Perspectives in Biology and Medicine

THE PHYSIOGNOMY OF COMPUTER SYSTEMS IN PATHOLOGY DEPARTMENTS ROBERT I. O'DESKY* and MARIONJ. BALLf Introduction As the health care community enters the decade of the 1980s, pressures and problems abound in every segment of the industry. No pathology department is immune to these insistent circumstances. Annually there are significant increases in the volume of tests being performed . Not only are more of the common tests being requested every year, but there is increasing pressure to perform a spiraling number of less frequently run procedures. Limitations on the reimbursement of some screening procedures potentially forces the decreased use of certain types of laboratory instrumentation. This results in a potential loss of some of the economics of mass screening instrumentation. New instrumentation is expensive, but even more significant than initial cost is the ongoing increased reagent cost that this new flexible instrumentation inflicts on the laboratory. Labor costs follow the inflationary spiral and are causing a new major impact on the pricing of procedures. These are only a sampling of the problems facing the pathology department of the 1980s. Into this environment of increasing costs come the administrative pressures for decreasing expenditures while providing superior testing capability. The pathology department must also support a disproportionate share of the overhead and operating expenses of the parent institution. These pressures have caused many affected health professionals to consider augmentative technology to help the department address these cost-containment dilemmas. During the past 25 years, the computer has become one of the major technological devices that the pathology department has turned to in an effort to address its major departmental problems. The computer has *Address: 3408 Balboa Lane, Columbia, Missouri 65201. tDirector, Computer Systems and Management Group, Temple University Health Sciences Center, Philadelphia, Pennsylvania 19104.© 1982 by the University of Chicago. AU rights reserved. 003 1 -5982/82/2503-0273$01 .00 454 I Robert I. O'Desky and MarionJ. Ball · Computer Systems been viewed as a potential panacea for everything from cell scanning and classification to autopsy reporting. Clinical laboratory systems vendors were very numerous at one point in time, but today most of them are no longer in existence [1, pp. 14-20]. Even the systems which perform well in one institution are not readily exportable [2]. Why are computer installations in pathology departments in such a chaotic state? Will the computer ever become the viable tool that it has the potential to be? What will it take to make the computer not only a valuable tool but one that is easily implemented and sensibly used? A Look at the Past and Present State of Pathology Department Computer Systems Given the problems above, perhaps a reasonable method of considering these questions would be to review how computers arrived at their current state. This review procedure might also provide some clues which could point to methods which might be employed to foster further usage, development, and enhancements. In the late 1950s and early 1960s, some pathologists affiliated with academic institutions obtained access to university computing facilities. These physicians attempted to set up tumor registries in order to facilitate statistical inquiries. This led to the development of comprehensive coding systems in order to ease the task of data preparation [3]. Some of this coding work provided the genesis for structures now commonly used in medical record keeping. Just as these computer endeavors were starting to be recognized, major changes were beginning to occur in the clinical chemistry laboratory . Automation was becoming well accepted, and the Technicon Auto Analyzer was appearing in chemistry laboratories. Following closely on the heels of these trends toward laboratory automation came a whole set ofcomputer companies who had answers for all of the problems created by automation. Each of these vendors had their own set of formulas and methods for thejustification of their computer system in the laboratory. The vendor cost justification was typically based on technologist time savings [4]. The justification formulas made it appear that technologist time savings, because ofelimination of interpolation tasks and transcriptions ofresults from one piece ofpaper to another, could easily pay for a clinical laboratory computer system. Unfortunately, these justifications seldom held up when put to test in the real world. Many laboratory directors...