The history of pathology informatics: A global perspective

Abstract

Pathology informatics has evolved to varying levels around the world. The history of pathology informatics in different countries is a tale with many dimensions. At first glance, it is the familiar story of individuals solving problems that arise in their clinical practice to enhance efficiency, better manage (e.g., digitize) laboratory information, as well as exploit emerging information technologies. Under the surface, however, lie powerful resource, regulatory, and societal forces that helped shape our discipline into what it is today. In this monograph, for the first time in the history of our discipline, we collectively perform a global review of the field of pathology informatics. In doing so, we illustrate how general far-reaching trends such as the advent of computers, the Internet and digital imaging have affected pathology informatics in the world at large. Major drivers in the field included the need for pathologists to comply with national standards for health information technology and telepathology applications to meet the scarcity of pathology services and trained people in certain countries. Following trials by a multitude of investigators, not all of them successful, it is apparent that innovation alone did not assure the success of many informatics tools and solutions. Common, ongoing barriers to the widespread adoption of informatics devices include poor information technology infrastructure in undeveloped areas, the cost of technology, and regulatory issues. This review offers a deeper understanding of how pathology informatics historically developed and provides insights into what the promising future might hold.

Keywords: History; clinical informatics; electronic medical record; laboratory information systems; pathology education; pathology informatics.

Figure 1

The telepathology project between the Armed Forces Institute of Pathology (left) and Mthatha General Hospital (right)

Figure 2

The South African Telemedicine System at St. Elizabeth Hospital, Lusikisiki

Figure 3

Major events in the history of pathology informatics in the USA

Figure 4

The CLAS-300. Top left: CLAS-300 with central alpha – numeric display keyboard and three remote universal data entry terminals. Top right: data entry on the CLAS-300 (note the large size of the computer components, as well as the magnetic tape-based storage). Bottom left: the CLAS-300’s line printer; this particular model, which featured a speed of 300 lines per minute, was considered an incredibly fast printer by 1970’s standards. Bottom right: the CLAS-300’s central input station; though a large unit, this station was – like the smaller remote data entry terminals: A "dumb" terminal that merely reflected the state of the mainframe that powered it. Photographs reproduced with permission

Figure 5

A timeline of selected Laboratory Information Systems (LIS) vendors from 1960’s to the present. It is important to note that this is a sampling and not an exact account of the full history of LIS vendors. ALS = Advanced Laboratory Systems; BSL = Berkeley Scientific Laboratories; CCA = Creative Computing Applications; CDC = Control Data Corporation; CHC = Community Health Computing; DEC = Digital Equipment Corporation; DHT = Dynamic Health Technologies; DNA = Diversified Numeric Applications; FF = Fletcher-Flora; HBOC = Huff, Barrington and Owens; IDX = IDX Systems (acquired by GE in 2006); KDS = Knowledge Data Systems; LCI = Laboratory Consulting, Inc.; MCK = McKesson; MJS = Michael J. Selner Systems; NLFC = New Lab Force Corporation; PGI = Patterson, Gorup, Illig; SAC = System Analysis Corporation; SCC = Soft Computer Consultants; SMS = Shared Medical systems; T and T = T and T Technology (Peter Tong). Image courtesy Weiner Consulting Services and Dennis Winsten and Associates

Figure 6

The live telepathology system connecting Boston Logan Airport and the Massachusetts general hospital in action. This is widely considered the first working telepathology system in history

Figure 7

Examples of the video streams the first telepathology system could generate. Left: peripheral blood smear; right: Urine cytology

Figure 8

Live demonstration (in 1986) of the first operational robotic telemicroscopy system in history. Top left: Dr. Alexander Miller and associate operating the robotic telemicroscopy system; top right: example of the video feed from the system; bottom left: Close-up of videoconferencing gear worn by participants; bottom right: Close-up demonstrating keyboard control of remote robotic microscope

Figure 9

Growth in Japanese telepathology installations, 2004-2010

Figure 10

Demonstration of image quality of first expert telepathology trials in Germany, 1990. Note the breaks of line connections