(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,
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.
But, from your vantage point, why should pathologists
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 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
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.
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,
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
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
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.
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
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
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
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,
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.
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,
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,
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
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,
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
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.
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,
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",
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.
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
a whole lot of educational offerings
beyond just the laboratory,
but in the broader medical practice as well.
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
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
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
is a great resource and it offers, I think,
over 20 different lectures or sort of
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.
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
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.
- 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
mcleducation@mayo.edu and reference this podcast.
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