The surgical pathologist in a client/server computer network: work support, quality assurance, and the graphical user interface.

Cympathy is a relational client/server database application designed to integrate the departmental work flow in anatomic pathology, segment information appropriately, and allow flexible interaction with standalone microcomputer programs. The database resides in a minicomputer server connected to 40 client microcomputers. Patient histories on consultation requests are scanned and maintained as bitmapped files; all information is stored on fixed disks. Client microcomputers use a graphical interface to update a patient-related status bar and retrieve any of the nearly 40 data entry tables for accessioning, ordering special stains and studies, block and slide production, reports, gross and microscopic findings, evaluation of analyses, Systematized Nomenclature in Medicine (SNOMED) coding, conference scheduling, logging of borrowed materials, queries, and specialized functions such as electron microscopy, including indexes for blocks, grids, and photonegatives. The application radically reduces the need for administrative personnel. Cympathy allows major refinements in the method of composing, distributing, and storing report information. Quality assurance protocols can be expanded to relate the frequency and quantification of microscopic findings retrieved in a structured query to the individual pathologist for a given type of specimen and diagnosis. Such queries can extend output to include the number of blocks and slides and all analyses, services, and procedures applied to each case. Debiting is automated through a flexible dependence on SNOMED codes, analyses, and number of slides generated. Any number of structured queries can be written and saved within Cympathy, addressed directly to the database server, or composed in microcomputer programs linked to the database by open database connectivity drivers. Within Cympathy, query results are output in a fixed table format, which can be expanded to include, for example, tabulations of gross and microscopic findings and analysis results. The application offers the opportunity for research and quality assurance in anatomic pathology without the need for hard copy output.