A Day in the Life ... Dr Mark Formby
Around 70% of people who enter hospital will need pathology to assist with their treatment. Behind the scenes, there’s a dedicated workforce manning the microscopes to ensure patients have access to high-quality and timely results. Dr Mark Formby is the Acting Director at NSW Health Pathology’s Anatomical Pathology Laboratory at John Hunter Hospital. As an anatomical pathologist, Mark examines tissues and organs to determine the causes and effects of particular diseases such as cancer. The findings are fundamental to medical diagnosis, patient management and research. On a day-to-day basis, most anatomical pathologists would examine a number of individual cases, ranging from skin biopsies through to understanding why a kidney transplant patient is rejecting a new organ or diagnosing breast or colon cancer. Mark’s work requires great attention to detail and he leads a team who pride themselves on making sure patients are given the answers they need, with the respect, dignity and compassion they deserve. Mark’s day looks a bit like this…
8:30–9:30 I arrive at work and join NSW Health Pathology’s Perinatal Post-Mortem Steering Committee teleconference. We are trying to improve expert perinatal post-mortem services and support, from referrals to examinations. There is a focus on offering a more consistent, efficient and family-centred care and help provide answers for those who have lost a baby.
9:30–10:00 I move to the Renal Biopsy Review meeting. This multidisciplinary team involves physicians from the Department of Renal Medicine, Advanced Trainees, Resident Medical Officers and students, together with the four pathologists who deal with renal biopsy specimens, renal laboratory staff and anatomical pathology registrars. At this meeting we present all of the week’s cases and discuss findings and plans for patient treatment.
10:00–11:00 After checking emails and responding to urgent messages, I review slides of tissue samples and prepare reports for clinicians. When reporting, I use ‘voice recognition’ software, which has delivered a significant reduction in our clerical staff’s workload. With this software, the pathologist is either sitting or standing at the bench and dictating into the headset with voice recognition software. The pathology terminology is embedded into the product and has commonly used phrases, templates or even entire stereotypical reports. It transfers the information on screen into the report in real time, and the pathologist can check their transcription as it comes up on the screen without having to use the keyboard. It has led to better workflow and productivity, and faster turnaround times. This timely interpretation and advice is critical to quality care for patients and the wider clinical team.
11:00–12:30 Next I turn my attention to reviewing and reporting patient cases, including urgent cancer, urology and renal biopsies. I order special stains or further studies for cases that don’t yield a diagnosis on the initial material. I also go around the laboratory from bench to bench overseeing the preparation of new specimens for examination and diagnosis.
12:30–14:30 I work with our lab technicians reviewing new cases on large screens instead of microscopes. These digital slides allow pathologists to zoom in to measure and pinpoint features in tissue samples in ways we haven’t been able to before. Digital images are stored centrally and can be accessed remotely from any digital pathology workstation. This makes it easier to call for us to obtain important second opinions from other pathology experts, no matter where they’re located.
14:30–16:00 I prepare cases for tomorrow’s Urology multidisciplinary team (MDT) meeting. I enjoy being part of a multidisciplinary team, where I contribute to discussions about individual patients with a team of surgeons, radiologists, oncologists, nurses and other colleagues. Between us we discuss all aspects of each patient’s care and review all the available evidence to make decisions about the best treatment or if any further investigations can be offered to the patient. Typically, the surgeon provides the background to the case, the radiologist shows the scan and I’ll describe the pathology findings, including the presence of any markers that will help decide the best course of treatment.
16:00–18:00 I return to my examination and reporting and also assist with audiovisual set-up for a regular meeting that brings together pathologists and local gastroenterologists. We review cases and discuss other aspects of the speciality, including research activities. I check emails again and find there is an urgent response needed to approve the selection criteria for a recruitment advertisement.
Digital innovation delivering smarter services
NSW Health Pathology delivers pathology and forensic and analytical science services across the state to help create better health and justice systems.
Its pathologists and scientists collaborate with clinical teams, providing interpretation and advice critical to the delivery of quality patient care. Their forensic science teams are experts in providing analysis and intelligence to help police solve crimes and secure justice. They have more than 50 information communications technology (ICT) projects underway to boost collaboration, enhance connectivity and deliver faster, better outcomes for our communities and customers across NSW.
Here’s a snapshot of some of the projects underway.
A new view with digital anatomical pathology
The anatomical pathology (AP) workplace is being revolutionalised by going digital. Digital AP means slides are viewed on screens instead of microscopes. This allows pathologists to zoom in to measure and pinpoint issues with tissue samples in ways they haven’t been able to before. Slides are stored centrally and accessed remotely from any digital pathology workstation. This makes it easier to call for a second opinion from other pathology experts, no matter where they’re located. NSW Health Pathology is trialling digital workstations at some of its AP labs to get a better understanding of benefits, implementation issues and how they can use this technology more widely.
Structured reporting improves accuracy
Structured reporting is backed by software that provides a series of predefined fields where pathologists can record data for patients’ cancer reports. It provides clearer, complete and more precise clinical information than the current free-text method of recording results. Report fields align with templates developed by the Royal College of Pathologists of Australasia (RCPA). The RCPA collaborated with colleges internationally, which means the data recorded in structured reporting is in line with world-class standards. The Cancer Institute NSW has received a demonstration of the software and is now exploring the best way to implement this technology in NSW Health Pathology’s anatomical pathology labs.
Taking genomics data to the cloud
NSW Health Pathology Genomics is pursuing cloud-based technology to manage the collection, analysis, storage and sharing of genomics data. While cloud technology has recently been used for the handling of genomics research data, they’re leading the way in adopting this technology for clinical diagnostics within the public healthcare system in Australia. This will enable better, faster access to genomic data which can be more easily shared with experts across our statewide genomics service. This will translate to better clinical decisions regardless of where a patient is based through closer connection to the referring clinics and their patients. These systems will also enable NSW Health Pathology to share genomics knowledge with the Australian Genomics Framework and will ensure that global genomics knowledge is available to local patients. They’re also performing security, privacy and assurance assessments on a broader range of cloud-based applications that show great promise in supporting our rapidly expanding genomics clinical service.
Pathology results in digital health records
Pathology test results from its South Eastern, Western and Rural laboratories are now part of HealtheNet — the statewide electronic medical record system accessed by NSW Health clinicians. This is the first time pathology results from NSW have been included. With more than 70% of patient treatment decisions based on pathology, providing easier access to results will help reduce time to treatment and improve care. HealtheNet provides a summary of a patient’s recent medical history from all Local Health Districts instantly. These results are also the first pathology results available in ‘My Health Record’ — the Australian Government’s initiative that gives patients control of their digital health record; what goes in it and who is allowed to access it. NSW Health Pathology is actively working on making its remaining pathology test results available through HealtheNet and My Health Record in the second half of 2018.
NSW Health Pathology has formed a collaborative partnership with Microsoft, Siemens, Intel, MuleSoft and Dius, to drive innovation in diagnostics. These cutting-edge partnerships combine Microsoft’s industry-leading Azure Internet of Things (IoT) platform with Siemen’s Open Point of Care management solution (POCellerator). This IoT approach positions NSW Health Pathology to take advantage of new and emerging technologies, and the goal is to create the world’s first scalable accredited point of care testing solution that will provide reliable, accessible service to patients and clinicians across the state, including in rural and remote locations. They are developing reliable information feeds that can transport the data collected on point of care devices directly into their electronic medical records, ensuring a seamless patient journey across multiple care settings. There are currently 10,000+ point of care testing devices in operation across NSW and they anticipate that over the next four years approximately five million tests will be carried out across the state. This will also have a significant impact on the growing number of people suffering from chronic illness — allowing them to safely monitor and manage their condition without having to present to their local acute hospital.
There’s an app for that
NSW Health Pathology is developing an app that will give clinicians secure access to NSW Health Pathology results and allow them to place orders from mobile devices. They’re working with a clinician reference group to make sure that functionality is practical and adds significant value to clinical decisions and patient care. With this input, they’ve developed a prototype that’s currently in testing. From there, a working version will be developed for a staged release to customers.
To find out more, visit www.pathology.health.nsw.gov.au.
Dr Mark Formby is Acting Director at NSW Health Pathology's Anatomical Pathology Laboratory...
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