Demand more: What GI physicians should expect from their pathology lab

The work of a pathology laboratory is immensely critical, as patients anxiously wait to hear word of a disease or clean bill of health. During that time, histotechnicians and pathologists are hard at work to produce an accurate, and potentially life saving, report and diagnosis.

This content is sponsored by Boston Scientific.

To ensure physicians deliver accurate diagnoses, histotechnicians and pathologists must work closely to provide this precise and timely information:


• Histotechnicians prepare thin slices of human tissue working with precision equipment, dyes and chemicalsto make abnormalities visible for microscopic examination by the pathologist.
• Equipped with slides prepared by histotechnicians, pathologists study the lab samples of body tissue to discover the causes and effects of diseases.
• Pathologists then relay their findings to physicians to make diagnoses.

While some pathology labs deliver diagnoses within multiple specialties, others, such as Boston Scientific, hone in on a single specialty. Located in Alpharetta, Ga., the GI-specialized pathology lab is certified by the College of American Pathologists.

"The things that we do everyday at Boston Scientific Pathology, including efficient turnaround time, high diagnostic quality and quality customer service, are in my opinion, things that should be the industry standard. Unfortunately, they're not," says Jeremy Miller, MD, Boston Scientific Pathology medical director. The pathologist's diagnosis influences how physicians approach the patient's treatment plan, so it's vital to deliver a high-quality analysis for every test.

What sets a GI-specialized pathology lab apart
Although similar to multispecialty labs, a GI-specialized pathology lab promises expert clinical value because all staff members are specifically trained in the specialty.

"For that ASC clinician who is solely focused on the GI tract, there is a level of confidence when you have specialty-trained pathologists and histotechnicians," says Torey Andrews, pathology lab manager at Boston Scientific. "They are going to give the best care to make the proper diagnosis and treatment plan for patients."

The specially trained staff continuously enhances their skills as they are only dissecting and orienting tissue from one area of the body. Histotechnicians and pathologists specializing in gastroenterology examine diseases of the liver, gallbladder and pancreas.

"Having continued handling of a particular tissue type allows for every member of the team to become experts in that area," says Ms. Andrews. "In multispecialty labs, you open the window for mishandling of certain tissues, and there can be a mix-up."
The specific knowledge GI specialty-trained histotechnicians bring to the table results in a close working relationship between histotechnicians and pathologists in a specialty lab.

"There's a need for communication and that relationship builds that skill set and knowledge of histotechnicians, and why there is such a reliance on histotechnicians," she adds. Histotechnicians know exactly what a specimen looks like upon receipt and understand how to properly dissect it.

"Diagnostic quality stems from the fact that our pathologists are GI specialized, and equally important, our histotechnicians that make the slides are GI specialized as well," says Dr. Miller.

GI-specialized pathology makes a difference when diagnosing sessile serrated adenomas, a premalignant flat lesion of the colon, for instance.

"This lesion is very difficult to diagnose and recent publications have shown that GI-specialized pathologists have a higher rate of diagnosing these lesions," Dr. Miller explains. A pedunculated polyp with a stalk attached to it is another instance where GI-specialized pathology can be a game changer. Histotechnicians must orient this specimen properly in order for the pathologist to not just provide an accurate diagnosis, but also provide definitive margin analysis.

"If a specimen is not oriented properly at embedding, the pathologist will not see that specimen properly, especially when it comes to tumors," explains Ms. Andrews. "You want to have a team that is very cognizant in the specimen they're handling." This confidence among the lab staff yields definitive diagnoses and consistent margin calls.

Additionally, the relationship between the pathologists and the gastroenterologists plays an important role. This relationship is a two-way street, requiring clinical staff to offer as much patient and procedure information as possible to the pathologist.

A study published in the Journal of Clinical Pathology dove into the relationship between pathologists and gastroenterologists, noting, "Pathologists must ensure accurate assessment and clear and relevant reportage, and the gastroenterologist must ensure proper and adequate sampling." Errors may occur due to miscommunication between these two entities, from varying verbiage to confusing clinician queries.

What you should expect from your GI pathology lab
A pathology lab delivering excellent customer service will likely achieve the following three missions:


1. Quality focus. Ensuring high quality should be the number one priority in any pathology lab. "A lab that focuses on quality is more adapt to ensuring it is going to get things right the first time," Ms. Andrews says.
2. Turnaround time. Customers want answers fast, and technology allows labs to meet those expectations. "We want to make sure [we deliver] fast and accurate diagnoses," adds Ms. Andrews.
3. Change management. Many labs are onboarding new clients, and these customers need to have a grasp of the compliance components regulating pathology labs. "Labs should set up clients for success, from how to submit a specimen to what's required on a requisition," Ms. Andrews says.

In addition to quality customer service, a high-performing GI pathology lab will possess accreditations. CMS requires all labs be certified under the Clinical Laboratory Improvement Amendments, which were designed to guarantee quality laboratory testing. Many healthcare providers may not realize, however, that the CAP laboratory accreditation is voluntary. The accreditation process spans two years, leveraging a peer-based inspector model encompassing regulatory and educational guidance. With the CAP certification, labs are eligible for Medicare reimbursements and are equipped with more power when negotiating payer contracts.

The CAP accreditation assists labs with meeting CLIA requirements, ensuring compliance and maintaining test result and patient diagnosis accuracy. "Accreditation plays a huge part for our customers," says Ms. Andrews.

In addition to accreditations, be sure to assess turnaround times. A GI pathology lab deals with small specimens, so the turnaround time for a report should occur as quickly as possible; the Boston Scientific Pathology lab set an internal standard to report on 94 percent of their cases within one business day from receipt, for instance. The company offers a secure online portal, which provides customers with real-time, 24/7 access to their GI pathology reports as well as direct results interfaces into their client's electronic health record and/or endoscopy report writer.

Customers should expect meaningful clinical data from their pathology lab that helps them best understand their practice and report key quality measures. These diagnostic reports should highlight data that relates to the following:


• Diagnosis summary
• Cancer registry
• Adenoma registry
• Referring physician list
• Options for adenoma detection reporting

Beyond traditional services, GI pathology labs can become a resource for researchers and physicians interested in data gathering and reporting. Many Boston Scientific clients want to know what information a lab provides to the National Tumor Registry. This information offers providers insight into how many specific tumor types a lab diagnoses annually. Many providers are interested in a particular age group prone to tumors, for example, for their own research.

Boston Scientific is also committed to offering personalized communication with its pathologists for any malignancy, highgrade dysplasia and significant abnormal diagnoses. A high-quality pathology lab will offer its customers access to pathology support experts as well as education programs for ASC and practice staff.

"Physicians should demand more from their pathology laboratory," emphasizes Dr. Miller. "We want to be directly involved in the patient's care and management, and the way that we do that is the way that we communicate directly with our customers."

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