College of American Pathologists
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  AP systems’ 3 most important features, ROI,
  and more





cap today



March 2007
Feature Story

CAP TODAY asked anatomic pathology systems vendors to share their thoughts about features that are the foundation of a comprehensive AP system, assessing return on investment for such systems, and the value of voice-recognition technology. Here’s what they had to say.

CAP TODAY: What are the three most important features of any comprehensive anatomic pathology system?

Gene Calvano, president, Small Business Computers of New England, Manchester, NH: The most important features of an AP system are:

  • Data entry and reporting. One goal of a laboratory is to efficiently produce an accurate, quality assured diagnostic report. An information system must be easy to use, flexible, and customized to allow an efficient flow of information. Each lab is unique—varying in size, specialty, and other features. The system must provide an optimal fit for entering data; eliminating errors; and retrieving information from login to report distribution, statistical reporting, and quality control.
  • The ease, response time, and cost of modifications. A system may appear complete when it is installed, but change will be required. Change results from new regulations, modified information flow, new tests or interfaces, management reports, client service requests, and more. The system must be conducive to change and the vendor responsive and willing to provide modifications at a reasonable price.
  • Interfaces. A system needs to be able to add multiple interfaces, such as billing and report-delivery interfaces, easily and cost effectively to maximize the level of service a lab provides its clients.

George Rugg, vice president and general manager, Laboratory Systems, Impac Medical Systems, Mountain View, Calif.: It usually takes multiple features to perform a function thoroughly on an AP system. The most important functions performed by an AP system are:

  • Workflow management. It is essential in anatomic pathology to be able to manage various complex processes. Workflow tools provide consistency, efficiency, and a means to measure and improve operations.
  • Code capture. Labs are required to be diligent about coding for reimbursement. An AP system must provide the tools for optimal code capture and be able to deal with the complexities of code modifiers.
  • Regulatory compliance. An AP system must provide documentation; operational controls, such as log files and user security; and standards compliance. The AP system should smooth the path to regulatory compliance.

Wally Soufi, chairman and CEO, Novovision, Princeton, NJ: The three most important features of an AP system are:

  • Interfaces with other systems. AP systems must work with electronic medical record systems; practice management, state, hospital, and lab information systems; and Web portals.
  • Flexible reporting formats and delivery methods. AP systems must generate unique reports based on specialty or a customer’s desired reporting format. They should be able to deliver these reports via paper and paperless methods, such as fax, voice, file transfer, and direct to EMR.
  • Ability to adapt and expand as lab regulations change and the menu of tests expands.

John Detwiler, president, PathLogix Corp., La Jolla, Calif.: A comprehensive anatomic pathology system has hundreds of features, but ease-of-use is most important. Most features should be so intuitive that special training is not required to use them.

The automation of customer service is another important feature. Inadequate automation of customer service is the most common deficiency of anatomic pathology systems.

Also of importance is a state-of-the-art, user-friendly Internet customer interface with on-line requisition entry and on-line reports.

CAP TODAY: How can you determine the return on investment from implementing an anatomic pathology system?

John Detwiler (PathLogix Corp.): The only way to reliably determine your future return on investment is to have the vendor install the system that you are considering on your server in your laboratory so that your pathologists and other staff can use and test it for about a month. The vendor will also need to train your staff on the system.

If you skip testing and make a buying decision based on presentations and demonstrations, you will not know enough about potential problems, inadequacies, staff acceptance, and other factors. Selecting an anatomic pathology system is risky. However, a one-month test can greatly reduce that risk and will enable you to estimate the time that will be saved.

Gene Calvano (Small Business Computers of New England): ROI for AP systems suited to small to medium-sized labs (fewer than 30,000 surgicals and fewer than 50,000 Paps annually) should not be measured in classical terms because the cost is most likely less than one full time-equivalent employee. Furthermore, a financial ROI is irrelevant because you simply need an AP system to run a lab. Just make sure you don’t pay big bucks—that is, more than $25,000—for the software.

A better ROI metric could be based on a subjective percentage fit. Evaluate your fit by considering such elements as turnaround time, quality assurance, client service, efficient information flow, report distribution, personnel costs, and productivity. Is the system providing an optimal fit in these areas, or would they benefit from change? In other words, is your AP system a 75 percent fit or 100 percent fit with the way you want to run your lab? The laboratory and the vendor should work together to maximize fit.

Wally Soufi (Novovision): ROI can be measured in a variety of ways depending on each lab’s situation. Some labs use a reduction in turnaround time or reduction in administrative time as measures, while others measure ROI by looking at customer retention, increase in case volume because of new capabilities in the AP system, or increase in client satisfaction.

George Rugg (Impac Medical Systems): Return on investment generally results from increasing revenue, improving productivity, or reducing expenses. Revenue increases often result from more accurate ordering and coding and the electronic transfer of data and charge capture. An efficient AP system increases a lab’s productivity, which permits case volume to grow without adding staff. Expense savings result from overtime reductions and electronic report processing.

CAP TODAY: How widely used are the voice-recognition features in anatomic pathology systems?

George Rugg (Impac Medical Systems): Voice-recognition features for anatomic pathology have not achieved the same level of success as in radiology. However, improvements in speech-recognition technology and the escalating cost of transcription services may lead to wider acceptance. On the other hand, a greater number of sections of the pathology report are generated from captured discrete data elements input into the system from pick lists. And voice recognition is not usually the preferred method for capturing discrete data.

How we use voice as a tool may change in the future. Voice may be used to:

  • supplement other input methods, such as pull-down lists, radio buttons, or check boxes, when interacting with the pathology system, not just to capture free text.
  • capture discrete data. Voice will need to be intelligently integrated with the application to make selections on the computer screen and to navigate through the application.

Gene Calvano (Small Business Computers of New England): One percent of our customer base (predominantly independent labs) uses voice recognition, about the same percentage as five years ago. The technology is getting better, but a majority of lab users are simply not ready to make it prime time. Other alternatives are seen as easier to use, more efficient, and a better fit. They range from the efficient use of macros/templates to outsourced transcription services.

Voice recognition needs 100 percent of a lab’s users to buy into it. It would not be efficient to have one pathologist use it and two others not use it. The best approach may be to introduce voice technology with a single lab function, such as for entering gross descriptions.

John Detwiler (PathLogix Corp.): Due primarily to the speed and convenience of customized glossaries, voice recognition is not widely used. I recommend using voice recognition in the histology department and customized glossaries for diagnoses.

The rapid increase in computer speeds is increasing the capabilities and reliability of voice recognition. The best voice-recognition systems are made by companies that specialize in such technology, so it is important that you choose an anatomic pathology system that is compatible with those major voice-recognition systems. Your anatomic pathology system should allow you to use voice recognition for all text input if you so choose.

Wally Soufi (Novovision): Many labs have found voice-recognition software for anatomic pathology to be a test of patience and of limited use when dealing with complicated cases. Built-in digital dictation systems (to record and dictate later), abbreviations, and stored descriptions are a more efficient and predictable substitute to voice recognition.


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