Search

Aim The Hema-Quebec HLA laboratory and stem cell donor registry performs HLA typing and donor search for more than 250 patients per year. We also do HLA typing for our cord blood registry (2000/year) and our stem cell donor registry (2000/year). Before February 2012, all the results from these activities and the follow up were done by paper work without informatics system support, thus increasing the risks for file loss and errors. In 2011, decision was taken to introduce a laboratory informatics system (LIS) to improve security and efficiency of the HLA laboratory and the cord blood and donor registries. Methods A French company, Inlog, was chosen to develop informatics modules which suit our needs. Three modules were developed: EdgeLab for the patient, donor, and cord blood unit HLA files; EdgeCell for the patient and donor files, the search activities, the data bank for donors, and the data bank and processing file for cord blood units; and EdgeLink to get these two first modules connected together and allow the transfer of information and results. The laboratory instruments have been interfaced and the majority of the laboratory forms have been integrated to reduce transcription. Results The EdgeLab module was implemented at the end of February 2012, following the EdgeCell module. The adaptation period for the staff extended through June 2012 where modifications to the system were needed. After this point, we could observe a clear decrease in unnecessary analysis repeats, non-conformance reports, paper work, and most of all in our turnaround time. Our delays for urgent typing could be reduced to almost half the time. A reorganization of the workflow was possible and allows us to increase our volume of HLA typing by more than 40%. Conclusions The benefit of a LIS implementation is obvious. Better control and turnaround time is achieved while the capacity of the HLA lab is increased.

Sir, Pathology informatics is now recognized as an important component of pathology training.[1,2] Learning objectives and rotations in informatics have been established in an effort to train pathology residents.[3,4] Educated residents and formally trained informatics fellows play an important role in the future of this specialty. However, the success of pathology informatics also relies on the competencies of their allies (pathology assistants, cytotechnologists, medical technologists) in informatics. While the American Society of Clinical Pathologists (ASCP) offers some informatics training to medical technologists through its “Qualification in Laboratory Informatics” program, unfortunately insufficient attention has been dedicated toward training the various technologists in the field of pathology. The Anisa I. Kanbour School of Cytotechnology at the University of Pittsburgh Medical Center (UPMC) recently updated their curriculum to include a course in informatics for its cytotechnology students. The hospital-based, 12-month program for postbaccalaureate biology graduates has traditionally been based mainly on training in morphology and limited to ancillary studies. However, in order to keep abreast with changes in the practice of cytopathology (e.g., molecular pathology and informatics),[5,6] modifications of the curriculum were deemed necessary to reflect current practices. In addition to keeping pace with evolving technologies in the field, impetus for this change in cytotechnology student training was partially market driven. Demands for new graduates who have a more diverse technical background than just morphologic skills are more desirable first-hires. In response to changing skill requirements, the American Society of Cytopathology (ASC) published a white paper in 2010 regarding the future needs of the profession.[7] The ASC commissioned the Forbes group whose findings outlined forces that might lead to the emergence of new professions or roles in cytology. The group emphasized the need to create new skills and expanding traditional roles merging morphologic skills with new technologies for the profession's survival. Professional predictions of traditional microscopy obsolescence, new guidelines calling for less frequent Pap testing, and the digitization of proficiency testing[8] necessitated course modernization. As a result, eight cytotechnology students were exposed to pathology informatics practices and technologies in the form of an interactive 2-day course. To the best of our knowledge, the school of cytotechnology at UPMC is currently the first of 31 accredited programs in the USA to offer a structured, formal informatics course. The course was provided by the collaborative effort between the school of cytotechnology and informatics division in the department of pathology. The goals of this course were to introduce the students to the fundamentals of pathology informatics (e.g., terminology, basic computing, coding, data management, etc.), explain and demonstrate to them various information technologies (e.g., laboratory information systems, digital imaging, telecytology, etc.), and offer them “hands-on” experiences (e.g., scanning glass slides to create whole slide images, perform internet literature searches). Students were required to construct a presentation of an interesting case in which they inserted both static and virtual images into the final report. The course was well received by the students who completed a questionnaire about it. The course evaluations indicated the participants’ overall satisfaction, with only slight reservation concerning the impact informatics will play in their future practices. Following the course, students were more comfortable with digital imaging, and even able to access the institution's digital slide teaching sets in preparation for their final examinations [Figure 1]. While informatics training may be considered important by many technologist training programs, inadequate resources and lack of formal, structured programs may limit training. Therefore, we recommend that programs begin to partner with pathology departments who have informatics resources to leverage their faculty and equipment such as whole slide scanners. In the near future we can anticipate that well-trained cytotechnologists will begin to fill a niche for informatics within pathology departments. Figure 1 Example of a digital slide teaching set for cytotechnology students

Genetic medicine is poised to revolutionise healthcare. No medical specialty field will be more transformed by the use of genetic technology and genetic knowledge than pathology and laboratory medicine. To help pathologists and laboratory professionals understand the strategic implications of these developments, this presentation will provide an overview of how health system dynamics, financial considerations, and advances in genetic technology will drive forward the clinical acceptance and use of molecular technologies in pathology testing services. Themes to be discussed include how new genetic technologies will be incorporated into diagnostic testing services, market adoption paths for personalised medicine and companion diagnostics, and the role of laboratory informatics in linking laboratories with referring clinicians. Opportunities for pathology to participate as a collaborative diagnostic service will be identified. Pathologists will gain a strategic understanding of the major trends in healthcare and how these trends will support advancements in molecular diagnostics. Information and concepts presented will complement the presentations which follow during this session.

The mouse N-ethyl-N-nitrosourea (ENU) mutagenesis program at the Genomics Institute of the Novartis Research Foundation (GNF) uses MouseTRACS to analyze phenotype screens and manage animal husbandry. MouseTRACS is a Web-based laboratory informatics system that electronically records and organizes mouse colony operations, prints cage cards, tracks inventory, manages requests, and reports Institutional Animal Care and Use Committee (IACUC) protocol usage. For efficient phenotype screening, MouseTRACS identifies mutants, visualizes data, and maps mutations. It displays and integrates phenotype and genotype data using likelihood odds ratio (LOD) plots of genetic linkage between genotype and phenotype. More detailed mapping intervals show individual single nucleotide polymorphism (SNP) markers in the context of phenotype. In addition, dynamically generated pedigree diagrams and inventory reports linked to screening results summarize the inheritance pattern and the degree of penetrance. MouseTRACS displays screening data in tables and uses standard charts such as box plots, histograms, scatter plots, and customized charts looking at clustered mice or cross pedigree comparisons. In summary, MouseTRACS enables the efficient screening, analysis, and management of thousands of animals to find mutant mice and identify novel gene functions. MouseTRACS is available under an open source license at http://www.mousetracs.sourceforge.net. Electronic Supplementary Material Electronic Supplementary material is available for this article at http://dx.doi.org/10.1007/s00335-005-1145-1 and accessible for authorised users.