per pathologistAPLIS + Barcode Integration potentially reduces 18.5% lab FTE to offset some of the incremental time required by imaging tasksHistology Lab T&M Study Summary
Case Entry6.0% FTE/PathImaging(TBD)
Imaging(TBD)Imaging(TBD)
Case Assembly
18.5% FTE/Lab
+ Tasks
- Tasks
Standalone
APLIS Integrated
APLIS & Barcode Integrated
Slide13Observed histology lab for entire shiftRecorded time to spent on tasks between coverslipping and courierExtracted time spent on Case Assembly tasks:Sorting and matching slides to casesSorting and matching cases to pathologists or services
Average Lab FTE (8 hours / day) = 18.5% FTEHistology Lab T&M Study MethodologyCase Assembly TimeAcademic Center Labs
Number of Labs Observed
4
Number of Total Observations
8 (days)
Range of Case Assembly Time
0:57:20 – 1:53:46
Average of Case Assembly Time / Day
1:29:16
Slide14Pathologist Time and Motion Study
Slide15Radiology realized significant improvements in productivity as the most significant value-add from PACS implementation.“Since the introduction of PACS, reporting times have decreased by 25% and the productivity improved by 18%.”Mackinnon AD, Billington RA, Adam EJ, et al. Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit. Clinical Radiology 2008; 63; 796-804.“…overall Radiology Department productivity increased by 12%, TAT improved by more than 60%. Timelier patient care resulted in decreased lengths of stay.... A well-planned PACS deployment simplifies imaging workflow and improves patient care throughout the hospital while delivering substantial financial benefits.”
Nitrosi A, Borasi G, Nicoli F, et al. A filmless radiology department in a full digital regional hospital: quantitative evaluation of the increased quality and efficiency. Journal of Digital Imaging 2007; 20(2); 140-148.
15Pathologist T&M Study ContextExperience from Radiology
Slide16The challenges pathologist experience from managing slides is similar to the challenges radiologists experienced with film.16Pathologist T&M Study ContextSimilarity of Pathology and Radiology
Slide1717Pathologist T&M Study GoalHypothesis: Inefficiencies exist in the pathologists’ workflow that can be improved by an all digital workflow.A before-and-after study of actual impact in pathology is in-progress, therefore the first study goal was to identify the potential opportunity.
Slide18Observe pathologists across multiple days, subspecialties, and sitesRecord time spent on each discrete taskBucket the tasks into common activitiesIdentify the buckets impacted by an all digital workflowCalculate opportunity as a percentage of total time spent on cases
NOTE: Results varied significantly across observations, both across and within pathologists.18Pathologist T&M Study MethodologySubspecialty Pathologist
s in Academic Setting
Number of Pathologists Observed
6
Number of Total Observations
12 (days)
Average Time on Case Work / Day
5:22:44
Slide19Pathologist T&M Study ResultsIdentified Opportunities for Time SavingsMatching: Matching paperwork to caseMatching new stains ordered upon arrivalTracking receipt of ordered slidesRe-checking slide to case matchReduced Error Correction: Transporting case to correct pathologistObtaining correct or missing paperwork
Reducing duplicate slides ordered Picking up wrong slides / missing slidesRetrieving Prior Cases: Sending request for prior caseContext switch away from current caseTracking receipt of requested prior casesTransporting Cases:
Giving for Pre-Signout Q/APackaging cases for consultOrganizing Cases:Prioritizing cases for reviewDividing with residents and fellowsTracking which cases are ready for reviewTracking cases for conferences
Querying for Cases:
Checking mailbox for new cases
Checking if STAT cases have arrived
Checking if Frozen Section cases are ready
Visibility of overdue cases
Searching for Cases:
Searching for cases when receiving phone call
Searching for “orphan” slides
Pulling cases for re-review at final sign-out
Passing cases between residents and fellows
Communication:
Sending ROI images vs. co-scheduling time at scope
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Slide20Workflow Opportunities13.4% (0:43:09)Slide Review36.0% (1:56:13)Other16.0% (0:51:43)
Reporting34.6% (1:51:38)Pathologist T&M Study ResultsBreakdown of Time Working Cases
Slide21Slide Review36.0% (1:56:13)Other16.0% (0:51:43)
Reporting34.6% (1:51:38)
Organizing Cases 24.1% (0:10:25)Querying for Cases 18.5% (0:07:59)Waiting for Delivery 11.2% (0:04:49)
Matching 10.5% (0:04:32)
Searching for Cases 9.4% (0:04:04)
Transporting Cases 9.2% (0:03:58)
Other 17.0% (0:07:21)
Workflow Opportunities
100% (0:43:09)
13.4%
Pathologist T&M Study Results
Breakdown of Workflow Opportunities
Slide22Common current uses:Tumor boardsFrozen sectionsConsultationsSecondary effects caused by delays from noted opportunities:Time re-orienting to case after waiting for prior casePhone-tag with ordering clinician after retrieving caseLevel-loading work:Continuous flow of cases from lab to pathologistDistribute workload across locationsSurrounding personnel:Resident matching (observed 1:26:11)Administrator preparing cases (observed 1:35:43)Prior case retrieval and re-storage
Slide transportationPathologist T&M Study ResultsAdditional Opportunities for Time Savings
Slide2313.4% opportunity for increase in available pathologists’ time from Workflow is a significant value-add opportunity for implementing digital pathology in routine useExample options for utilizing this time:Increase volumes without additional staffIncrease utilization of patient historyIncrease rate of quality assurance reviewImprove recruiting and retentionImpact of secondary effects has opportunity to show significant additional opportunityReducing dependence on surrounding personnel drives efficiency across department
Scoped for analysis in before-and-after studyAdditional analysis of Slide Review efficiency opportunities is suggested from radiology“Time-motion analysis showed a reduction of 16.2% in the overall time required for soft-copy interpretation of CT compared with that of film.”Reiner BI, Siegel EL, Hooper FJ, et al. Radiologists’ Productivity in the Interpretation of CT Scans: A Comparison of PACS with Conventional Film. AJR 2001; 176; 861-864.Pathologist T&M Study Summary
Slide24Routine use of an all-digital workflow shows…Opportunity to increase available pathologist time from workflow savings Observed average 13.4% per pathologist in addition to savings from secondary effects, frozen sections, tumor boards, consults, slide reviewQuality, Profitability, LifestyleOpportunity to eliminate case assembly tasks in the lab Observed average 18.5% FTE per labOffset some of the additional time required for new Imaging tasks
Efficiency of pathology department has downstream effects Clinician Efficiency and Patient CarePatient satisfaction, timely treatment, reduced length of stayT&M Study Conclusions
Slide25curtis.stratman@omnyx.comContact