(electronic music) (electronic music) - This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, the Bow Tie Bandit of Blood, a transfusion medicine pathologist at Mayo Clinic. And today, we're rounding with Dr. Justin Juskewitch and Dr. Andrew Norgan, both assistant professors of laboratory medicine and pathology here at Mayo Clinic, to talk with us about informatics for the pathologist.
They're both leaders in this field, and I'm grateful for both of you guys joining us today. - [Justin] Good morning. - [Andrew] Thanks for having us. - [Host] All right, so let's kick off with kind of, - [Host] All right, so let's kick off with kind of, you know, I think as pathologists, maybe we're used to calling the help desk at our institutions or sometimes dealing with IT for support on our projects. or sometimes dealing with IT for support on our projects.
But, from your vantage point, why should pathologists care about informatics in 2022? care about informatics in 2022? - I think actually informatics has been in the core of pathology and lab medicine for a very, very long time. Our field was the first to spearhead the use of information systems to collect data and to help facilitate laboratory testing and to help facilitate laboratory testing and anatomic pathology consultations for decades now.
And we've been able to use that technology up to this point to really help optimize the care we bring to patients to really help optimize the care we bring to patients and the workflows within our lab. And so, informatics, really, in some respects in healthcare, got its start in the medical laboratory and has been able to empower us to be able to use that data, to use that information and the knowledge we glean from it to really transform clinical practice.
So, I would actually reframe the question slightly as to why should pathologists continue to care about informatics? Because we have been, in large part, thought leaders, especially during the early inception of this field. What do you think, Dr. Norgan?
- [Andrew] Yeah, I agree completely and I just extend on that, I think healthcare organizations have done a great job up to this point in sort of recording, cataloging, warehousing their information, and maybe we've been less successful at taking that information and creating value for the patient from that information and bring that back into the practice.
And if we look at every other industry, they're probably 10, maybe 20 years ahead of us in using information to do whatever it is they do better.
And so, I think as we look at informatics going forward now in time, and especially with artificial intelligence and machine learning coming to the fore, and with cloud technologies making it easier to bring information together, compute on that, find some value, and again bring that back into your practice, it's a great time for pathologists to be digging in and understanding well, how can I use this data and this information to improve whatever aspect of the practice I'm doing,
be that anatomic pathology, clinical pathology, or something related to either of those. - [Host] I really appreciate you guys putting me on the right track. We're really continuing our interests in informatics. We're really continuing our interests in informatics.
But you guys really are, you know, "informaticians", But you guys really are, you know, "informaticians", if that's the right word, but, and I love picking your brain, but, you know, not all of us can be information experts like you, not all of us can be information experts like you, although we certainly are using it in our practice. although we certainly are using it in our practice.
I was wondering if you could kind of share with our audience, what are some of the fundamentals that pathologists in practice, pathologists in training that pathologists in practice, pathologists in training should be aware of and might be thinking about? should be aware of and might be thinking about? - You know, fundamentally, I think it's critical for people to understand the systems that exist for managing and organizing the data.
And so, in a healthcare institution, at sort of a first approximation, that's the laboratory information system and the electronic health record. Those are the systems that are really going to allow communication of information to the clinicians.
And so understanding, how does information flow into these systems, how does information flow out of these systems, and again, at what point are there opportunities to do value-added work with this information to improve whatever it is we're doing as a pathologist, whether you're running a laboratory, or very much, you know, doing case-based anatomic pathology work, there are opportunities to use that data to do that work better with higher quality and to bring, again,
new technologies to the work that we're doing. So, fundamentally understanding, what are those data types, how do those systems talk to one another, how do those systems allow third party systems to interface with them and add value, be that again, middleware, or other kinds of things that we see deployed in our systems, I think that's a fundamental piece that people need to understand.
I think the other piece, and I'll let maybe Dr. Juskewitch talk about this a little bit more is understanding how to use that data to develop verifiable insights how to use that data to develop verifiable insights so, you know, when we look at publishing now, pretty much every paper has a statistical component to it. Every machine learning paper certainly has statistical aspects to it.
And as we're looking to bring those technologies into our practice and they become part of what it means to, quote unquote, "do medicine" or "do pathology", I think it's critical that we have enough understanding of those technologies' systems approaches, and fields that we're able to adequately judge, you know, what is good work, what is maybe not so good work, where are the flaws in the methodology of this study, and so on and so forth. - [Justin] Yeah, I completely agree.
So, what Dr. Norgan is talking about has been kind of the involvement of evidence-based medicine, I would say across most fields of medicine, if not all over, like, the past decade or so. if not all over, like, the past decade or so. The next level up is not just the application The next level up is not just the application of those, you know, those skills to now a new area of research, evaluating machine learning and artificial intelligence and stuff.
But I think the next level up that will be for pathologists and particularly pathology trainees coming in is going to be data literacy.
So, it's knowing how your data is captured, in what form it is captured, and then in what form it is captured, and then based off of those forms, how do you do, you know, based off of those forms, how do you do, you know, as you're taking data out of your LIS or hopefully in some sort of replicated source from that, how do you evaluate the data critically that you're getting out, find any errors or missing data elements, use the appropriate technique
or missing data elements, use the appropriate technique to fill those in and then be able to take that data to start generating insights. And it may be the most simple statistical comparison to begin with, and evolving that way upward towards machine learning.
But to be perfectly honest, for many of us operationally in the lab or in the anatomic pathology space, being able-just to be able to access our data, manipulate it, and present it in ways that can inform even operational things in real time in our labs, have been, and continue to be huge value-add gains have been, and continue to be huge value-add gains for the laboratory and our patients. - [Host] That's interesting.
As I hear you guys explaining these fundamentals, in my head, I'm really almost constructing a map of, like, you know, the system, you know, and the flows, you know, there's rivers or something flowing through there. But that's really an interesting way to really also highlight, you know, understanding the system that we work in and how it can affect change.
Is this kind of the same strategy you guys take when, I know you guys are teaching our Inner Pathology Residency program, teaching informatics, our Inner Pathology Residency program, teaching informatics, is this kind of the same approach you take there or is there a different approach and why might you go that way? - [Andrew] So, we sort of have two approaches that we've gone down. that we've gone down.
One is a didactic approach where we cover kind of a core curriculum that's been developed by CAP and by the Association for Pathology Informatics. It's known as the pathology informatics for residents, or pathology informatics essentials for residents. And that curriculum lays down really, again, kind of getting to your earlier question, the baseline level of knowledge that would be expected of a pathology resident in sort of the realm of informatics.
So everything that Justin and I have been talking about in terms of data literacy systems, how systems talk to one another, the standards that are used in the industry to facilitate that communication, et cetera, and so on. So we have a didactic curriculum built around that. And then we have a sort of application-based curriculum where we try to get people to actually dig in and work with the data and perform some of these functions.
Again, not to become computer programmers, per se, or anything else, but to have sort of that experiential learning of encountering data-based problems and then strategies for solving those problems in order to accomplish the kinds of tasks Justin was talking about earlier, be it an analytic task, or putting a system into place that's going to take data in and then put out some sort of altered data to facilitate a laboratory function, and so on.
We expect, you know, a pathologist or laboratorian, you'll be sort of in charge of making these things happen but you probably won't be doing all of them yourself. And so the facility we're hoping people walk away with is to know what's possible.
So what can be done, what are the likely issues that are going to be encountered in pursuing that, what are possible solutions to those issues so that they can guide their team in sort of figuring out the problem, solving the problem, and finally implementing that solution.
- [Justin] And circling back around, I think the sweet part or the sweet spot for pathologists is that we, as part of our training, and then part of our laboratory directorship roles, we have a whole lot of experience in the validation and evaluation of new laboratory tests or new offerings.
And these informatics tools, And these informatics tools, whether they're software applications or just simple data visualizations that help these workflows can be the same methodologies and the same way of talking and evaluating them really do run in, and evaluating them really do run in, are pretty much the same.
And so, as part of our training and our role already, we already have a leg up on being able to evaluate these and assess their impact, good or bad, on our workflows and our patient care. So, pathologists already have the mindset and the training to be able to begin to take these offerings and do the critical evaluation and being the leaders of those groups within their labs that Dr. Norgan talked about.
- And how do you guys recommend that pathologists - And how do you guys recommend that pathologists reach out to informatics experts for collaboration? Like you said, you know, having a general understanding and what's possible is healthy and important, but, you know, and what's possible is healthy and important, but, you know, how do we interact with the informatics group? - Like you would any other subspecialty expert you've got in your large laboratory.
I'm particularly partial to tea, so, a free tea for me will get you about 30 minutes of good conversation. Andy's laughing because for him, it's coffee. But to be honest, just like, I don't think there is any magic formula. It's a phone call, it's running into a colleague in the hallway, it's an email.
But coming to that conversation with a crystallized idea of what your need or your desired, you know, product of what your need or your desired, you know, product or functionality is, and some idea where that data resides is actually a really good starting place to start those conversations because then it makes it easier for individuals with an informatics background to start scoping in their head exactly how big of an ask it is and what sort of data infrastructure is already in place
on which that offering may be built. But, to be honest, for most of the time when I need some help from the informatics crew here at our own institution, it starts with a page, it starts with a phone call, it starts with an email, and usually an offer to buy them coffee. Right, Dr. Norgan? - Yeah, I completely agree. It's just like engaging any other expert that you would to help solve a clinical or procedural problem in your laboratory or again anatomic pathology area.
in your laboratory or again anatomic pathology area. I think, you know, breaking it out more generally, it's going to be very different depending on the kind of institution you're at, the size of that institution, and how developed that institution's current approach is towards information management and informatics.
But every institution's going to have a CMIO, many institutions will have an associate CMIO for laboratory medicine and pathology or someone, you know, over the lab's areas, and that's an individual you should be able to engage with and start to talk about the issues that you're facing in your laboratory, or in your practice, and how the systems that your institution might be able to address those.
Most departments at divisions will have that person or that group of people who are sort of the informatics folks. In DMLP, here, we have a vice chair of informatics who has kind of a scope over the LIS and the interchange between the LIS and the EHR who'd be, again, a wonderful person to address with those kinds of issues and questions. And then, new in our department, we actually have a division of computational pathology and AI.
So, a whole group of individuals now who are really dedicated to that and who would be resources at our institution that you could reach out to. And I think other institutions are doing similar things so, be it someone in your division department, or at the associate or actual CMIO level, or at the associate or actual CMIO level, there's someone at your institution who cares about data and using that data to solve clinical problems and you should be able to reach out to them.
- That's really helpful. I appreciate both your advices on this about, you know, having an idea of what your issue is and what you want, where some data is, and also how you might reach out to, and the acronym "CMIO", and the acronym "CMIO", is that Chief Medical Informatics Officer? - Chief Medical Information Officer I think is usually, and it's, you know, they sit next to that CIO who's more of a technical person or an IT person and often bring in that sort of medical aspect to them.
Frequently, the CMIO is going to be an informatics strained physician. - I see. So, I'm on team coffee, that's who I'm buying coffee for, it sounds like. (Host and Andrew laugh) So, we've been talking about a couple of different things. I was curious for those of us, like myself, who, you know, I remember doing my informatics rotation in my residency program, I think it was maybe 14 or 15 years ago. 14 or 15 years ago. I'm sure I'm quite outdated at this point in time.
I was curious, are there any informatics resources that you guys recommend that those of us could kind of brush up on our, you know, we've been talking about systems, you were using the acronym LIS for laboratory informatics systems, EHR for electronic health record, but then also, we've been talking about data literacy. Are there any, you know, resources you guys recommend?
- So if you had asked us, what, 10 to 15 years ago, the list would've been really, really short because informatics as a field has been, just like all of these new divisions are spinning out and now we have fellowships, and now this is a medical subspecialty. Those resources have been expanding more and more. So, on the pathology side, the American Society for Clinical Pathology has some online offerings and they also have some textbooks that they now offer for sale, either electronic or print.
So there are some resources there. The American Medical Informatics Association Association, AMIA also has been really busy spinning up AMIA also has been really busy spinning up a whole lot of educational offerings beyond just the laboratory, but in the broader medical practice as well. And then as Dr. Norgan mentioned, And then as Dr. Norgan mentioned, the Association for Pathology Informatics now has an annual conference, and part of that conference is a lot of workshops.
And then depending on how deep you want to go into the weeds as far as data science and how much do you want to actually start learning how to manipulate data on your own, a lot of the different programming languages and stuff now have conferences and workshops that they offer now have conferences and workshops that they offer and the online resources just for reading to be able to start learning how to do some of that data literacy and manipulating data and stuff and making visualizations
those offerings available online have exploded those offerings available online have exploded over the last decade or so, I would say. Dr. Norgan? - Yeah, agree completely with all of the suggestions.
I think if you want a sort of healthcare and pathology specific look at informatics, the University of Pathology Informatics by ASCP the University of Pathology Informatics by ASCP is a great resource and it offers, I think, over 20 different lectures or sort of over 20 different lectures or sort of blocks of curriculum that cover, really, blocks of curriculum that cover, really, a large spectrum of informatics. So you can pick and choose.
I think there is some cost associated with that, or at least it might be governed by your institution's subscription to ASCP resources. But there are certainly pieces in there that I think are valuable and would round out someone's informatics education. The online resources have exploded in the last probably 5 years, especially. in the last probably 5 years, especially. They're not always specific to pathology, but I think that's okay. A lot of the problems are really generalizable problems.
And so, for free, you can get an education in data science, data literacy in one of the popular open source programming languages Python or R. And you can do that all at your own pace online with no cost at all on any computer. So I would say it's incredibly accessible if you want to learn about some of these things.
If you want to go further and actually develop real expertise in one of these areas, maybe an area related, again, to your work, say you're in molecular pathology and you want to learn bioinformatics more deeply or your statistical background isn't what you wish it was and you want to beef up on that or you want to learn about AI and machine learning.
There are online sort of learning platforms that now have what I would argue, I mean the curriculum is coming from MIT and Harvard and Stanford, it's really, you're getting I think a top tier education and those would be platforms like edX or Coursera. There's often a free option associated if you don't need credit and don't need to sort of be able to take that and use it for something downstream.
You can subscribe to these courses and go through them at your own pace without cost, or I think there's a minimal cost associated with some of them. So, really great opportunities to go out So, really great opportunities to go out and get an education in an area of informatics that interests you and that is relevant to the kind of work that you do. - [Host] That's phenomenal. So we're going to, for our listeners, we're going to put a number of those recommendations in the show notes.
And we've been routing with Dr. Juskewitch and Dr. Norgan. Thank you both for taking the time to talk with our listeners today and help us to continue our interests in informatics. and help us to continue our interests in informatics. - Pleasure. - [Andrew] Thanks very much. - [Host] So to all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions by email. Please direct any suggestions to [email protected] and reference this podcast.
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