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This article presents a case study in designing, developing, and implementing a web-enabled reporting application for the anatomical pathology (histopathology) department of a tertiary care teaching hospital in India. The article describes workflows, requirements assessment, and implementation methods that the investigators adopted for deploying the solution. The primary focus of the study was to demonstrate the requirements assessment performed, the strategies adopted, and the challenges encountered during the development and implementation. The study demonstrates a successful deployment as well as successful adoption of healthcare information technology by the end users. Factors that played a crucial role in adoption included the combination of people, processes, and technology. The lessons learned from this study would help application developers design efficient systems that suit the requirements of the end users while keeping in mind the ever-changing need for workflows and scalability in a developing country.

Pathological and cytological reports are unique, because the results are not numerical, and they may become the final diagnosis, having a direct bearing on further therapeutic decisions. Recently, the numbers of medical incidents/accidents, in which pathology technologists and/or pathologists have been involved, have been increasing. It is of concern that a lack of proper procedures in pathology practice may give rise to serious accidents affecting patients\' lives. For accurate pathology diagnoses, highly skilled pathological technicians and well-knowledgeable pathologists are necessary but, in addition, precise quality assurance is essential. Efforts to prevent pre analytical errors are presented and discussed.

BACKGROUND: The workload of histopathologists is traditionally assessed by the total number of specimens handled annually (TSA). Development in medical science has resulted in an increased demand by clinicians for more information in histopathology reports. Inclusion of this information requires more work. Annual information output (AIO) is the total number of specimens handled annually multiplied by the average number of items of information per histopathology report (AIR). An item of information is any pathological feature of prognostic or therapeutic relevance.
OBJECTIVE: This study aims to determine whether there has been an increase in annual information output (AIO) during a 17-year period.
METHODS: This is a retrospective study in a University Department of Pathology. 200 histopathology reports per year at 4 yearly intervals from 1982 to 1998 were examined. TSA, AIR and AIO were calculated.
RESULTS: TSA increased from 2912 in 1982 to 3919 in 1998 (34.6% increase). AIR increased from 1.11 to 3.12 (181.1% increase). AIO increased from 3232.3 to 12227.3 (278.3% increase).
CONCLUSIONS: The increase in AIO was greater than the increase in TSA. Thus the use of TSA alone will not reflect the increase in workload accurately. We recommend the use of AIO rather than TSA to quantify workload and staffing requirements of histopathologists.

This guideline reviews the introduction and development of business planning in the National Health Service. A guideline for writing a business case for service development that would form part of a pathology business plan has been developed. This guideline outlines six steps that are required in the preparation of a business case. The format of the guideline has been developed largely from other national guidelines that have been published for the development of capital projects. In view of the publication of these guidelines, the scope of this guideline excludes business cases for information, management, and technology projects and large capital projects.

OBJECTIVE: To analyze the influence of prelaboratory and intralaboratory factors on the turnaround time of the reports in order to develop a reference database for continuous quality improvement, a retrospective study of the timeliness was reported.
METHODS: Using cluster sampling of a total of 5,979 pathology reports selected by sampling a single month\'s reports from each quarter of the year 2000, of which there were 5,250 cases from routine biopsy and 729 cases from operative specimen. The timeliness and the factors that influence the turnaround time of the two types of surgical pathology reports were analyzed.
RESULTS: 4,872 pathology reports of 5,250 routine biopsy cases were completed in 3 working days, and 613 of 729 cases of the operative specimens were completed in 4 working days. The percentage was 92.8% and 84.1% respectively. Factors that significantly contributed to the increase in turnover time of biopsy reports included request of immunohistochemical staining, delayed arrival of the operative specimen at the laboratory after frozen section, additional recutting, intradepartment consultation and decalcification etc. As for the operative cases, several factors were associated with delayed report: second day arrival of the operative specimen at the laboratory after frozen section, lack of the adequate clinical history, request for immunohistochemical staining etc.
CONCLUSIONS: The majority of surgical pathology reports in the department can be completed timely and the timeliness meets the general standard. Only about 10 percent of the reports were delayed because of some prelaboratory and intralaboratory factors, for which there were 33.5% and 66.5% respectively for routine biopsy, and 50.9% and 49.1% respectively for operative specimen.

The surgical report is an important means of documenting normal and abnormal findings, and for distilling such information into a meaningful clinico-pathologic correlation. An audit of the quality of placental reports from four laboratories was performed using an arbitrary numerical scoring scheme that examined the gross, histologic, and commentary components of each report. The mean scores from the four laboratories were not statistically different from each other. Three (2%) and 48 (33%) of the 147 singleton placentas scored less than 50 and 75%, respectively, on this scoring scheme. None and 14 (41%) of the placentas from 34 multiple pregnancies scored less than 50 and 75%, respectively. Different aspects of the gross and histologic examination were reported variably by the laboratories. Commentaries on gross or histologic abnormalities, and in relation to clinical indications, were inconsistently reported. The standards of placental surgical reporting can be improved. The use of templates and checklists for reporting of placentas may be considered.

The information contained in pathology reports of radical prostatectomy specimens is critically important to treating physicians for the selection of adjuvant therapy, the evaluation of therapy, estimating prognosis, and analyzing outcomes. This information is also important to patients and their families. The first phase of this study consisted of a retrospective chart review of 554 cases of radical prostatectomy (ICD-9-CM procedure code of 60.5) in New York State for the second six-month period of 1996. This review focused on ten elements (quality indicators): submission of a frozen section, location of the adenocarcinoma, proportion of specimen involved by adenocarcinoma, perineural involvement, vascular involvement, seminal vesicle status, periprostate fat status, number of nodes submitted, status of nodes, and PIN (prostate intra-epithelial neoplasia). The second phase of this project consisted of an educational feedback program involving the directors of pathology laboratories in all hospitals in New York State. A post-intervention review of the medical charts of all male Medicare patients discharged from New York State acute care hospitals with the ICD-9-CM procedure code of 60.5 (radical prostatectomy) was conducted for the six-month period February 1 through July 31, 1999. A total of 304 charts were reviewed. Performance on the ten indicators in the first phase of the study varied from 14.8% (periprostate fat status) to 85.9% (seminal vesicle involvement). Performance for all hospitals was 50% for four quality indicators and less than 70% for seven. Post-intervention improvements in performance occurred with nine of the ten quality indicators. These improvements ranged from 1.4% (status of lymph nodes submitted) to 23.9% (proportion of specimen involved by adenocarcinoma). The results of this study demonstrate that the issues identified in the baseline with radical prostatectomy pathology reports were amenable to a cooperative educational intervention.

This paper examines the progressive exertion of external managerial control over New Zealand pathologists as the country\'s New Public Management health reforms were implemented during the 1990s. Perspectives on professionalism, and its role in the effective use of resources, are discussed as part of the examination of this shift in decision-making power from pathologists to external management. Our analysis, based on a range of archived and interview data collected over the period 1997-2000, suggests that publicly unacceptable compromises in pathology service quality were risked by the pursuit of tight bureaucratic and free market controls over pathology practice. The paper concludes with suggestions for a health professional control model facilitative of maximal health gain.

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