Monaco Sara E, Koah Amber E, Xing Juan, Ahmed Ishtiaque, Cuda Jackie, Cunningham Jayna, Metahri Djamila, Progar Abbigal, Pantanowitz Liron
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Diagn Cytopathol. 2019 Mar;47(3):206-213. doi: 10.1002/dc.24077. Epub 2018 Dec 26.
There are limited publications that address technical and practical informatics considerations when implementing telecytology for rapid on-site evaluation (ROSE). Our aim was to share the experience of deploying telecytology for ROSE at our institution.
Key informatics issues relevant to adopting telecytology for ROSE at our institution were appraised including workflow, information technology (IT), validation, training, and quality assurance (QA).
A dynamic telemicroscopy solution was selected that required trained cytotechnologists to attend on-site procedures for ROSE. For validation 60 cases were reviewed using the first camera at each facility, but only 20 cases to validate subsequent cameras. A concordance rate of >90% between ROSE interpretation performed digitally to original interpretations was required for clinical validation. After reviewing 440 cases from two comparable time periods before and after implementation, employing telecytology was shown to decrease cytopathologists' work time per ROSE case from an average of 20.95 min per case to 2.91 min per case (86% time savings). The non-diagnostic rate for traditional ROSE was 7.7% compared with 4.1% after the implementation of telecytology, and the deferral rate went from 43.6% for traditional ROSE to 44.1% with telecytology. Traditional ROSE diagnoses correlated with final diagnoses in 91.8% cases, compared to 95.5% with telecytology.
Challenges when implementing telecytology for ROSE included technical issues, workflow concerns, and incorporating trainees into daily practice. The end result of our implementation was the adoption of an innovative way to deliver a ROSE service that maximised efficiency for cytopathologists without compromising diagnostic performance.
在实施远程细胞学进行快速现场评估（ROSE）时，涉及技术和实际信息学考量的出版物有限。我们的目的是分享在我们机构部署远程细胞学用于ROSE的经验。
评估了在我们机构采用远程细胞学进行ROSE时相关的关键信息学问题，包括工作流程、信息技术（IT）、验证、培训和质量保证（QA）。
选择了一种动态远程显微镜解决方案，该方案要求训练有素的细胞技术人员参与ROSE的现场操作。为进行验证，在每个设施使用第一台相机对60例病例进行了审查，但后续相机仅需验证20例病例。临床验证要求数字执行的ROSE解读与原始解读之间的一致性率>90%。在审查了实施前后两个可比时间段的440例病例后，结果显示采用远程细胞学可将细胞病理学家处理每例ROSE病例的工作时间从平均每例20.95分钟减少至2.91分钟（节省86%的时间）。传统ROSE的非诊断率为7.7%，而实施远程细胞学后为4.1%，延迟率从传统ROSE的43.6%升至远程细胞学的44.1%。传统ROSE诊断与最终诊断在91.8%的病例中相关，而远程细胞学为95.5%。
实施远程细胞学用于ROSE时面临的挑战包括技术问题、工作流程问题以及将实习生纳入日常实践。我们实施的最终结果是采用了一种创新方式来提供ROSE服务，在不影响诊断性能的情况下，最大限度地提高了细胞病理学家的效率。
