Informatics Training in Pathology Residency Programs: Proposed Learning Objectives and Skill Sets for the New Millennium

The core mission of the medical specialty of pathology is to provide information necessary for clinical decision making. This information is the ultimate product of clinical and anatomic pathology laboratories, and it is typically delivered to clinicians through electronic information systems. The optimal management of this information and these information systems is crucial to the success of pathologists and the laboratories that they direct. Effective information management is also crucial for success in current practice growth opportunities such as integration of pathology services across multiple facilities and development of outreach testing programs. The management of information and information systems plays a key role in important collaborative opportunities, such as outcomes research and clinical practice guideline development, as well as future growth opportunities and emerging technologies, such as digital image capture and management, telepathology consultation, and high-throughput genomics and proteomics analysis systems.

The movement from paper-based to electronic access of the scientific literature has fundamentally changed the manner and speed of communication of current medical knowledge. The availability of vendor and other technical information via the Internet provides additional resources that allow large amounts of data to be assembled rapidly to support decision making. Thus, the ability to search, retrieve, and evaluate the electronic literature is essential in optimally addressing clinical consultations and laboratory management questions. The increasing availability of training and continuing medical education opportunities in electronic form indicates that familiarity with these technologies will be important in maintaining up-to-date clinical and laboratory skills. These facts imply that to be successful in the health care environment of today and tomorrow, to make the most appropriate decisions for their laboratories, and to advance pathology as a professional specialty, all pathologists should possess a basic knowledge of informatics as well as proficiency in the use of key information technology tools.

Informatics in pathology differs from informatics in most other medical specialties because, by definition, it extends beyond the personal use of informatics tools in clinical practice to include the management of information and information technology tools that will be used by others both within and outside the field of pathology.1–7 Thus, pathology informatics training should include an introduction to pathology information systems and the larger enterprise information system environments in which pathology systems operate, in addition to training in tools supporting personal clinical practice. Available data suggest that pathology residents, including those with significant skills in desktop computing, do not have a good understanding of enterprise computing environments or pathology information systems.8 Although pathology residency training programs commonly offer some form of informatics training, often as practical experience combined with other rotations, this training is not based on a standard curriculum with a generally accepted set of knowledge and skills objectives. Thus, existing training programs do not clearly provide competency in all areas that are unique to pathology informatics and necessary in pathology practice.9–11 

We present a proposal that defines a standard and specific set of learning objectives and proficiencies for resident training in fundamental pathology informatics. The objectives and skill sets encompassed by this proposal were developed by the Training and Education Committee of the Association for Pathology Informatics,1 and they include input from several academic residency programs with well-established pathology informatics training components.

As in other pathology subspecialty areas, training in pathology informatics can be thought of as a continuum that ranges from training necessary to secure baseline knowledge and proficiency, to more advanced training for those with a particular interest in the field, and finally, to fellowship training or advanced degrees in pursuit of a career in this subspecialty (Figure). The focus of this proposal is core informatics training appropriate for all anatomic pathology and clinical pathology residents. Thus, our knowledge and proficiency objectives are not intended to define the field of pathology informatics or to provide a framework for advanced or fellowship training.

The overall goals of this proposal are to achieve the following:

• Define a core set of learning objectives in pathology informatics necessary for residents to succeed as information managers.

• Create a framework for integrating informatics into pathology resident education in anatomic and clinical pathology.

• Provide a level of proficiency with computers and information technologies that will enable the use of these tools as integral components of pathology training, practice, and research.

• Equip residents with information and experience that will help them make optimal decisions regarding information management processes and systems in the laboratories in which they practice.

• Provide a knowledge foundation for lifelong learning in the area of pathology informatics.

• Outline a basis for the formal assessment and evaluation of trainees' competency in pathology informatics.

The primary components of our proposal encompass learning objectives and recommended skill sets. Although some guidelines for informatics training have been outlined earlier,12–16 this proposal includes a comprehensive and detailed set of knowledge applications and proficiencies appropriate for guiding the design of a basic curriculum.

Our proposal builds on and extends prior recommendations while defining the training goals as precisely as possible. The learning objectives include those related both to general computing and to pathology informatics specifically. Proficiency expectations include the ability to use software that facilitates and adds value to the work of pathologists, such as the use of the laboratory information system (LIS), productivity software, and analysis tools. Other topics covered in this proposal include guidelines for the assessment and evaluation of residents' informatics competency, suggestions regarding curriculum structure and implementation, and recommendations regarding computing infrastructure for residents.

The specific informatics learning objectives are presented in Appendix 1. They include terminology, concepts, and examples of knowledge applications. Primary topic areas are general computing fundamentals, LISs, enterprise computing topics, regulatory issues, data analysis, security/privacy/confidentiality, digital imaging, emerging technologies, and pathology informatics resources. Proficiency objectives for software use are presented in Appendix 2. Software types include LISs (anatomic pathology and clinical pathology), desktop operating systems, word processing, spreadsheets, presentation graphics, electronic mail, Web browsers, network navigation, data backup and protection, literature searches and bibliographic managers, databases, and digital image management.

This proposal defines learning objectives and skill sets that will assist training program administrators in developing or supplementing a curriculum in pathology informatics. The proposal is intended as a framework for conveying to trainees core knowledge and competency bases rather than as a prescription for the use of specific methods or teaching tools. To define a curriculum, these learning objectives and proficiency recommendations should be combined with locally developed teaching materials, instructional strategies and tools, and evaluation methods. Our proposal allows for and recommends flexibility in implementation that is adapted to meet local needs, draws on the expertise of local faculty members, and evolves over time.

When residents enter training, they should be given log-in passwords and some type of formal, basic orientation in the use of the LIS(s) deployed in the department. Such an orientation would include an introduction to the basic navigational skills, the conventions present in the system (eg, test mnemonic format), and the basics of retrieving patient data as required for the initial rotations in the residency program.

The informatics curriculum proper is then best implemented as the combination of core rotations and longitudinal experiences integrated into anatomic pathology and clinical pathology rotations. The core informatics rotation might be either a stand-alone or a dedicated period within other rotations. Didactic sessions are recommended to cover terminology, fundamentals, theoretic concepts, and topics (eg, database theory, LIS selection) that do not readily lend themselves to the type of instruction given as part of daily experience during rotations. Computer laboratory sessions or assignments to be carried out individually at computers are useful accompaniments to didactics for developing skills such as the construction of databases and the creation of presentations. Other instructional material such as literature articles, book chapters, and Web sites may be provided to supplement lectures, laboratory sessions, and experience and to enhance self-paced study.

Possible approaches to structuring a pathology informatics didactic lecture series include (1) a regular (eg, weekly) lecture series of 1 or 2 years' duration; (2) a concentrated informatics block in which didactic sessions and laboratory sessions/assignments are presented; and (3) a lecture series embedded in other rotations that specifically address informatics topics in that practice area. The latter approaches may require a greater degree of repetition on the part of the faculty as new residents periodically rotate on to the service, but they may also allow presentations to more readily build on each other and thus present greater depth (approach 2) or provide a clearer context for the relevance of informatics to daily practice (approach 3).

Many pathology residents enter their training programs with some basic proficiency with standard word processing, spreadsheets, presentation graphics, and similar applications. Thus, it may be appropriate for programs to address some proficiency objectives by providing self-study material or assignments demonstrating proficiency in basic productivity applications rather than scheduled instruction. Alternatively, many institutions offer classes in the use of applications such as word processing, spreadsheets, and presentation graphics, and residency programs may take advantage of these programs for residents who would benefit from them.

More advanced proficiencies related to use of the LIS and productivity tools may be taught effectively as experiences integrated into rotations. Residents should be encouraged and provided with resources to make use of these tools in the completion of routine work, presentations, and research projects. Further, exercises can be developed to highlight aspects of information technology used in the laboratory. For example, the heuristics used in automated microbial identification systems (such as Vitek) can be analyzed, providing useful clinical information as well as informatics skills. Hands-on demonstrations of software (eg, presentation graphics, literature searching, bibliography managers) are often the most effective teaching method.

Ideally, a pathologist with expertise and/or interest in pathology informatics would be primarily responsible for oversight of the informatics training. This individual could provide much of the didactic instruction, but others should contribute to the training program. Pathologists, laboratory scientists, and LIS support staff can provide instruction in areas of expertise and/or interest. It is also beneficial to include enterprise information system administration and staff as contributors to the training, particularly in the areas of enterprise information system design, network design, and security. The enterprise information security officer, if available, should participate in appropriate sections of the rotation. These individuals can provide important alternative perspectives on information system topics.

Implementing an informatics curriculum that is based on our proposal requires the commitment of significant resources and time. Three of us (J.M.T., J.H.H., and J.C.H.) have well-developed, formalized content for pathology informatics education in our training programs, and these experiences have provided a guide to the necessary resources. In these programs, the total contact time ranges from 16.5 to 63 hours, and the trainees' experiences include both didactic sessions and hands-on experiences. The number of faculty involved in informatics training in these programs ranges from 3 to 19 and includes pathologists and information system management staff. Some programs also include upper-level residents as instructors.

Assessment of trainees' competency in pathology informatics provides information about residents' learning and preparedness and about the effectiveness of the curriculum implementation. Appropriate assessment also drives student learning by demonstrating to the students their own proficiencies and deficits. Three components of assessment are recommended: (1) written examination(s); (2) observation of competencies; and (3) subjective assessment during rotations.

Residents may take a written (or computer based) examination on a regular basis, depending on the structure of training. The aims of these examinations are to motivate residents, to provide an objective measure of each resident's understanding of basic terminology and concepts, and to provide the program with a benchmark of resident progress. Conducting pretests before residents start the curriculum and comparing the results with tests given postinstruction adds another good measure of the program's effectiveness. The learning objectives described in the present study provide the basis for such an examination.

Direct observation of the proficiencies provides an opportunity for the direct demonstration of skills related to the operation of software and hardware. Such an observation could be performed at regular intervals and/or on an ad hoc basis during the year on various rotations. Remedial action through interactive teaching could then be applied if necessary.

Subjective assessment by departmental faculty may be similar to that performed for other subject areas in a pathology residency. One of the key criteria is the faculty member's assessment of resident competency with the use of informatics tools within the context of the rotation. Additionally, as with other aspects of the training program, a mechanism to evaluate the effectiveness of the informatics training from the trainees' perspective should be included and should cover the performance of the course faculty as well as the quality and relevance of the course content.

Residents' computing infrastructure refers to hardware, software, and other information technology resources that are dedicated solely for resident use. Surveys10,11 have indicated that computing resources available to residents are often lacking. Resident-dedicated infrastructure is necessary for effective integration of informatics into pathology training. Preferably, each resident should be provided her/his own personal computer connected to the hospital's information network. If the provision of individual personal computers is not possible, residents must have access to an adequate number of shared personal computers that are dedicated to resident use. Residents also must have access to printers, basic productivity software, reference books and manuals for all hardware and software, clinical information system client software, and e-mail accounts. Additional strongly recommended baseline resources for residents include individual local area network accounts and dedicated space on a departmental file server, access to network printers, a document image scanner, digital projection equipment for presentations, removable media devices (eg, CD-RW drive, Zip drive), and Internet access with standard communications software (eg, FTP, telnet/SSH, Web browsers).

A detailed discussion of advanced pathology informatics training and research is outside the scope of this proposal; however, several points merit mention. It is suggested that advanced training opportunities be made available for residents with special interest in pathology informatics. Such experiences might include (1) more exposure to and involvement in daily or longitudinal informatics-related activities in the department (eg, attendance at quality meetings, involvement in hospital electronic medical record or order entry system development); (2) the application of informatics skills while completing a project related to a laboratory rotation or service; (3) individualized instruction in an area of interest in informatics; and (4) research projects in pathology informatics. Advanced fellowship training and degree programs in medical informatics are available at a number of institutions (for example, National Library of Medicine training grant sites; see http://www.nlm.nih.gov/ep/T15Training.html), several of which offer medical informatics training with a pathology focus.

Resources such as on-line education, textbooks, and literature directed specifically to pathology informatics are limited, but the general literature commonly features articles with a pathology informatics orientation. These resources may be found in general pathology journals (eg, Archives of Pathology & Laboratory Medicine, American Journal of Clinical Pathology, Human Pathology) as well as in the medical informatics literature (eg, Journal of the American Medical Informatics Association). Two annual national conferences dedicated to pathology informatics—Automated Information Management in the Clinical Laboratory (AIMCL)17 and Advancing Pathology Informatics, Imaging, and the Internet (APIII)18—represent additional resources in pathology informatics education that are appropriate for faculty or residents. These meetings offer educational and scientific content as well as opportunities to interact with national leaders in pathology/medical informatics and information technology vendors. A number of awards that underwrite residents' travel expenses are offered for these meetings. General pathology meetings also frequently provide presentations related to pathology informatics.

Pathology informatics has gained increased recognition as a discipline within the medical specialty of pathology. Increasing numbers of pathology departments have designated directors of pathology informatics, and the API (Association for Pathology Informatics) has been formed with the mission of promoting pathology informatics as an academic discipline and a clinical subspecialty of pathology. Pathology informatics is a diverse subspecialty that encompasses clinical, technical, administrative, research, and regulatory elements. The content of this proposal represents that subset of pathology informatics believed necessary for the training of pathology residents.

Pathology informatics naturally shares part of its knowledge base with general medical informatics and other areas of information science. However, it is distinguished by unique features that relate to clinical and anatomic pathology practice: LIS system selection and management; the use of information systems in the pathology workflow (eg, pathology image capture, processing, storage, and retrieval); the modeling and management of tissue and cellular data; pathology systems as enterprise computing components; and clinical data encoding, analysis, and reporting. Our recommendations and suggestions target important concepts that underlie these unique pathology applications. We also include topics related to general and desktop computing because these are important for effective practice and self-education in any medical discipline. Our recommendations in this area are similar to those of the Medical Informatics Panel of the Association of American Medical Colleges.19 These skills, over time, are likely to be incorporated into undergraduate medical training. Until this occurs, pathology residency programs should include this component in their informatics training.

The notion that information management is central to the specialty of pathology is not new. More than a decade ago, Korpman20 as well as Weinstein and Bloom21 called on pathologists to become information specialists and stressed the opportunities, if not the necessities, for pathologists to capitalize on their unique experience as information managers to advance the profession and enhance its contributions to patient care. The latter authors, as well as Friedman,22 Buffone and Beck,14 and Becich et al,15 have previously called for the recognition and development of pathology informatics as a subspecialty within the discipline of pathology, given the crucial role of information management in the practice of pathology. Elevitch23 and Friedman24 have argued that pathologists must enhance their perceived value within health care organizations and that, to do this, pathologists should look to the areas of quality improvement, cost savings, and integration of the technical aspects of their work with the organizational aspects—all of which require effective information management.

Various themes regarding the importance of informatics in pathology have been reiterated and amplified recently.25–32 Weinstein26 cites new technologies that pathologists will use to add value to the pathology laboratory report. These technologies will facilitate the acquisition of specialized, expert knowledge and enable the transfer of this expertise to the pathology report. In an examination of the future of pathology training, Gorstein and Weinstein27 foresee the necessity for informatics technology to be integrated into general pathology training as well as the increasing necessity for pathologists to obtain a comfort level and facility with these tools. They also foresee a potential future in which the most valuable pathologists are those who can integrate information generated by multiple laboratory modalities, be they anatomic, clinical, molecular, or other modalities.

Sinard and Morrow28 go a step further and argue that pathology informatics will be a critical part of the profession's ability to meet its current and future challenges. They outline informatics activities that go beyond using current LISs to include data analysis and interpretation issues such as data mining and decision support. They portray a scenario in which the pathologist must use such tools to manage the flow of electronic data from numerous sources in order to provide meaningful analyses useful in patient management decisions and, by doing so, maintain her/his central role as diagnostic specialist. Becich29 outlines the coming effects of genomics on the laboratory and describes the critical role of informatics in ensuring pathology's leadership in the molecular diagnosis and molecular classification of diseases. Additionally, informatics in pathology supports clinical research and optimal medical practice through access to and analysis of pathology data,30,31 including outcomes studies.

Despite the growing recognition of the importance of informatics in pathology and the calls for greater emphasis on informatics in pathology training, evidence and experience suggest that informatics is still not adequately addressed in training programs. Although traditional areas of anatomic and clinical pathology training employ well-known and formal learning objectives and proficiencies, such items have not been as well developed or as widely implemented for pathology informatics training. Results of surveys9–11 indicate that formal or standard training in some programs is lacking. Furthermore, in many programs, informatics training is confined largely to instruction in the use of departmental LIS(s) and standard desktop software. Traffic on the API on-line discussion group often includes requests from residents for guidance regarding informatics training.

A legitimate concern about a proposal of this type, particularly one that involves 2 rapidly advancing fields such as informatics and pathology, is the potential for obsolescence or loss of relevance after a relatively short time. We envision the learning objectives and skill sets that we present as a point of departure and as a robust framework of topics, the specific content of which may be expected to evolve as technologies and the practice of pathology change. This proposal is offered with the expectation of change and growth in specific content.

The informatics training we propose not only addresses the needs for the intelligent, modern practice of pathology, but it also provides a good base for those interested in pursuing pathology informatics as a career focus. For these individuals, this core training would be a point of departure for advanced, individualized training in pathology informatics or fellowship training in medical informatics at nationally recognized programs. Pathologists pursuing such training and career tracks will be beneficial to the specialty. It is our hope that this proposal provides a focus, direction, and framework for fundamental training in the important discipline of pathology informatics for years to come.

Define and use the following terms in the proper context. Where applicable, provide a specific example of the item and/or describe the use of the item or its relevance to your laboratory. Compare and contrast related terms.

• Computer

• Hardware

• Software

• Program

• Information system

• Bit

• Byte (kilo-, mega-, giga-, tera-)

• Analog

• Digital

• File

• Directory

• Folder

• Standard

• Protocol

• ASCII (American Standard Code for Information Interchange)

• Unicode

• Network

• Bandwidth

• Backup

• Redundancy

• CPU (central processing unit)

• Megahertz

• RAM (random access memory)

• ROM (read-only memory)

• Hard disk drive (HDD)

• Redundant array of independent/inexpensive disks (RAIDs)

• CD-ROM (compact disk read-only memory)

• CD-RW (compact disk read-write)

• DVD (digital versatile disk)

• Tape drive

• Floppy disk

• Microfiche

• Bus

• Card

• Peripheral

• Microcomputer

• Minicomputer

• Mainframe computer

• Multiuser system

• Terminal server

• “Dumb” terminal

• Personal digital assistant (PDA)

• Operating system

• GUI (graphical user interface)

• Application

• Programming language

• Device driver

• Terminal emulator

• Word processor

• Spreadsheet

• Presentation graphics

• Database

• E-mail (electronic mail)

• License

• Open source

• Local area network (LAN)

• Network interface card (NIC)

• Ethernet (fast, gigabit)

• Network hub

• Router/gateway/switch

• Fiber-optic cable

• Wireless

• Client/server architecture

• Network operating system

• Internet protocol (IP)

• Port

• File server

• Application server

• Print server

• Middleware

• “N-tier” architecture

• Component software

• Cluster

• Thin client

• Wide area network (WAN)

• Telecommunications technologies—POTS (plain old telephone service), modem, cable modem, ISDN (integrated services digital network), DSL (digital subscriber line), T1, T3

• Internet

• Internet service provider (ISP)

• Intranet

• Extranet

• Virtual private network (VPN)

• World Wide Web

• Web browser

• Applet

• Plug-in

• Domain name

• URL (uniform resource locator)

• FTP (file transfer protocol)

• Telnet

• SSH (secure shell)

• Hypertext

• http (hypertext transfer protocol)

• Markup language and tags

• HTML (hypertext markup language)

• XML (extensible markup language)

• PDF (portable document format) document

• List the 3 most important determinants of computer hardware system performance and explain their interrelationship.

• Differentiate between memory and persistent storage in computer systems.

• Rank the following storage media from lowest to highest capacity: Zip disk, floppy disk, CD, DVD, 30 gigabyte (GB) hard disk drive.

• List the hardware platforms and operating systems in use in your laboratory.

• Describe the advantages and disadvantages of using an interface engine over creating multiple point-to-point interfaces.

• Rank the following network technologies in order of increasing bandwidth: T1, T3, modem, ISDN, DSL, Ethernet.

• Describe the difference between the Internet and the World Wide Web.

• Contrast text formatting and markup language.

• Contrast the different types of software licensing strategies including per seat license, site license, shareware, freeware, and open source software.

• Draw and label a diagram of different network topologies including LAN and WAN.

• Draw and label a diagram of a generic enterprise 3-tier information system.

Define and use the following terms in the proper context. Where applicable, provide a specific example of the item and/or describe the use of the item or its relevance to your laboratory. Compare and contrast related terms.

• Order entry

• Accession number

• Maintenance table

• Mnemonic

• Worksheet

• Cumulative report

• Interim report

• Management report

• Audit trail

• Remote printing

• Line printer

• Bar code

• Backup

• Fault tolerance

• Purge

• Instrument interface

• Application interface

• Interface engine

• Translation table

• Admission-discharge-transfer (ADT)

• Test area

• Database

• Database management system (DBMS)

• Query language

• SQL (structured query language)

• ODBC (open database connectivity)

• Structured medical language

• HL7 (Health Level 7)

• ASCII (American Standard Code for Information Interchange)

• ASTM (American Society for Testing and Materials)

• LOINC (Logical Observation Identifier Names and Codes)

• DICOM (Digital Imaging and Communications in Medicine)

• SNOMED (Systematized Nomenclature of Medicine)

• ICD-9, ICD-10 (International Classification of Disease)

• CPT (Current Procedural Terminology)

• Application service provider (ASP)

• Software licensing

• Requirements analysis

• RFP (request for proposal)

• Scope document

• Technical specifications document

• Source code

• Code escrow

• Software version/build

• Maintenance fee

• Service level agreement (SLA)

• Alpha and beta software

• Developmental partnership

• System manager

• User support

• Help desk

• List the major features of a laboratory information system (LIS). Describe the major elements of an LIS database for both anatomic pathology and clinical pathology systems. Describe rules-based automatic result verification and reflexive test ordering and give examples.

• Name the LIS system(s) in use in the laboratory. List their major components and indicate the type of system (multiuser vs client server), the approximate number of users, the query method, the approximate cost, and the laboratory and nonlaboratory clients that it serves.

• Explain the implications of implementing a client/server LIS (compared to a mainframe-based or multiuser LIS) for laboratory operations, LIS system support, and budgeting of costs.

• Describe the major components, specifications, and factors to be considered when evaluating an LIS for implementation. Discuss trade-offs between the various components and factors.

• List the major steps involved in evaluating, acquiring, and implementing an LIS. Describe the RFP process. List the major elements of a system purchase contract. Describe the components of cost of an LIS.

• Discuss methods for financial justification of new technology such as an LIS. Define payback period, return on investment, internal rate of return, and net present value.

• List the advantages and disadvantages of long-term on-line storage of laboratory records. List alternatives to long-term on-line storage and discuss the benefits and drawbacks of each.

• Describe different methods for integrating laboratory information and LISs at multiple sites (eg, multifacility software vs multiple interfaces/interface engine) and discuss the advantages and disadvantages of each.

• Describe some of the most important differences to consider between hospital-focused laboratory computing and outreach/reference laboratory computing.

• Discuss the advantages and disadvantages of the ASP approach to implementing systems. Outline the important topics covered in an SLA with an ASP vendor.

• Discuss the differences (functional, regulatory, and operational) between anatomic pathology information systems and clinical pathology information systems. Discuss the advantages and disadvantages of combined and separate anatomic pathology and clinical pathology systems.

• Contrast “best-of-breed” and “all-in-one” approaches to decisions about system selection and implementation.

• Discuss the advantages and disadvantages of developmental partnership and alpha/beta testing agreements.

• Describe the relevance of the Internet and Web to laboratories, particularly for performing LIS-type functions of test ordering and result access.

• Discuss the advantages and disadvantages of standardized vocabularies for data coding and interchange. List several examples (eg, SNOMED, ICD-9/10, HL7, LOINC, ASCII) and identify their primary function (eg, billing, interface, disease classification).

• Discuss the role of the laboratory, laboratory data, and LISs in enterprise-wide electronic medical record systems.

Define and use the following terms in the proper context. Where applicable, provide a specific example of the item and/or describe the use of the item or its relevance to your laboratory. Compare and contrast related terms.

• Relational, flat file, hierarchical, and object-oriented databases

• Data model

• Data field

• Data record

• Data repository

• Data warehouse

• Data mining

• OLTP (on-line transaction processing)

• OLAP (on-line analytical processing)

• Expert system

• Contrast flat file databases with relational and object-oriented databases.

• Distinguish the purposes and limitations of transaction processing and analytic processing.

• Differentiate between data repository and data warehouse.

• List 4 analysis strategies useful in data mining.

• Contrast rule-based expert systems with neural networks.

• Discuss the usefulness of expert systems in the setting of physician order entry for laboratory testing.

Define and use the following terms in the proper context. Where applicable, provide a specific example of the item and/or describe the use of the item or its relevance to your laboratory. Compare and contrast related terms.

• Confidentiality

• Security

• HIPAA (Health Insurance Portability and Accountability Act)

• Authentication

• Password

• Biometrics

• Audit trails

• Encryption/decryption

• Certificate of authority

• Firewall

• Secure sockets layer (SSL)

• Discuss the following security methods in terms of advantages, disadvantages, effectiveness, processing overhead, storage requirements, and implementation and monitoring: password protection, audit trails, authentication, encryption, firewall.

• Describe methods for data protection and backup used with respect to your laboratory's information system(s).

• Discuss patient privacy and confidentiality as it relates to laboratory records. Define the laboratory's and laboratorians' responsibilities regarding privacy and confidentiality. Explain the relevance of HIPAA to the laboratory.

• Carry out a mock inspection of the laboratory computer system area and/or pathology informatics division using the pertinent area(s) of the College of American Pathologists (CAP) checklists.

• Assess the compliance of the blood bank LIS (or blood bank component of the LIS) and of the information handling policies and procedures in the blood bank related to CAP, American Association of Blood Banks (AABB), and Food and Drug Administration (FDA) requirements.

• Discuss specific requirements for data handling and storage of cytopathology data related to the Clinical Laboratory Improvement Act (CLIA), quality assurance, and quality control.

• Discuss data handling, storage, and transmission/dissemination in the context of HIPAA.

Define and use the following terms in the proper context. Where applicable, provide a specific example of the item and/or describe the use of the item or its relevance to your laboratory. Compare and contrast related terms.

• Pixel

• Resolution

• Color depth

• Compression (lossy, lossless), compression ratio

• Image analysis: quantitative and qualitative

• Whole slide scanning

• Image databases and storage systems

• Calculate the size (in megabytes/gigabytes) that would be expected for a digital image file, given the bit depth and resolution conditions under which it was captured.

• List the major components of a digital imaging workstation.

• Identify potential uses for digital imaging in your department. List benefits and drawbacks to implementing digital imaging. Discuss other considerations in digital imaging with respect to file formats, storage requirements, image transmission, and image reproduction.

• Define telepathology and discuss its primary potential applications. Distinguish between static and dynamic methods of telepathology. Describe the major benefits, challenges, and limitations to the use of diagnostic telepathology.

• Give a working definition of image analysis. Discuss image analysis in terms of potential applications and advantages and limitations.

• Describe the storage issues and solutions for pathology image repositories and databases.

Define the following terms and describe their potential impact on information management in pathology:

• Voice recognition in computer systems

• Laboratory automation systems

• Genomics, proteomics

• DNA chip arrays

• Tissue microarrays

• Nanotechnology

• Name major pathology informatics and medical informatics professional societies and briefly describe the main focus of each.

• Identify sources of pathology informatics and learning resources including Web sites, national meetings, and journals.

Demonstrate basic proficiency in the use of each of the following types of software by successfully performing the associated task(s):

• Retrieve patient laboratory test results.

• Perform a clinical order entry for a specimen.

• Print an inpatient and outpatient chart to a chart printer.

• Sign out laboratory results as appropriate, including peripheral smear reviews, body fluid reviews, protein electrophoreses, transfusion reactions, and/or blood bank reviews.

• Review and sign out laboratory quality control reports.

• Specify and/or perform a database search for retrieval, analysis, or downloading.

• Retrieve patient results (eg, surgical pathology and cytopathology).

• Access a surgical pathology specimen and a cytopathology specimen.

• Edit text of microscopic and gross descriptions, final diagnoses, and other case data on-line.

• Sign out surgical pathology and cytopathology cases as appropriate.

• Perform a SNOMED search (if applicable).

• Specify and/or perform a database search for retrieval, analysis, or downloading.

• Recognize common malfunctions.

• Install system software.

• Install and remove application programs.

• Use the file system to organize application programs and data files.

• Search for and find files and applications on the hard drive.

• Create a document (preferably a manuscript) that includes tables, columns, embedded graphics, footnotes/endnotes, and page numbers.

• Create a spreadsheet for presentation of data (preferably clinical or research data).

• Prepare a pie chart and bar graph from data in a spreadsheet.

• Perform basic functions and statistical operations on spreadsheet data—sum, mean, SD.

• Create a presentation with speaker's notes.

• Incorporate graphics from scanned or Internet-derived files into the presentation.

• Understand the appropriate use of text formatting, slide master design, slide transitions, and builds to deliver an effective presentation.

• Deliver a presentation from a laptop or desktop using a projector (if available).

• Send and receive e-mail to/from members of the department and to/from another site or institution.

• Use return receipts and attachments.

• Forward, reply to, save, and print e-mail.

• Participate in an Internet mailing list and understand how to manage communications with the list.

• Configure an e-mail client program to send and receive mail from an e-mail server.

• Connect to the Web and navigate to various sites.

• Search the Web for information relating to a subject of interest.

• Download files from the Web with appropriate decoding/decompression.

• Connect to and disconnect from a file server.

• Create a folder and save a document on a file server.

• Change file server password.

• Print to different network printers.

• Save a file to a removable media device.

• Perform a scan for viruses on a local hard drive.

• Create and change passwords that have good security characteristics.

• Perform a literature search, print out the search, save the search to disk, and import the search into a bibliography manager.

• Sort references in a reference manager by name and publication date.

• Create a citation format in a reference manager.

• Search for references in a reference manager by name, topic, and publication date range to generate a sublist of found references.

• Use a bibliography manager to format references for a manuscript or a presentation handout.

• Create a simple relational database.

• Add and delete records using this database.

• Create queries to retrieve and format data from single and multiple tables.

• Capture a digital image of pathologic material (eg, gross, slide, gel).

• Perform basic image manipulation including brightness, contrast, color balance, cropping, and addition of annotation labels.

• Insert a digital image into a presentation or word processor document.

• Create and save a digital image using a document scanner.