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How a word processor simplifies pathology reporting.

Like many people, we thought a word processor was a glorified typewriter. Our laboratory's first IBM Displaywriter would stretch our secretarial skills, we knew, but it didn't seem to promise much change in the way paperwork was handled.

How wrong we were. As Lee A. Barbieri has noted ("Word Processing with a Microcomputer," MLO, May 1984), a word processor can be used to compile and update procedure manuals, and to prepare reports, correspondence, forms, memos, and bills, often in a fraction of the time consumed by manual methods. We have found our share of valuable uses and labor-saving features.

For example, we can preview proposed formats for different kinds of reports, since everything entered on the keyboard initially appears on a CRT screen. Should the page be typed on vertically, 8-1/2 X 11, or horizontally, 11 X 8-1/2? Will seven columns be too crowded? Does it look better if the row headings are switched with the column headings?

After trying different formats, we usually present the possibilities to the pathologist or supervisor for whom the work is being prepared. The person involved may suggest further variations. Since it's so easy to move things around, we can entertain new possibilities without sacrificing very much time.

We prepare all the pathology and cytology reports, in addition to our more routine secretarial work. The word processor enables us to generate the reports rapidly, uniformly, and accurately.

Our laboratory has a standard pathology report form with pre-printed headings (patient name, age, room number, surgeon's name, etc.). Patient information is typed in the appropriate spaces, along with a gross description of the submitted specimen, the microscopic findings, the diagnosis, and the SNOP (surgical nomenclature of pathology) code.

the word processor's printer automatically fills in the pathology form after we have entered all the information into the microcomputer and proofread it on the screen. We use a four-carbon form, and there are no erasures.

None of the information headings appears on the screen. How then do we know how much room to allow for each entry so that the printer will type the patient's name, address, and other data in the correct spaces on the form?

We have set up a "shell" with stop codes marking the places where we need to stop and provide information. This shell is comparable to a set of tabs on a standard typewriter. In this case, however, the tabs differ for different lines of the report, and we can automatically skip lines, too.

We ordinarily get tape recordings of the gross descriptions, which are usually performed by a pathologist assistant, on the day the specimens are received. We are then able to prepare the first part of the pathology report--patient information plus the gross description. This is stored on a floppy disk. On the top strip of paper that holds the multi-copy form together (later discarded when the copies are separated), we note where the preliminary report is stored on the floppy disk and where the next typing line will be.

The pathologists refer to the preliminary reports as they perform microscopic examinations and tape their descriptions and diagnoses. The reports are given back to us with the tapes. The notations at the top tell us on which line to begin adding the information dictated by our pathologists.

The primary advantages of this entire approach are the ease with which we can make corrections and print perfect copies, and the ability to store information for a day or two without generating a final report, pending special stains or recuts sought by the pathologists.

Every month we review all the surgical specimens and, in a separate file we record cases where cancer was found. We enter the surgical specimen number and the SNOP code, which indicates the topography and morphology of the specimens that were cancerous.

the information is stored permanently on a floppy disk. It enables us to list cancer cases by site (topography), such as skin, breast, prostate, or lung, and by type (morphology), such as adenocarcinoma, epidermoid carcinoma, transitional cell carcinoma, or a combination of more than one type. In this manner, pathologists and clinicians can follow the reliative incidence of different kinds of cancer among our patient population.

Our cytology report forms required a shell with stop codes for patient information and laboratory findings, just as the pathology forms did. One convenient aspect of preparing these reports is a set of 43 standard descriptions for class I cytological smears, developed several years ago by our cytologist. When dictating during his examination, he refers by number to the appropriate description. We call up the description by pressing the number keys.

A stroke of the "get" key and the 1 key will automatically produce this report: "Negative Class I Papanicolaou Smear: This smear shows a predominance of precornified epithelial cells. Cornified epithelial cells and polymorphonuclear leukocytes are also present." The 2 key issues a similar message, except that it's in the plural--smears instead of a smear. And 3 reverses the epithelial cell observations by making the cornified cells predominant.

We can also combine descriptions. If the cytologist cites 25 and 38 in connection with a class I smear, the report will contain these two sentences: "trichomonas is present. This is not an atrophic smear."

For smears in classes II through V, we enter the cytologist's dictated comments onto the CRT screen. As with class I smears, these are then automatically typed onto a cytology report form.

Our pathologists have a policy calling for all suspicious (classes III and IV) and positive (class V) Pap smears to be followed up monthly. The intent is to be certain that physicians who submitted such slides have seen the reports, contacted their patients, and made arrangements for some furtheer step, such as a repeat Pap smear or a biopsy. We keep track by setting up a microcomputer file with the patient's name, physician's name, specimen number, type of specimen, and class of smear. This file indicates whether or not we have received a follow-up specimen after our initial report.

Each month on the microcomputer, we call up all suspicious or positive specimens lacking evidence of further action. The physicians concerned are sent a letter indicating that no follow-up is in our records.

No glorified typewriter can come close to doing all this.
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Copyright 1985 Gale, Cengage Learning. All rights reserved.

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Author:Hastie, Gina M.; Pyles, Lois
Publication:Medical Laboratory Observer
Date:May 1, 1985
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