Dark Daily visits the anatomic pathology department and clinical laboratory at University Health Network
DATELINE: Toronto, Ontario, Canada—Here in the downtown area of Ontario’s largest city is a healthcare organization known as University Health Network (UHN) that operates one of the province’s larger consolidated clinical laboratory organizations. In support of its hospitals, the UHN Laboratory provides an impressive menu of medical laboratory tests.
In Canada, the United States, and other developed nations, there are ongoing efforts to consolidate clinical laboratory testing across multiple hospitals that are clustered nearby to each other. Thus, some outcomes seen today at the UHN laboratory provide useful insights into the benefits of similar projects to integrate—within one lab organization—the medical laboratory testing activities that are delivered to all the hospitals participating in the consolidated laboratory organization.
On Wednesday of this week, Dark Daily editor Robert Michel was welcomed on a laboratory site visit by both the anatomic pathology department and the clinical laboratory. The site visit began in anatomic pathology. The most notable story here is how UHN pathologists are engaged in one of the world’s most advanced efforts to use digital pathology technology in ways that advance patient care.
UHN Pathologists Regularly Use Digital Pathology Technology
Internally, pathologists are now in their seventh year of using telepathology and digital pathology to provide frozen section services to the UHN hospitals that are located close together in Toronto’s downtown district. Externally, UHN pathologists now regularly use digital pathology to support specific anatomic pathology services at three hospitals, one of which is located about 437 miles north of Toronto.
Details of this innovative use of digital pathology services were provided by Jagdish Butany, M.D., MBBS, MS, FRCPC, and Andrew Evans, M.D., Ph.D., FRCPC. The frozen section service, when it was first instituted in 2004, had several goals.
First, the pathologists wanted to shorten the time to answer for the referring surgeons. Second, the pathologists wanted to eliminate the need to physically travel from one hospital to the next to be physically present when the frozen section images were available for viewing. Third, by transmitting the digital image from the hospital where the surgery was happening to the central pathology office at UNH, it would make it possible for the pathologist to have colleagues review certain frozen section images to ensure the accuracy of the findings reported to the surgeon.
These goals were met and surgeons and pathologists are fully satisfied with this digital pathology arrangement. UHN pathologists next saw an opportunity to use digital pathology to provide frozen section support to the Timmins and District Hospital, located 437 miles north of Toronto. This arrangement is used on days when Timmins Hospital has no pathologist on site and has similarly proved successful.
Another notable development in anatomic pathology at UHN is that its pathologists are collaborating with PICOE—the Pathology Innovation Centre of Excellence. PICOE was organized by General Electric Healthcare and Omnyx, LLC, with grants from several sources, including the Province of Ontario. UHN pathologists are collaborating with PICOE in such areas as evaluating existing pathology workflow and assessing the image analysis capabilities of the Omnyx digital pathology system in how it handles different types of tissue.
Clinical Laboratory Serves the Four UHN Hospitals in Toronto
Next was the tour of the UHN core clinical laboratory. Tom Clancy, Director of Core Lab Services, and Marni Lollo, Manager of Core Lab Services, provided an overview of their laboratory. It provides medical laboratory testing services to 471-bed Toronto General Hospital, where the laboratory is physically located, and also to 220-bed Princess Margaret Hospital, and 256-bed Toronto Western Margaret Hospital.
The core laboratory facility includes automation for the high volume chemistry line and selected islands of automation. The UHN laboratory operates as a reference and esoteric laboratory for other hospitals in Ontario and thus has an extensive menu of in-house laboratory assays. Among the opportunities it is developing is expanded use of mass spectrometry for selected tests. The goal is to realize the dual benefits of improved lab test quality while performing these tests at a more competitive cost.
Like other larger, multi-hospital laboratory organizations, the UHN laboratory is responsible for managing the parent institution’s point-of-care testing (POCT) activities. Approximately 3,500 nurses and hospital staff are qualified to conduct POCT, which is used extensively within UHN.
Some pathologists and clinical laboratory managers may recall that, during the 1990s, the UHN laboratory was part of Toronto Medical Laboratories (TML). This was an über-lab consolidation project that included the MDS Laboratories (now renamed LifeLabs) facility in Toronto. TML operated from an off-site lab facility near the UHN hospital complex.
However, in 2007, TML was dissolved and the two partner labs once again began to function independently of each other.
UHN’s laboratory does have one big project ahead of it. It has launched a request for proposal (RFP) process to purchase and install a new LIS (laboratory information system). It currently uses the GE CentricityUltra laboratory information system that is no longer supported by the vendor. UHN originally acquired this LIS from Triple-G Corporation, which was then based in Ontario. GE acquired Triple-G in 2003.
The Laboratory Medicine Program at University Health Network is a sizeable operation. Its consolidated clinical laboratory performs more than 12 million tests per year and it has 400 employees.
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Robert L. Michel
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