Tech success: Rapid recovery
Army speeds diagnoses with digitized medical samples
Col. Renata Greenspan, AFIP director, said the system is unique because the agency can refer doctors to so many cases and even show them unusual presentations.
Photo courtesy of Armed Forces Institute of Pathology
Every day, medical staffs worldwide look to the Armed Forces Institute of Pathology for help in making diagnoses based on samples of materials such as tumors and tissue.
However, until recently, the decades-old system relied heavily on physically shipping slides from distant facilities to AFIP's headquarters in Washington. The slowness of the process discouraged some from using it.
So about two years ago, AFIP undertook a modernization project to digitize pathology samples, said Col. Renata Greenspan, AFIP director.
Information Manufacturing Corp. in Rocket Center, W.Va., was brought in to scan and digitize the data, store it and develop a search application to allow easy access to all the newly digitized data.
"This wealth of material is very important for education and research," Greenspan said.
So far, 4.5 million records have been digitized. In addition to historical medical data that AFIP had, medical information from closed military bases, the Automated Central Tumor Registry and other sources is being digitized, Greenspan said. AFIP officials plan to digitize about 2 million records a year.
The Army started collecting specimens and information about them in 1862, when researchers were looking at Civil War soldiers' wounds and the effects of those wounds, Greenspan said. Today, AFIP collects from 60,000 to 80,000 specimens a year and has an inventory of several million specimens.
Sifting through all of those records was beyond arduous, said Barclay Butler, IMC's vice president and general manager of health services operations.
"They have racks and racks of three-by-five cards, like what you'd see at a huge, inner-city library card catalog," Butler said. "Doctors can use it to find a case similar to one they've received, but it is very labor-intensive and difficult."
The heart of the IMC project is use of computer scanners to save the data, and optical character recognition tools to capture the metadata about the cases, including the diagnosis information, Butler said.
IMC uses OCR products from Prime Recognition Inc. of Woodinville, Wash., said Tom Murphy, IMC's vice president of corporate development
The accuracy of the data collected is crucial to fully leveraging IMC's search portal tool, Web Search Store Retrieve and Distribute (WSSRD), Murphy said.
"The portal gives you access to all the file cabinets associated with these data sets," Murphy said. WSSRD has a proprietary, built-in keyword search engine, and that is the portal AFIP uses to enter the system, he said.
Although IMC did not work with a systems integrator on the AFIP project, its data collecting, data storage and WSSRD tool will work well in any application in which paper or other physical format records need to be digitized, the company said.
IMC has worked with the National Oceanic and Atmospheric Administration, scanning, storing and providing Web access to thousands of handwritten weather observations.
The company also has digitized volumes from the National Weather Service's library, protecting the originals while making available digitally the information they contain.
For AFIP, a portal called "Ask AFIP" eventually will be developed, Greenspan said. It will be an interactive database with a Google-like front-end search feature. Medical professionals will be able use it for research or to request a consultation, she said.
"What's unique about this system is, because our repository is very extensive, we can refer doctors to many cases and even show them unusual presentations," Greenspan said.
"We can tell them, 'This is what it is. We have other cases like it, that's how they look and presented, and this is what happened to the patient.' "
To make the system easy to use for medical personnel, a decision-support portal that automates the process of accepting inquiries in a digital format is being developed, Butler said. That system will help patients at inaccessible locations, such as at a forward military hospital in Iraq.
"Sometimes they'll have a pathologist, and sometimes they'll have a technician that is not qualified to make a diagnosis," Butler said. "It could be out in the desert that they [are presented with] a skin lesion that they don't recognize. With this system, they can take a sample of that, do their digitization and send it back to AFIP. Then AFIP can come back with its diagnosis."
Butler sees civilian applications for WSSRD as the push continues to reduce medical errors by automating records. An essential part of that system would require digitizing old patient records.
"It's wonderful to go forward with that, but if I don't know what the baseline labs were for a patient, then I don't know where the starting point is," Butler said. "To properly assess the health of a patient, you need the history."
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