PRACTICAL PATHOLOGY INFORMATICS PRACTICAL PATHOLOGY INFORMATICS Demystifying informatics for the practicing anatomic pathologist John H. Sinard, MD, PhD Director, Pathology Informatics Program Department of Pathology Yale University School of Medicine New Haven, CT Springer John H. Sinard, MD, PhD Director, Pathology Informatics Program Department of Pathology Yale University School of Medicine New Haven, CT USA Library of Congress Cataloging-in-Publication Data Sinard, John H. Practical pathology informatics : demystifying informatics for the practicing anatomic pathologist / John H. Sinard. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-387-28057-8 (alk. paper) ISBN-10: 0-387-28057-X (alk. paper) 1. Pathology. 2. Medical informatics. 3. Anatomy, Pathological. I. Title. [DNLM: 1. Medical Informatics—methods. 2. Pathology—methods. QZ 26.5 S615p 2005] RB25.S52 2005 65.5’04261—dc22 2005050011 ISBN -10 0-387-28057-X e-ISBN 0-387-28058-8 ISBN -13 978-0-387-28057-8 e-ISBN 978-0-387-28058-5 Printed on acid-free paper. © 2006 Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed in the United States of America. 9 8 7 6 5 4 3 2 1 SPIN 11013969 springeronline.com This book is dedicated to my nieces and nephews: Thomas, Rebecca, Claire, and Andrew Contributing Author (Chapter 11): Michael Krauthammer, MD, PhD Department of Pathology Yale University School of Medicine New Haven, CT Preface Almost all areas of intellectual pursuit in which there is an element of subjectivity share an interesting internal paradox. At first exposure, the field is a complete mystery. Then, as one acquires some of the domain knowledge and learns about the rules, the field starts to make sense, and before long may even seem trivial. However, as one delves deeper and acquires experience, complexities and subtleties begin to re-emerge, as well as realization of the validity of some of the exceptions to the rules, and the field is suddenly less obvious and clear than it was before. This is the value of experience; this is where true insight starts to emerge. Informatics shares this internal paradox. When I peruse the books available on informatics, it is this insight which I am seeking. The details of the data I can look up on the internet, but the insight is harder to find, and only comes from having developed and implemented (or at least tried to implement) various solutions. It would be absurd to suggest that any one solution, no matter how successful in a particular environment, will work well in every other environment, and I personally question the insight of any author who claims that a particular solution to an information management problem is the one right solution. Of course, insight can only be presented in the context of information. This book is a mixture of information, interpretation, perspective, and, I would like to think, a little insight. When I lecture or give a conference to pathology residents about gross, autopsy, or ophthalmic pathology, I have a pretty good idea going in what level of knowledge I can expect from my audience, from the first year residents up through the fellows. Lecturing on informatics topics, however, is more difficult, not because the material is any more esoteric, but rather because the range of knowledge of my audience can be enormous: some have already designed and deployed complete computer-based solutions to some problem, while others still approach the keyboard and mouse with some degree of apprehension. The target audience for this book is equally broad. Designed around the curriculum I developed for teaching informatics Practical Patholo^ Informatics to pathology residents, the goal of this book is to introduce and demystify a variety of topics in the broad discipline of pathology informatics. In no way have I attempted to cover the entire scope of this discipline, but rather have focused on issues of particular relevance to the practicing anatomic pathologist. It is not my intention to turn anyone into an informatician (?informaticist?). Rather, I hope to provide the reader with enough information about the pros and cons of various elements of the field, and to share some insight into their complexity, so that the reader will be able to evaluate the topic in an educated fashion. It is up to the reader to weigh the competing factors presented and then, tempered with an understanding of their own unique environment, to make an individualized assessment as to the best approach from the perspective of their needs. Toward that end, what follows are multiple relatively short chapters, each introducing and discussing some aspect of pathology informatics. The scope, in my opinion, represents the fund of knowledge with which a typical practicing pathologist should be familiar. In fact, the early chapters contain basic information about computers and databases which is applicable to any discipline, with the later chapters containing more anatomic pathology specific topics. The scope of this text would also be an appropriate core for residency training in pathology informatics. In an attempt to appeal to a broader audience, I have included both basic as well as some less basic information. Since I have always felt that it is better to understand something than to simply memorize it, the detail provided is sufficient for the reader to obtain an understanding of the topic being presented. I have also included, where appropriate, my views of the pros and cons behind the more controversial aspects of each topic. For the most part, I present information and analysis (although I must confess that the first and last chapters are really more like editorials). The chapters can be read in any order. Each chapter is divided into several short sections. If at any point a section drifts into the "too obscure", simply go on to the next section. Throughout the discussions, I will not recommend specific vendors or products, but rather focus on general principles and processes which will remain applicable as the vendors and products come and go. If each reader takes away at least a different perspective on the breath of pathology informatics, its role as a tool in the daily practice of pathology, and an appreciation for how informatics will be key in shaping the way we practice medicine in the future, I will consider my efforts in writing this book worth while. Acknowledgments First, I would like to thank my informal consultants, the members of the operational informatics unit of Yale Pathology, for helping to create an environment which allowed me to pursue my interests in this area, as well as for working hard enough to give me the time to write this book. These include Agatha Daley, Peter Gershkovich, Katie Henderson, Janos Lobb, Brian Paquin, Sophia Gyory, Emma Walz-Vaitkus, and Mark Mattie. Secondly, 1 want to thank the residents of the Anatomic Pathology Residency Training Program at Yale-New Haven Hospital for giving me a forum to "try out" some of my material, and for consistently reminding me of the importance of informatics training for our future pathologists. In particular, thanks to Yuri Fedoriw, my first "informatics rotation" resident, for input and suggestions which helped me get through some of the more difficult parts of this book. Similarly, thanks to Wally Henricks for helpful comments on a portion of this book, and Jon Morrow for many discussions on the future of pathology informatics. Finally, I want to thank the anonymous person who, on their evaluation of the first presentation of my informatics short course at the United States and Canadian Academy of Pathology annual meeting, wrote simply "when are you going to write your book?" Copyrights and Trademarks This book contains some specific examples, and as such must refer to products either copyrighted or trademarked (registered or otherwise) by various manufacturers. Reference to these products is for educational purposes only, and is in no way intended to represent advertisement, endorsement, or any claim of intellectual property on my part. The owners of these trademarks are acknowledged here rather than throughout the text. Adobe Systems, Inc.: Postscript, Acrobat, PDF, TIFF, Photoshop American Medical Association: CPT Apache Software Foundation, Inc.: Apache Apple Computer, Inc.: Apple, Macintosh, Mac, OS 9, OS X, PICT, FireWire, TrueType, Safari, Keynote Bluetooth SIG, Inc: Bluetooth, Bluetooth logo Centronics Data Computer Corporation: Centronics College of American Pathologists: SNOMED, SNOMED II, SNOMED III, SNOMED RT, SNOMED CT, Checklists CompuServe, Inc.: GIF dBase, Inc.: dBase Dell Computer Corporation: Dell Eastman Kodak Company: PhotoCD Health Level Seven, Inc.: HL7 Hewlett-Packard, Inc: HP, DEC, Compaq Intel, Inc.: Intel, Pentium, Celeron International Business Machines, Inc.: IBM, DB2, PowerPC, G5, VGA Iomega, Inc.: Zip Stephen King and Doubleday, Inc.: Jack Torrance, Overlook Hotel Lemke Software GmbH: GraphlcConverter Microsoft Corporation: Microsoft, Windows, NT, Windows XP, Windows 2000, Windows 98, PowerPoint, Word, MS-DOS, Visual Basic, SQL Server, Outlook, Internet Explorer, Active Server Pages, ODBC Motorola, Inc.: Motorola Mozilla Foundation: Firefox MySQL AB: mySQL National Library of Medicine: UMLS, PubMed, MEDLINE