HK1136056B - Report generation with integrated quality management - Google Patents

Abstract

Reports are generated by a computing engine using user inputs to a template and automatically added quality management values. Quality management reports can be automatically generated at selected intervals, such as daily, monthly, and yearly. Users are thus able to meet required quality assurance standards.

Description

Report generation with integrated quality management

Technical Field

The present invention relates to a method and system for generating reports incorporating multiple values from a database and including quality management information, and more particularly, to a system and method for generating pathology reports with sufficient quality management to meet required criteria.

Background

Generating reports by ordinary writing (longhand) can be a tedious, time consuming task. Inventions such as shorthand and dictation with transcription shorten the amount of time required to generate reports.

Dictation software such as Naturally Speaking by Dragon and Via Voice by IBM has evolved to include advanced versions that take into account the limited command control functionality of macrocommands and Voice commands such as Via Voice. Not only is the data from the report transcribed by the software, but the software also has limited ability to allow the user to dictate commands to the software, so the software can provide formatting operations or can move within the text without user intervention.

In modern world standards, regulations, and ordinances often require a certain amount of quality assurance or quality control over various reports that affect people's lives. Typical quality assurance requires sampling five or ten percent of the total number of reports generated to determine if the reports were properly generated. Any sampling scheme requires careful selection of samples to be representative of the original population (here the total number of reports generated).

Beginning in approximately 1990, pathologists began using computer dictation software to generate reports. A general problem arising from the use of dictation software or dictations replaced by software in general is that it is difficult and time consuming to generate useful quality assurance reports.

It would be advantageous to have a system and method of generating reports that provides better quality management than those currently available.

Disclosure of Invention

According to one aspect of the invention, a system is provided that includes a configurable data retrieval device and an input device configurable to receive data and one or more commands. The system also includes a calculation engine coupled to the input device for at least a period of time. The compute engine receives data in one or more commands from the input device, and the compute engine is configured to access the configurable data retrieval device. The computing engine is further configured to generate a report, wherein the report includes the data, the value retrieved from the configurable data retrieval device in response to at least one of the one or more commands, and the quality management value determined by the computing engine. The computing engine is further configured to store the data in one or more selected locations in the configurable data retrieval device in response to a selected command from the one or more commands.

According to another aspect of the invention, a method of creating a report is provided. The method comprises the following steps: a record is entered about one or more observations using an input device. These records include one or more commands on how to present one or more observations in the report. The method also includes a device receiving the records from the input device, and the device extracting one or more commands from the records and arranging one or more observations in a report based on the one or more commands. The method further includes the device adding the one or more quality management values to the report and generating the report.

According to still another aspect of the present invention, there is provided a database system including: a first set of records, wherein each item in the first set of records corresponds to a data item of a category in the first set. The database system also includes a second set of records, wherein each entry in the second set of records corresponds to a command of a category in the second set. Each command of a category in the second set includes a corresponding code. The database system also includes a database engine configured to retrieve a string of values, wherein each of the string of values corresponds to an item in the first set or a code in the second set. The database engine is further configured to respond to the code with a corresponding command from the second set of records. The database engine is further configured to respond to selected data items having one or more quality management values in addition to one or more records in the first set of records and the second set of records.

According to yet another aspect of the invention, another method of generating a report is provided. The method comprises the following steps: providing a plurality of data fields editable by a user entering a record using the data entry device; and providing navigation by a user to any of the plurality of data fields using the data input device. The method further includes obtaining the record in database format from an input device and providing the automated report via electronic transmission.

Drawings

Various aspects of the present invention will become apparent and more readily appreciated from the following description of the presently preferred exemplary embodiments, taken in conjunction with the accompanying drawings of which:

FIG. 1A is a general data flow diagram for report generation according to one embodiment of the present invention;

FIG. 1B is a flow diagram of a general method of report generation according to one embodiment of the invention.

FIG. 2 is a data flow diagram of initial data collection in a process of generating a report, according to one embodiment of the invention.

FIG. 3 is a data flow diagram of an initial procedure and inputs according to one embodiment of the invention.

FIG. 4 is a data flow diagram of an optional secondary program and input values according to one embodiment of the present invention.

FIG. 5 is a data flow diagram of generating a final report item according to one embodiment of the present invention.

FIG. 6 is a data flow diagram of a daily transfer including daily report generation and backup according to one embodiment of the present invention.

Fig. 7 is a data flow diagram of monthly quality assurance report generation according to one embodiment of the present invention.

FIG. 8 is a data flow diagram of initial data collection in a pathology report generation embodiment of the present invention.

FIG. 9 is a data flow diagram of a pathologist's initial exam in a pathology report generation embodiment of the present invention.

FIG. 10 is a data flow diagram of a pathologist slide exam of a pathology report generation embodiment of the present invention.

Fig. 11 is a data flow diagram of a pathologist sign out (sign out) of a pathology report generation embodiment of the present invention.

Fig. 12 is a data flow diagram of daily transfers performed in a pathology report generation embodiment of the present invention.

FIG. 13 is a data flow diagram of a quality assurance report generated in a pathology report generation embodiment of the present invention.

Detailed Description

As used herein, the following terms are given the following definitions when interpreting the specification and drawings. A user includes a person or machine that provides input through an input device. Observations include results that a user sees, determines, or computes using any available natural, augmented, or artificial perceptions. The record includes observations, commands, and/or representations of observations and/or commands. The compute engine comprises a device, computer, or network attached device or computer that provides computing power to process input from an input device, retrieve items from a database, memory, or over a network, and/or compare, compute, or compute a plurality of values in any way based on input or stored values, such as quality management metrics. Data includes any one or more data, and thus "data" refers to any one or more values, observations, or records of a general term. The commands include data used by the compute engine to represent locations in memory, decision parameters, and/or representations of steps of the overall process to be performed. The automatic update mechanism includes a method of updating more than one local and/or remote record without user intervention. When any one linked record is changed, all linked versions of that record are changed by an automatic update mechanism. The auto-update mechanism updates from a changeable item to a linked item in only one direction. The database may comprise a flat file database or may comprise a multi-tiered or relational database. An entry in a database may be a pointer to another database, or may be a data entry, or it may be a command code that indicates to the database engine that a command needs to be executed, as opposed to data being entered into a report or template.

As shown in FIG. 1A, a general flow diagram 100 of one embodiment of the invention illustrates a user 105 providing data, observations, records, commands, and/or other values to or through an input device 110. The input device 110 provides the user's data, observations, commands and/or values to the calculation engine 115. Further, compute engine 115 may read values from one or more databases 120 and/or external information stores 130. The calculation engine 115 may also store the user's data, observations, commands and/or values in one or more databases 120 and/or an information store in the external information store 130. The calculation engine 115 incorporates the input provided by the user(s) through the input device 110 with the entries in the database 120 and/or the entries in the external information store 130 into one or more reports 125. One or more reviewers 135, which may or may not have access to the external information store 130, may review the reports 125. In generating one of the reports 125, one of the reviewers 135 may become the user 105. It should be noted that the database 120 and/or the remote information store 130 may be local to the user or remotely accessed over some type of network.

The input device 110 may be different in different embodiments of the present invention. In one embodiment, the input device 110 is a voice dictation and transcription device or system. For some applications, quietness may be more important than hands-free. In another embodiment, the input device 110 is a real or virtual touch screen or touch pad, including a touch pad projected into space or onto a surface. In some instances, the hand will provide more useful input than voice. In yet another embodiment, the input device 110 is a stylus on a screen or surface, or other handwriting recognition system. Other input devices 110 are also contemplated, as will be apparent to those skilled in the art having the benefit of this disclosure.

According to various embodiments of the present invention, the input device 105 is a microphone loaded into a calculation engine 115 for processing speech recognition and for processing database calculations. The microphone must be available for speech recognition. In one embodiment, a boom microphone may be used. In another embodiment, a head-mounted microphone may be used. Other microphone types may be used as desired.

Referring now back to fig. 1B, a general method 150 of generating a report with an integrated quality management indicator is shown. The method 150 begins with a user (e.g., the user in FIG. 1A) receiving a request to generate some type of report, block 155. In various exemplary and illustrative embodiments of the invention, the report may be a pathologist's report on slide specimens or a police's traffic accident report. Next, the user 105 uses the template, box 160. In various embodiments of the invention, a computing engine (e.g., the computing engine in FIG. 1A) may use any number of stored templates corresponding to any number of reports to be generated. The user 105 may use only the user's own templates, or the user 105 may use a common global template, or may even use templates that are available to all users of a given system. In one embodiment, the user 105 provides an indication of the desired template to the calculation engine 115 using the input device 110 shown in FIG. 1A. The user 105 enters data, box 165. In a preferred embodiment, the user inputs data using the input device 110. In other embodiments, the user may enter data using any data entry technique or device.

According to the method 150, the calculation engine 115 acts on the data, in response to which it populates the template with observations and database entries, block 170. The data entered by the user 105 may include any one or more of values, observations, commands, or records known or provided by the user 105. The observations of the user 105 may be placed in fields in the template by the calculation engine 115. Other fields in the template may be populated with database entries by the compute engine 115. The options of the database 120 to be accessed or the items in a given database to be added to the template may be selected in response to data provided by the user. The compute engine also adds a quality management indicator to the template, block 175.

Quality management indicators added to the template are permanently or temporarily added based on the template and/or fields populated into the template. Examples of quality management indicators include a mandatory error check field necessary for the results to be saved and/or transmitted, a limit entry field to accept only a corresponding set of possible entries, and/or a description or quantity field. Exemplary types of quality management indicator fields include a status field, a prediction field, a source field, a comparison field, a relevance field, a referral (referral) field, a quantitative metrics field, a recommended behavior field, an applicability field, a sample applicability field, a timing field, a delay cause field, an identification field, a location indicator field, a notification field, an adequacy (adequacy) field, and a timing field.

Examples of actual pathology quality management indicators include: tissue status, slide code, slide acceptability, pre-match, tissue source, initial assessment, initial suspicion, correlation impression, committee referral, cytomatch (cytomatch) -cytology slide to tissue slide comparison, recommended behavior based on cytomatch, suitability of sample for diagnosis, hospital consultation agreement, behavior based on hospital consultation, outcome, frozen specimen evaluation, behavior based on correlation of frozen specimen to diagnosis, number of frozen specimens, time to evaluate frozen specimens, delay in evaluating frozen specimens, delay-based behavior, degree of difference in frozen specimen and final diagnosis, pathologist identification, examination typist, last page of examination report indicator, notification of possible difference from clinical indication to pathologist, indication of lack of sufficient specimen.

According to method 150, user 105 is finished providing input and a determination is made (at decision block 180) as to whether to continue to add more input (by returning to block 165) or to generate a report (such as one of reports 125 of FIG. 1A, block 185). In some embodiments, for some paths through blocks 165-180, the computing engine does not have to add any content to the template in blocks 170 or 175 when the user 105 provides input in block 165. In some implementations of blocks 165-180, the user may provide the data in block 165 while the computing engine acts on the data in block 170 without adding the quality management indicator in block 175, or the computing engine may act on the data in block 170 without adding any content to the template in block 170 and with the quality management indicator added to the template in block 175. The report generated in block 185 may be any type of report. The reports may be archived in database 120 shown in FIG. 1A or in external information storage 130 shown in FIG. 1A. In some embodiments, the report generated in block 185 will be electronically transmitted to a reviewer, such as one of reviewers 135 shown in FIG. 1A.

Turning now to FIG. 2, an initial data collection flow diagram 200 in accordance with one embodiment of the present invention begins with a request for information 205. The request information 205 may include information to which the user 105 will provide a response or observation. The request for information 205 may also include a description of the person, place, or thing to be observed, including the number of observations. The request information 205 is provided to a data item history 210, where the user 105 can evaluate previous observations and past inputs made. The data item history record 210 may be updated with a database of context information 215. The data item history 210 and contextual information 215 may be used in a data entry file 220 for integration. Data input files 220 may include data files from any number of sources related to observations made by user 105. The data input file 220 may also be updated with historical case information 225. The historical case information 225 may include historical data related to the request information 205. The data input file 220 is linked so that updated data can be provided through the external reviewer's data 230. The data input file 220 is also capable of receiving entries from the code-name criteria value entry 240 and the code-description value 245. The report 250 is generated using a data input file 220 of values available from the data item historian 210, contextual information 215, historical case information 225, external reviewer data 230, code name standard values 240, and/or code description values 245 working together. Preferably, the external reviewer's data 230, and possibly other values, are updated using an automatic update mechanism 235.

Turning now to FIG. 3, a general flow diagram 300 illustrates an initial procedure and input 365 that receives various values from various sources. These sources include context information 315, and data item history values 310. These values may also be received from the historical case file 325. These inputs may be received from standard values 360 for all reports, including quality assurance codes and auto-query values from the items. The incorporation of these values into the initial program and input 365 is preferably caused by a user entering a code.

In one embodiment, the operations of fig. 2 and 3 are performed separately. In this embodiment, the operations of FIG. 2 are followed by the operations of FIG. 3, and then the operations of FIG. 4 or FIG. 5. In this embodiment, separate log files may be created during or after the operations of FIG. 2 and FIG. 3.

In another embodiment, the operations of fig. 2 and 3 are performed simultaneously. In a concurrently executing embodiment, the method moves directly from concurrently executing the operations of fig. 2 and 3 to the operations of fig. 4 or 5. In this concurrently executing embodiment, a unified log file may be created during or after the operations of fig. 2 and 3 are performed concurrently.

Fig. 4 shows a flow chart 400 showing inputs for an optional secondary program 480. Typically, the values from the initial program 465 are provided in the initialize secondary program 480. It should be noted that the initial program is typically provided into the secondary program values 480 through an automatic update mechanism 475. As with the initial program 365 shown in FIG. 3, the secondary program 480 shown in FIG. 4 may receive input from the data item history record 410 and the background 415. These items may also be received from historical case files 425 and/or external reviewer data 430. External reviewer data 430 is typically provided using an automatic update mechanism 435 to provide new or updated values from a storage device (e.g., one of the external information stores 130 shown in FIG. 1A) to a secondary program 480. The standard name-code-description value 455 is also typically provided in secondary program 480 based on an indication provided by user 105 as data (as shown in block 170 of FIG. 1B). The normalized values 460 for all reporting and quality assurance coding and automatic queries are provided to the secondary program 480 based on the automatic updates 470. These values from the secondary program 480 may also be stored as normalized values 460. The initial procedure 465 and the secondary procedure 480 may be used to generate one or more periodic reports 450.

Fig. 5 shows a data flow diagram 500 for generating a final report item, a final quality control encoding, and a comment 590. Typically, upon initialization of the final report entry 590, values from the secondary 580 and/or initial 465 procedures are provided. These values are typically provided through an automatic update mechanism 585. As previously shown in fig. 3 and 4, a data item history record 510 and contextual information 515 may be provided to generate a final report item 590. The historical case files 525 may also be provided to the final report entry 590. Reviewer data 530 may be provided to final report entry 590 through an automatic update mechanism 535. As described above, the standard name-code-description value 555 may also be provided to the final report entry 590, typically based on a user indication in the command. The normalized values 560 for all reports, quality assurance coding, and auto-query values may be provided to the final report entry 590 by an auto-update mechanism 570. The final report item may also be stored as a normalized value 560 for all reports.

Upon receiving at least one indication requesting an automatically generated report, the system may be configured to automatically send the report with the electronic signature of the person who completed the case via electronic output 595. Preferably, the report complies with all regulatory requirements. Electronic interface 595 preferably automatically inserts the submitter's fax number into the completed case(s) and sends the report to the submitter(s).

The interface can determine whether the submitter(s) have a valid fax number that has been verified by them, whether the case has been faxed previously, and only faxes to the submitter(s) that need the fax. If the case has been faxed before but the presenter does not know it for some reason, then there is an automatic override function to allow the latest fax to be resent.

The interface 595 may be initiated by programmed voice macros, keyboard macros, input devices, or execution via the end of a daily menu routine. It can be applied to existing cases, all completed cases, selectively applied by the user to only cases completed by the user, or any range of cases.

In addition, a notification is sent to all submitters of any case that has been retained for more than the standard time, including demographic case information, specimen information, the date the case was received, and the reason the case was retained. If there are multiple submitters for a case, each submitter will receive a fax if a valid fax number is on each submitter's document.

Turning now to FIG. 6, a data flow diagram 600 for periodic transfers is shown, in accordance with one embodiment of the present invention. Periodic transfer checks 610 are exchanged with periodic files 605. Periodic files 605 are used to generate periodic quality management reports 650 and are typically provided to user standardized files 660 for report type and to historical files 625 through an automated transfer mechanism 655. Typically, the periodic file 605 is also used to update the user standardized file 665 for all reported values, typically through an automatic transfer mechanism 655. The user standardized file 660 for report type may also be used to update the master standardized file 670. The history files 625 may include monthly case files 630, yearly case files 635, and historical case files 640. Periodic files 605 and history files 625 may be provided and stored as backup files 615, background history files 645, and/or reviewer history files 620.

Turning now to fig. 7, a data flow diagram 700 of quality management report generation is shown, in accordance with one embodiment of the present invention. Data from the monthly case file 705 is included in the monthly quality assurance file 715. The monthly quality assurance file 715 is used to make comparisons, consistency checks, and reviews 720. Typically, the historical quality assurance file 725 is provided through the automated transfer mechanism 710 along with the comparisons, consistency checks, and reviews 720 to generate reports 750, which may be generated by category. The categories of quality assurance reports generated are defined by the user or by the system. Examples of quality assurance reports include status verification, predictive validation, and user efficiency and/or accuracy/reliability. In various embodiments, a separate report may be generated for each quality management indicator. In other embodiments, the report may be generated based on cross-correlation between or among multiple quality management indicators.

Turning now to fig. 8-13, embodiments of pathology report generation of the present invention are described in detail.

The general process is to look at the pathology laboratory in the hospital for all tissues coming through the hospital from any source. The source may be surgery, biopsy or examination. Whatever the tissue, any specimen used is sent out through the pathology laboratory. Anything observed in the pathology laboratory requires a report to be written.

Reports are written at various stages during the examination. For example, a preliminary examination of an original specimen slice of a body, slide, or the like is recorded. The tissue may then be sent for special investigation. A particular researcher may perform their own internal staining or procedures on specimens sent for a particular study. In all cases, they generally prepared cross sections for microscopic observation. Once this is done, the pathologist will examine the cross section and make another report. After the second report is completed, a diagnosis will be given by the pathologist. The diagnostic report will be completed, signed and sent to the referring physician.

Sometimes, the reported diagnosis is inconclusive. This can be a difficult case. The pathology is sent out for an outpatient consultation (outpatient consultation) or for someone to examine it and obtain a second or third point of view. If an outside consultation is required, additional reports will be sent.

According to various embodiments of the invention, in all of the various stages, there are multiple databases for tracking each of the different reports. These reports are transferred from one database to another as the case passes through the offices of different physicians.

The history of the reports may be saved in a monthly file, a yearly file, and a historical file. Monthly case files typically have quality control or quality assurance reports relating thereto. There are many different reports depending on the type of slide, or specimen, or the particular matter to be examined anywhere depending on the slide quality, review quality, quality of the out-patient consultation. These reports include information such as how long it takes to process the cases, the quality of the examination, the quality of the preliminary diagnosis of the practitioner as opposed to what the pathologist sees. Each set of items, each template, each report, and each item of each template is preferably a separate database from the databases linked by the unique identifier. The databases and their corresponding database structures and configurations described herein are exemplary and illustrative, however, other databases and database structures and configurations may be used as desired. For example, a single database merged database may be used.

These databases are updated for each new report written and for completeness so that the pathologist holds a history of all reports completed, daily, monthly, yearly, and personal. Each pathologist has a standard database for each field, and there is a separate database for each pathologist. The daily case file can be used by anyone using the system. Each pathologist may have a different view of the daily case files. That is, each pathologist can view the daily case files using the same database and using different display screens that identify the pathologist. In looking up the standard cases, each pathologist may have their own standard file using their own standard cases. There is also a master standard file containing all standard cases, and if a pathologist encounters a case that is not in the pathologist's standard case file, the pathologist can access the master standard file to determine which case standard file to use.

Whether the examination is a visual examination or a microscopic examination, whether the activity is a diagnosis or a consultation, if the diagnosis needs to be changed, or if there is already a series of examinations, the data is put into the appropriate fields saved into the database for the specific patient and the specific tissue by dictating the data and voice commands. A specific billing code may be generated for each diagnosis. The system automatically tracks the date and time of each item. Basic demographic data of the patient may be automatically limited. Daily reports may be printed automatically. Monthly quality assurance reports may be automatically printed. At the end of the month, the data may be transferred to appropriate files, calculations made, reports printed, all analyses made, and monthly quality assurance reports may even be transferred directly to the hospital so that the hospital knows the quality assurance parameters for each pathologist working at that time.

The billing code may be automatically generated according to the type and quantity of specimens examined. The correct billing (CPT) code is also automatically assigned if any additional steps, specimen analysis, testing, or special handling of the specimen are required during the examination process. Each billing code is linked to a particular case and, if desired. May be printed with the case information or transmitted electronically to a billing service or other billing report. This procedure allows billing codes to be retained with the appropriate cases for future review or audit as needed. In addition, this ensures accurate and timely patient billing while complying with any government approved billing changes or restrictions. If desired, the billing code may be printed with the completed case report and electronically transmitted (including automated facsimile) to the appropriate billing address.

According to the illustrative pathology report generation embodiment, beginning with fig. 8, the method begins with an initial data collection data flow 1200. The specimen laboratory request 1205 may include patient account information and a specimen description for use by the pathologist. The data in the specimen laboratory request 1205 is provided to or integrated with the histology log 1210. The histology log 1210 may include a description and quantity of all specimens and slides examined by a pathologist in a given group, institution, hospital, etc. The patient demographics 1215 may include name, date of birth, gender, hospital, billing number, room number, etc. The patient demographics 1215 are provided to the histology log 1210 and also to the specimen file log 1220. The specimen files from the hospital physician, the outside physician, and the medical team physician are all in the specimen log file 1220.

Historical case information 1225, which may include case numbers, demographic information, specimens, description, and diagnostic data, is automatically linked to the specimen log file 1220, typically by account number or name lookup. Physician information 1230, typically found by name (which may include code, medical area, and phone number) is also provided to the specimen log file 1220. The tissue name, standardized location name, and code 1240A are typically incorporated into the specimen log file 1220 by user input commands. A standardized description of tissue type and code 1240B and a standardized sample specimen description 1240C are also incorporated into the specimen log file 1220, typically by user input commands.

A slide and specimen preparation and histology log 1210 may be generated. The initial log automatically retrieves patient demographic information based on the previously assigned patient id hospital number. The log also allows for automatic retrieval of previous case history information by the aforementioned hospital id. If id does not exist, a lookup function is used to examine the previous case by patient name and retrieve the data corresponding to the current patient.

Specimen location and type are entered by lookup into standard anatomical pathology descriptions linked to appropriate (CPT) billing codes. This log information is transmitted to the pathologist's first case exam data and saved in the histology database for future use. The block number of each slide is automatically calculated according to the specimen type and the pathology slide required. The block allocation can be influenced by examining the pathologist, if necessary. The link between the completed case exam and the histology log is maintained with an automatically generated case number and allows specimen quality information to be sent back from the completed case to a log file for subsequent reporting and review.

Turning now to FIG. 9, a data flow diagram 1300 is shown for a pathologist preliminary examination in accordance with a pathology report generation embodiment of the present invention. The generation of the daily preliminary exam 1365 includes the use of input device 110, which may include dictation, keyboard, or voice input to visually inspect one or more specimens. The specimen log file 1220 is incorporated into the daily preliminary exam 1365. Patient demographics 1215 may be incorporated into the daily preliminary exam 1365. Histology log 1210 data may also be incorporated into the daily preliminary exam 1365. Historical case information files 1225, physician data 1230, and tissue names 1240A may also be incorporated into the daily preliminary exam 1365. Physician data 1230 is preferably retained for new and revised information by the automatic update mechanism 1330 so that the daily preliminary exam 1365 is always up-to-date. Tissue area standardized location codes 1340B and disease name standardized codes 1340C may also be incorporated into the daily preliminary exam 1365. Standardized exam files 1320 are preferably incorporated into the daily preliminary exam 1365 through an automated transport mechanism. A tumor standardized description and billing code file 1340A may be incorporated into the daily preliminary exam 1365. In fig. 9, preferably, the combination is made by a user inputting a command or instruction.

Turning now to FIG. 10, a data flow diagram 1400 of a pathologist slide exam of pathology report generation is shown, in accordance with one embodiment of the present invention. The generation of the daily slide exam 1480 includes the user 105 describing one or more visual exams of one or more specimens using the input device 110 (including dictation, keyboard, or voice input). The daily preliminary exam 1365 is incorporated into the daily slide exam 1480. Daily preliminary exams 1365 are provided to the daily slide exam by an automated transport mechanism 1465. Patient demographics 1215 are incorporated into the daily slide exam 1480. The histology log 1210 may also be incorporated into a daily slide exam 1480. Historical case information files 1225, physician data 1230, and tissue names 1240A may also be incorporated into the daily slide exam 1480. The physician data 1230 is preferably retained as new and revised information by the automatic update 1330 so that the daily slide exam 1480 always includes up-to-date information. A tissue region standardized location code 1340B and a disease name standardized code 1340C are also typically incorporated into the daily slide exam 1480 by user input codes. The standardized exam files 1320 are typically incorporated into daily slide exams 1480 through an automated data transfer mechanism 1420. It should be noted that the daily slide exam 1480 may be reintegrated into the standardized exam files 1320. Tumors, special staining, and billing code files for additional analysis requests, patient billing, and quality assurance 1440 are preferably incorporated into the daily slide exam 1480.

Turning now to FIG. 11, a data flow 1500 of pathologist sign out in pathology report generation is shown, in accordance with one embodiment of the present invention. Daily slide exams 1480 are provided to the pathologist sign out 1590 through update mechanism 1580. The patient demographics 1215 and histology log 1210 may be incorporated into the pathologist sign out 1590. Historical case information files 1225, physician data 1230, and tissue name standardized location names and codes 1240A may also be incorporated into the pathologist sign out 1590. Physician data is typically updated for new and revised information through the automatic update mechanism 1330 so that pathologist sign out 1590 always has the most up-to-date information. Tissue area standardized location codes 1340B and disease name standardized codes 1340C are also incorporated into the pathologist sign out 1590, typically by user input codes. Tumor, special stain, and billing code files 1440 are also typically incorporated into pathologist sign out 1590 with command codes. Standardized exam files 1320 are automatically transferred to pathologist sign out 1590 through automatic update mechanism 1420. The pathologist sign out 1590 values may be reintegrated into the standardized exam file 1320. Pathologist sign out 1590 should include the diagnostic terms and final quality check comments and coding.

Upon receiving at least one indication of a request for an automatically generated report, the system may be configured to automatically send via facsimile output 595 a case report with an electronic signature of a pathologist who has completed a case diagnosis. The report preferably complies with all regulatory requirements (e.g., HIPAA). The fax interface automatically inserts the fax number of the submitting physician(s) into the completed case and sends a report to the submitting physician(s).

The interface can determine whether the submitting physician(s) have a valid fax number that has been verified by them, and whether the case has been previously faxed and only faxed to the physician(s) who need it. If the case has been faxed before but if the physician does not receive it for some reason, the automatic override function allows the latest fax to be retransmitted.

The interface may be initiated by programmed voice macros, keyboard macros, input devices, or execution via the end of a daily menu routine. It can be applied to existing cases, all completed cases, or selectively by the pathologist to only the cases completed by him or her. The user may automatically select their own report or all completed reports for faxing.

Further, a notification is sent to all submitting physicians informing them that any case has been retained for more than the standard time, including demographic case information, specimen information, date the case was received, and reason for retaining the case. If a case has multiple submitting physicians, each physician will receive a fax if a valid fax number is on the file for that person. The retained cases that have been faxed are marked to prevent the same case from being sent multiple times until completion. If desired, the case is retransmitted to any other attending physician or sent to the first few physicians upon request. The transmission is accomplished by a calculated link between the attending physician(s) for one case, a separate data file containing transmission routing information, and a programmed link established in the report to communicate appropriate dialing and/or routing instructions to a fax server or other electronic service.

Turning now to fig. 12, a data flow diagram 1600 for daily transfers for quality assurance purposes is shown. The daily case file 1605 typically includes all pathologist exam results, quality checks, quality assurance coding, and billing information. The data transfer check 1610 is executed by the computing engine to check that the quality assurance code is complete, that the date is correct, and that all cases that have been retained are reviewed for completion at the request of the pathologist. Daily case files 1605 exchange data with a data transfer exam database 1610. Daily reports 1450 may be automatically generated from daily case files 1605 by an automatic update mechanism 1655. The daily case files 1605 are provided to and updated with standardized physician's exam file 1660. Standardized physician exam files 1660 may contain initial and final pathologist reviews, and quality assurance coding. All daily case files can be converted to standard templates for future exams, except for the standardized physician exam file 1660. It should be noted that the daily case file information 1605 may also be provided to a standard back-up standardized physician exam file 1665.

The standardized physician exam file 1660 may also be used to update a master standardized exam file 1670 (which includes standard templates for all physicians). Daily case files 1605 are provided and incorporated into historical case information files 1225, including one or more of monthly case files 1630, yearly case files 1635, and historical case files 1640. Each monthly case file 1630 includes all pathologist exam results, quality assurance checks and coding, and billing information over a one month period. The monthly case files 1630 are used for monthly quality assurance reports. Each annual case file 1635 includes all pathologist exam results, quality assurance checks and coding, and billing information over a year's time. The historical case file 1640 includes all pathologist exam results, all quality assurance checks, and all coding and billing information for all time periods. There are also backed up annual case files 1615 that are saved for backup purposes. There will also be a name history file with patient demographics 1645 that will be maintained for all patients. The hospital case history file 1620 may be updated for all cases for a given hospital.

Turning now to FIG. 13, a data flow diagram 1700 is shown in which a quality assurance report is generated for a pathology report generation embodiment of the present invention. The monthly case files 1630 are incorporated into the monthly quality assurance files 1715 for the hospital, outside medical group, physician, etc. These values are preferably transferred using an automatic update transfer mechanism 1710B. The monthly case files 1630 are also incorporated into the historical quality assurance files 1725 for the hospital, external medical group, physician, etc. using the automated data transfer mechanism 1710A. The monthly quality assurance file 1715 may include one or more of the following groups shown at 1720: diagnostic comparisons, breast examinations, specimen quality, tissue correlations, cryopreservation comparisons, cytological comparisons, slide quality, retention time, internal physician reviews, and/or external hospital consultation physician reviews. These groups are merely exemplary and illustrative, and may include other groups. The monthly quality assurance file 1715, which includes the subsets in 1720, is used to generate a quality assurance report 1715 for any one or more of the subsets including diagnostic comparisons, breast examinations, specimen quality, tissue correlations, cryopreservation comparisons, cytological comparisons, slide quality, retention time, internal physician reviews, and/or external hospital consultant reviews. These quality assurance reports are exemplary and illustrative only, and other reports may be generated as desired.

According to various aspects of the present invention, a pathologist can input data on the spot while performing an observation. The pathologist is allowed to enter data for a particular case, so this is expected, and the system can create reports at the end of the day, at the end of the week, or at any time, which becomes the basis for quality assurance on any anatomical pathology specimen sent to the hospital or laboratory. The american academy of pathology (CAP) requires ten percent of all cases to be reviewed, but does not require which and how to review these ten percent. CAP requires a reviewer to explain which cases were reviewed and how they compare to general expectations. If the cases being reviewed do not match the general expectations, the report must explain why they do not match the general expectations and whether they have a serious impact on the patient.

When quality assurance is performed in return, much data is skipped. It is difficult to go back to scrutinize these materials and extract information that can be used to improve the quality performance of the pathological system. Retrospective review only extracts a small fraction of cases, representing a small fraction of the work performed. According to various embodiments of the present invention, up to 100% of cases may be performed up to 100% of the time based on anticipated, ongoing reviews. In one embodiment, more than 90% of all cases are reviewed.

Histology is the preparation of slides and the preparation of materials. The pathologist removes the wet tissue (like breast tissue), for example, takes a tissue section, and then places the tissue on a glass slide through a process that causes it to grow out. The tissue is then examined under a microscope. During the preparation from wet tissue to glass slides, a staining process is performed. One quality assurance report that is required is the quality of the staining process.

In performing a daily preliminary exam 1365, or a daily slide exam 1480, or a pathologist sign out 1590, the user 105 (here the pathologist) will remember the standard template to be filled in for the particular report. The template may be from a pathologist's personal collection of templates or may be retrieved from a standard template database. Navigation from item to item in the template is performed by voice commands or other commands through the input device 110 shown in FIG. 1A. In one embodiment of the invention, new item positions are made in the middle of the report, wherein the item positions set at the beginning or end of the report are unalterable.

As an example of observation using data and commands, a visual inspection of the tissue is considered. A template for visual inspection is identified that is limited by the voice command (pull in) at which the visual inspection occurs. The second voice command may indicate a variety of biopsies, for example, a gastric biopsy and a rectal biopsy. The voice command defines the described field data required for the visual examination of various biopsies of the stomach and rectum based on the given data and commands. If the stomach presents with chronic gastritis or mild chronic gastritis, the database system macros will restrict the required description based on what is essentially a voice-simplified operation, and also enter additional items that need to be done. If the rectum has, for example, a polyp, and there is no rectal polyp normalization template but a colon polyp template, the colon polyp template is called, modified, and saved as a macro for the rectal polyp.

The database entry may also include a billing code. The file, report, or other item may automatically enter a billing code in response to the value of the data entered into the report and/or a command within the data entered into the report. As an example of a quality assurance mechanism that can be automatically applied to reports without other input required by the pathologist or user, consider pathological reports that do not provide anamnesis. Quality assurance reports of daily, monthly, yearly, or any historical value for a given pathologist group or hospital will highlight terms that do not have the anamnesis provided.

The quality assurance data may be filled in separately, may be automatically filled in by the compute engine, or may be provided automatically, e.g., as a timestamp of the start, completion, etc. of the report. Cases in which cytology needs to be compared with later tissue will be considered. The quality management report may indicate whether the cytological report is consistent with a biopsy of tissue. If there is an out-patient consultation and the case is sent elsewhere, the quality management report may indicate whether the out-patient consultation is consistent with the diagnosis made by the original pathologist. If the frozen sections are compared to a later diagnosis, or to a later preliminary review of the cryo-tissues, to determine if the cryo-tissues match the diagnosis, the quality management report may indicate whether they are consistent. In another example, CAP requires cell source (cytosource) and cell type (cytotype) data to allow reporting of how many slides will be read by a pathologist for non-gynecological cytology. Pathologists are typically limited to viewing up to 100 cytology slides a day. Daily reports determine exactly how many slides the pathologist has read.

The following are specific embodiments of the present invention for generating pathology reports with subsequent statistical reports based on at least daily and monthly basis. The whole method ensures the report precision and quality. Standardized case templates and master patient and physician data files are widely used to ensure consistent and repeatable reporting of case exams. Since 1990 there has been a 100% quality assurance review of all pathologist exams in relational databases, allowing for rapid and extensive reporting and case analysis. Data redundancy is guaranteed using regular daily backups of multiple locations, backups of data during important daily operations, including transferring data from different file structures, and multiple files of the same data. The plurality of files include monthly, yearly and historical archive files, and they are used not only as backups, but also as data sources for daily, monthly and yearly quality assurance and statistical analysis. All daily cases are printed and faxed or delivered to the attending physician(s) upon completion. Further, the cases may be printed by a group medical team, a designated physician, staff member, pathologist or secretary according to the specific case, and the specific date or range of dates of the present year or previous year(s) and the number of copies of the exam may be changed according to the desires of the group medical team or attending physician.

Efficiency of operation is ensured by considering keyboard and voice input availability for data items, navigation commands, data lookups, and selection of fields and/or records. There is a wide range of applications for both keyboards and voice macros to perform data retrieval, lookups, print requests, field calculations, searches, and the like. Standardized inspection reports can be immediately retrieved in the inspection field without the need for re-typing. A single data item combined with data from a single source is automatically transferred to a plurality of different file structures having the same field name. Automatic data retrieval is based on matching field information from the examination and the master document. The field calculation is based on the entered inspection data and/or standard values.

Information, such as patient demographic information, is manually looked up from a large number of master files for retrieving unknown case information. When the first character is entered or spoken, the corresponding value is displayed almost immediately from the master file (even with hundreds of thousands or more records in the master file). When the subsequent character is entered, the search is further refined until the desired information is found. Multiple records from the master file are displayed simultaneously and page and cursor keys can be used at any time or voice activated to select the desired record. The desired information from the master file is then automatically inserted into the check file. The lookup information (i.e., name) need not be a value placed in the check field. The code for the patient, such as the patient number, may be the retrieved value and will become the basis for automatically retrieving other patient information from the master file without performing a lookup. The selection field has only a limited number of acceptable values (e.g., pathologist name). When the data entry fields for these fields are reached, these acceptable values will be displayed (pop-up) on the screen and only one of those values may be selected.

Completed records are transferred from each file continuously on a daily basis. Daily log data is kept in a log file. The transmission is based on a date range, but is typically the current date. All the total information is transferred to the case exam file every day, the information is backed up, and then the new information waiting is deleted from the log file(s). Daily case exams and monthly completed case reports await monthly quality assurance reports and analysis. Case reports completed each year are generated automatically or on demand. There is a historical archive of all cases. Completed cases are transferred daily from the case exam file to the monthly, yearly and archival files. Once the daily transfer is successfully completed, a backup of the daily file is made and the information for the completed cases is deleted from the daily file leaving the cases in reserve until additional information or review is completed.

The description of the patient file includes patient demographic data transferred from the hospital (or clinic, etc.) file, including name, hospital number, patient number, age, date of birth, and date of arrival at the hospital.

Patient log data is generated, including the following information: case number and exam date, demographic data using automatic lookup based on patient number used to access the demographic file, and retrieval information. The attending physician information(s) includes manual name lookup from a physician file, automatic retrieval of a diagnosis code, automatic retrieval of an original code (physician practice location, e.g., surgery, OB-GYN, endoscopy, etc.), and automatic retrieval of a fax number. Case information includes the number of refrigerator slides, the type, source and number of cytological slides, the number of previously examined cases for the same patient contained in the historical archive (where manual lookup is performed based on patient name and date of birth for matching with individuals and retrieving the appropriate case number), and cytological data, if any. The cytological data includes the type of specimen (e.g., cerebrospinal fluid, saliva, etc.), the source of the tissue or substance (e.g., kidney, lung, liver, etc.), and the number of slides. Information for the specimen(s) (e.g., up to twelve (or other number as desired)) includes: sources of tissue or substance (e.g., kidney, chest, etc.) with information retrieved from the master tissue name file to ensure standardized reporting and accuracy, use free text based on the actual specimen, type of specimen (e.g., wash, biopsy, fluid, section, etc.), and specimen description is based on automatic calculation of other items.

The general exam file includes all data transferred from the log file plus the results of the pathologist's preliminary visual examination of the patient's tissue or material submitted by the attending physician(s). Patient case information from the above-mentioned input archive case number(s) is automatically printed and made available to the pathologist who performs the examination. Once the preliminary examination of the daily cases transferred from the log file is completed, the information of each case is transferred to the daily examination file. Once the case records are transferred and a backup copy is created, the information is deleted and the file is ready for the next transfer from the log file. The general exam file information includes log information, general exam results based on a pathologist's visual examination of the material, lookup value(s), if any, for normalizing case information that allows rapid input of all duplicate information from previous similar cases, pre-and post-operative diagnosis of the attending physician(s), normalizing, if necessary, tissue and disease codes, and the name of the pathologist performing the examination.

The daily exam file includes all data transferred from the general exam file plus the results of the pathologist's microscopic examination of the slides, case diagnoses, quality assurance review data, and completed case information. A variety of field types are used to help ensure accurate and complete evaluation of patient exams and acute data items. These types include force/error checking, limit items, compute and lookup fields described in the following summary. The daily exam file includes log information, total exam results, reports of a pathologist's microscopic examination of the slides, the pathologist's case diagnoses, mandatory error check terms field, limit terms field, calculation fields, lookup fields, and quality assurance fields.

Mandatory error checking entry fields require that the information in these fields can be saved or transferred before checking. The data in these fields is necessary for proper reporting of inspection results and quality assurance analysis. The mandatory error check entry fields in this embodiment are: "std" -transferring case information to standardized case file-y or n; "and" -annex cases-y or n; "cty" -type of cell sap; "cs" -a source of cellular fluid; "# cs" -number of cell slides; "rev" -the pathologist reviews the information. The check result will not be transmitted without an entry in this field. "arev" -status of the above review; "origin of specimen" -the medical area of attending physicians; "sentinel" -sentinel lymph node-y or n is present in the specimen; "report date" -completion date of the pathologist's exam (results will not be delivered if there is no entry in this field). "hold" -case complete-y or n (exam does not have to be interrupted for transfer); and "Rhold" -the reason for the reservation (no exam will be transmitted if there is no value in this field, and must have a value other than the reserved status if the case is already on reservation for more than three days).

The restricted item field is an item restricted to only one selection displayed on the screen when the field is selected.

The following is a table of restricted entry fields and associated options for each field. The values in this table are exemplary and illustrative only.

Limit term field names	Options to limit fields
		Text indicator on a single line of bc-important cases-text	n-Standard layout, g-Total of non-emphasized text and diagnostic items form 80 columns of text, ctrl F8 to access
and-indicators of annex cases with additional information	n-non-annex case y-annex case
		sentiln-cases were sent for sentinel lymph node assay	N-sentinel lymph node in Y-specimen of sentinel lymph node
Tissue cd 1-tissue status	A-abnormal D-N-no abnormal characteristic F-fibrous adhesion/fibrous occlusion
		Slide code-acceptable or problematic	01-acceptable slide 00-no slide 02-air under slide 03-coverslipper 04-irregular staining 05-broken section 06-marking problem 07-over staining 08-incomplete section 09-embedding problem 10-processing problem 11-unacceptable special staining 12-insufficient material 13-others
ASLIDE-actions to be taken if there is a problem with a slide	01-accept 02-redo
		Pre-match-pathologist description and clinical relevance	01-is, Pre DX match 02-unknown Pre DX 03-different 04-unknown ways of Pre DX to find 05-irrelevant Pre DX 06-SIMV/other 07-verbal match 08-verbal disagreement
sc-specimen code-describing the adequacy of the specimen	Sufficient 01, unsuitable marking 02, unsuitable fixation 03, one or more specimens 04 in a container, free tissue 05, insufficient material 06 on a slide, not indicated anesthesia type 07, inadequate specimen 08, unsuitable requirements

	Sufficient but not sufficient 10, incorrect specimen 11, contaminated specimen
		cs-cell liquid source	nn Bl-free bladder kd kidney bt mammary gland lg lung ty thyroid lv liver bnBone ln lymph node st soft tissue sp cerebrospinal fluid ov ovary ur urine pl pleura ac bad cavity jt joint pr pericardium oo other organs
cty-liquid source of cells	nn Urless urine bw bronchial flushing fluid pf pleural fluid csf csfbp FNA/TNBba mammary gland puncture of ovarian fluid brs brushing/smear sm saliva ot others
		Number of c # s-cell slides	Count value
correlation of cytomtch-cells with sample data	00-cell free 01-match 02-mismatch 03-others
		Acyto	01-none 02-notify physician 03-appendix report 04-pathologist review 05-CME06-GF
Pathologist	M.RundellJ.SmithL.JonesE.Yang
		sec-name abbreviation of case typist (often dictated by pathologist)	mrjslj

	New temporary blank for eystdds 1sc2sc3
		Page number	1-last page blank
sqa-secretary quality assurance	Y-correctly typed case G-syntax error C-coding error I-information incorrect O-missing data S-spelling error
		Reviewer	NO-blank EY-Yang doctor MR-Rundell doctor JS-Smith doctor LJ-Jones doctor YS-Yang doctor and Smith doctor YJ-Yang doctor and Jones doctor RS-Rundell doctor and Smith doctor SJ-Smith doctor and Jones doctor RY-Rundell doctor and Yang doctor RJ-Rundell doctor and Jones doctor XY-random Yang doctor XR-random Rundell doctorRaw XS-random Smith doctor XJ-random Jones doctor
arev	00-no review 01-diagnosis of consensus 02-consensus-appendix report 03-consensus-hospital consultation 04-consensus-review of similar cases 05-CME 06-inconsistency of opinion-hospital consultation 07-inconsistency of opinion-review of literature&Diagnosis turned into consensus
		Outside consultation	01-unused outside consultation 02-consistent outside consultation 03-consistent consultation differences 04-inconsistent consultation diagnosis 05-others

Reason for aout-sending out	00-no external hospital consultation 01-no 02-appendix report 03-other external hospital consultation 04-automated review of similar cases 05-CME06-GF
		Sentout-sending out for out-hospital consultation	NONE-MDA-free-MD anderson dr. henry-Page doctor dr. Richard-Richard doctor dr. David-David doctor pro path-propathayo-Mayo clinic TCH-texas children hospital BAYLOR-beller medical institute-OTHER
Evaluation of Cold-preserved (multiple) Cold-preserved specimens	00-unchilled 01-cryopreserved dx matched 02 with final dx-difference in wording 03-focal lesion 04-consistently delayed 05-delayed, different 06-failure to roughly identify lesion 07-sampling problem 08-slicing problem 09-staining problem 10-interpretation problem 11-labeling problem 12-communication problem 13-others
		Afxmatch-action taken if there is a problem with refrigerated specimens	01-none 02-notify physician 03-appendix report 04-review all similar cases 05-CME06-GF
rfd-causes of delay, if any	N-No-delay U-non-Schedule case C-Schedule Conflict L-MD delayed response T-Innovation
		afd-action taken after delay, if any	N-none C-coordinated review by schedule S-personnel training T-pathologist training _ -no-behavior

Characterization of the evaluation and diagnosis of fmm-cryopreserved specimens, if any	N-no refrigeration or no diagnostic ramifications M-little refrigeration diagnostic ramifications Y-very big refrigeration diagnostic ramifications
		mam-mammary material source, if any	N-mammary gland free C-core biopsy by radiologist S-core biopsy by surgeon X-partial biopsy M-mastectomy specimen L-fine needle punch location O-others
Premen-preliminary mammary diagnosis, if any	N-mammary gland-free C-calcified M-major lesions A-Arch. DistS-heterogeneous Density D-non diagnostic
		ms-preliminary suspicion of Breast cancer, if any	0-no mammary gland 1-very low suspicion 2-lower suspicion 3-moderate suspicion 4-suspicion 5-high suspicion
Correlation of mammat-pathologist's exam and clinical impression	00-no mammary gland 01-mammary gland, no information 02-mammary gland, match 03-mammary gland, no match
		sm/basc-location indicator of case referenced by pathologist	Blank BASCDSCSM
hr-indicator in case of special handling required	n-without special treatment y-desiredRequired special coloring-blank
		ha-the actions to be taken subsequently, if any	n-behavioral-free r-recut d-deeper s-multilayer slice
Hold	N-UnRetention H-Retention
		Cause of rhold-retention, if any	N-non-Retention of B-sentinel lymph node clearing C-outside consultation D-decalcification E-ER/PRK-fixation L-lymph node clearing P-physician review (which can be assigned or randomized) S-specific staining

	T-more tissues X-other sections O-computer downtime
		ahold-action to be taken after retention, if any	00-Un-Retention 01-Inactive 02-Notification pathologist 03-Notification of physicians 04-Notification of histology 05-Notification of service department 06-Notification of consultants 07-monitoring 08-GF

The calculated fields have field values that are based on values from other fields in the same file or values from other linked files. Manual data entry is not allowed since the required information is entered automatically. Default equations may be specified for a field, but they are just suggested values. This value is automatically inserted only if there is currently no data in the field. The rewriting can be performed by the operator, if necessary. Exemplary calculated fields and corresponding default equations are as follows:

mamact-breast behavior field

if[mammat]＝“01”or[mammat]＝“03”

then“01”else“03”

Type-patient case source, i.e., S, P, B or G, and initial item determination in an appropriate log file.

left([case no]，1)

Prntcase-case number, no page number

left([case no]，12)

Pcode-physician code for quality assurance report statistics

filelookup([physician.physician]，[physician.pcode]，[physician1])

Pcodee 2-physician code for quality assurance report statistics

filelookup([physician.physician]，[physician.pcode]，[physician2])

ff.o-type of attending physician-surgery, gynecologist, endoscopy, etc

filelookup([physician.physician]，[physician.o]，[physician1])

gg.1n-determination of whether it is a lymphodepletion case

select([gross]！“clearing”，“ln”)else“nl”

Lnp-whether or not lymph node clearing Page is required

select([ln]！“ln”，“Lymph Node Clearing Page Required”)else“No LN Page Required”

Whether dc-submitted cases were used for decalcification

select([gross]！“submitted for decal”，“dc”)else“nd”

Dcp-whether or not decalcification (decalcification) page is required

select([dc]！“dc”，“Decal Page Required”)else“No DecalRequired”

Sn-whether there is sentinel lymph node case

select([specimen1]！“senti”，“sn”)([specimen2]！“senti”，“sn”)([specimen3]！“senti”，“sn”)([specimen4]！“senti”，“sn”)([specimen5]！“senti”，“sn”)([specimen6]！“senti”，“sn”)else“ns”

Whether snp requires sentinel lymph node pages

select([sn]！Sentinel Lymph Node Page Required)else“No SentinelPage Required”

md-pathologist's initials

select(pathologist]＝“M.Rundell，”，“MR”)

(pathologist]＝“E.Yang，”，“EY”)(pathologist]＝“J.Smith，”，“JS”)

(pathologist]＝“L.Jones，”，“LJ”)else blank

Clinact-informing physicians of possible differences between pathological examination and clinical impression

if ([ match ] - "03" or [ match ] - "04" or [ match ] - "05" or [ match ] - "08") then "Note: Path Dx may not be consistent with the clinical impression, suggesting clinical relevance. "else blank

Specact-submitted tissue is insufficient for diagnosis

if ([ sc ] - "04" or [ sc ] - "05" or [ sc ] - "07") then ". times.note: the prescribed pathological diagnosis cannot be made. If clinically indicated, additional tissues are required, "else if [ sc ] ═ 09" then ". times.note: sufficient tissue but not the designated case diagnosis "else if [ sc ] -" 02 "then" Note, which specimen was improperly fixed "else blank upon receipt

Hcase no-case number in case special staining is required

select([hr]＝“y”，[prntcase])else null

qq. hreq date-date of special staining requirement

select([hr]＝“y”，today)else blank

Htime-time required for special dyeing

select([hr]＝“y”，time)else blank

Rholdreq-reason why cases were retained

if[hr]＝“y”then[rhold]else null

The lookup field has field values that are based on values retrieved from other fields in the linked file. Instant data searches are possible with records from hundreds to hundreds of thousands in related files. The search may be done manually by typing the closest character of the match and selecting the desired record, or automatically based on a consistent match of the field values in the relevant file with the desired information inserted into the appropriate field, without any operator action. The results of the manual search may be rewritten and the results of the automatic search may be changed only if the search is a default equation or suggested value and not a calculated field.

Sdl-search field based on specimen in standardized case file of the pathologist performing the examination. A lookup id is returned that includes the physician's initials and the case id. The case id is used as a link to automatically find other identical fields from the standardized pathologist file in the current case. The lookup value is a suggested value for its corresponding field and may be rewritten by the examining pathologist if desired.

The lookup fields linked to the sdl value are as follows: total number (summary of physical and microscopic pathologist exams); diagnosis (pathologist's case conclusion); tissue cdl; a slide code; an aslide; pre-matching; sc; cs; cty, respectively; cytomtch; t1-t5 (representing the tissue code of the tissue sample area for the case); d01-d05 (corresponding to disease code of tissue sample); a tumor code; tnm (tumor node metastasis indicating the size and nature of the lymph node tumor); qacomment (pathologist quality assurance comments on cases, if any); sec; refrigerating; an afxmatch; mam; premam; ms; a mmat; and mamact (the action to be taken if there is such a difference).

T1-t 5-find the main organization area file by name. A two-digit code representing the region is returned.

cc.d01-d 05-find the main disease file by name. A five digit code representing the disease type is returned.

Abname1-5-look up the historical archive file by patient name. Any previously examined case numbers are returned.

ee. physician-lookup master physician file. The name of the attending physician is returned.

ff. physician 2-lookup master physician file. The name of the attending physician is returned.

Ss 1-12-find main stain type file. The desired stain code is returned.

Quality assurance fields are fields that summarize data from various fields in a history file for trend and statistical analysis, reporting of exam-related results by department, and source of cases. The quality assurance field includes: tissue cdl, slide code, aslide; pre-matching; mam; premam; ms; a mmat; mamact (submission of the case to the committee if there is a diagnostic discrepancy between the examining physician and the pathologist); bmark (number of breast biomarkers in the specimen); cytomtch; acyto (behavior suggested by correlation of cells and specimen slides); sc; consultation of an outside hospital; aout (behavior of a pathologist suggested as a result of an outside consultation if the outside consultation is used); refrigerating; an afxmatch; refrigerated code (number of refrigerated specimens); fmin (time in minutes to complete the refrigerated specimen examination); rfd (for reasons of delay >20 minutes in cold storage inspection); afd (behavior of pathologist recommended for delays exceeding 20 minutes); fmm (degree of divergence between diagnosis and final diagnosis of the cryopreserved specimen); a pathologist; sec; page (representation of the last page containing an examination of quality assurance statistics); tumor code (standardized code of tumor, if any); tnm (tumor node metastasis); clinact (advice to inform the examining physician of the possible divergence from the clinical impression printed on the daily report); and specact (an indication of the lack of specimen sufficiency for diagnosis printed on a daily report).

The daily quality assurance reports generated are shown in the table below.

Report name	Title	Description of the invention
			Dtsumhi	Daily preservation of case indices	Daily preservation of indexing of cases
Dayhold	Daily remaining cases	Summary of daily retained cases
					Retention review
Dholdcss	Daily Retention review behavior	Summary of the remaining cases, reasons for the remaining and pending behaviour, if any
					Sentinel lymph node Retention cases
Sentlnd	Daily sentinel lymph node Retention cases	General summary of sentinel lymph node casesTo be administered
					Retention of mammary gland cases
Erpr	Retention of ER/PR cases in the mammary gland	Summary of the remaining mammary ER/PR cases
			Brim	Reserved cases of breast transplantation	Summary of the remaining cases of breast transplants
Breastn	Remaining non-malignant mammary gland cases	Summary of remaining non-malignant breast cases
					Retained prostate case
Prosn	Remaining non-malignant prostate cases	Summary of remaining non-malignant prostate cases
					Case of retained slide
Dslidpro	Slide review of retained cases	Summary report of remaining cases due to insufficient slides
					Review of retained cases
Dtholdno	The case is kept by the pathologist	Retaining summary case reports for days beyond recommended threshold
			Mdholno	Cases retained by the pathologist, with w pages in post	As above, the page breaks made by the pathologist

The monthly exam file includes all data transferred from the daily exam file when the case is complete. The yearly exam file includes all data transferred from the daily exam file at the completion of the case. The historical archive exam file includes all data transferred from the daily exam file at the completion of the case, except for the following: specimen information, pathologist physical and microscopic examination results, special staining request information, and any pathologist quality assurance comments. Daily reports cover completed cases that are transferred on a daily basis to monthly, yearly, and historical archives.

The following table shows the monthly quality assurance reports generated.

Report name	Title	Description of the invention
			Qaindexs	Cases of QA S	Indexing of monthly QA reports
		Clinical diagnosis versus pathological diagnosis
			Preopcfs	Case counting by department	Number and type of distinction
Monpreos	Case review report	Diagnosis before and after op versus Final diagnosis
					Breast case review
Mnmsuss	Total number of breast cases in surgical department	The breast tissue type, examination relevance, suspect grade and tumor to biopsy relationship were counted by the physician
			Mnmsusx	Total number of breast cases in radiology department	Breast tissue type, examination relevance, suspicion rating by physicianAnd tumor to biopsy correlation for enumeration
Mnmsusdx	Total number of breast cases in radiology department	Counting of breast tissue type and suspect grade by a physician
			Mnmsums	Total number of breast cases in all departments	Counting of breast tissue type and suspect grade by a physician
Mams	Review reports by department	Summary report of all breast cases including tissue and biopsy type and examination differences, if any
					Specimen review
Mnspecos	Total number of specimens of department	Departmental count of all cases versus deficient cases
			Specos	Department's specimen report	Summary case report for all cases lacking specimens
		Organization review
			Tisssums	Total number of tissue classes	Total number of different tissue types
Tissrevs	Organizing reports by type	Total case report by tissue type in case the type does not match the examination result
					Review of refrigeration check
Mnfxmats	Total of refrigeration classesNumber of	Total number of types of differences between cryo-preserved tissue and final examination
			Frozens	Cold-preserved case pair final diagnosis	Number of case reviews or cryo-sections completed for a time exceeding a threshold
		Cell review
			Moncytos	Total number of cytological cases	Class counting of comparative fractions of cell fluid examination versus final diagnosis
Cytodifs	Cytological action report	Summary report of cases when there is a difference between the cellular fluid and the final examination
					Slide review
Monslids	Total number of slide categories	Total number of defects in slide
			Slids	Slide review report of case	Summary case report with defective slides
		Review of retained cases
			Monholds	Summary of Retention case analysis	Total number of categories of number of cases exceeding a retention threshold for a certain number of days
Holds	Retention of case reports	Maintaining summaries of certain days above recommendation threshold

		Case report
					Internal review
Monarevs	Total number of review categories	Total number of cases reviewed internally by the pathologist and actions taken, if any
			arevs	Reporting of actions taken	Total case report in case of internal pathologist review inconsistent with preliminary pathologist exam
		Review by out-hospital consultant
			Monouts	Total number of cases sent externally	Total number of cases sent by the pathologist for out-patient consultation and examination differences, if any
Exterior part	Out-hospital consultation case report	Sending a Total review of all cases for out-patient consultation

Similar reports may be generated each year and/or over any period of time specified. In various embodiments, both daily and monthly reports may be identical in form, differing only in time period range. These daily reports may allow the pathologist to take prompt treatment as needed during the exam and report as a pipeline as required for the monthly reporting process. Monthly reports may be automatically sorted and printed by the required hospital departments, and outside physicians or medical groups suitably allow for quick and easy distribution of the reports.

Any cases designated as "standards" or templates for exam reports of future similar cases are identified and transferred to the appropriate pathologist's and overall standard files.

Cases with problematic slides are also identified and transferred to the histology log file for future review and review.

Cases that diverge between the diagnosis and clinical impression of the examining physician(s) are transferred to the pre-match log file for future review.

In addition to the foregoing individual inspection reports, the following exemplary internal reports may be printed as a guide to internal verification of the data in the report, and other diagnostic or inspection procedures still needed. The following screen display names are exemplary and illustrative only.

1. List of completed cases daily. The screen is displayed as "dailycastr".

2. Daily reporting of cytology slides by a pathologist. The number of slides examined by the pathologist is easily verified to ensure that the number of daily cases does not exceed the recommended guidelines. The screen is shown as "cytslide #".

3. A review of cases that diverge between pre-and post-operative diagnosis of the examining physician and the clinical impression of the pathologist. The screen is shown as "prematchlog".

4. A review of cases still remaining. The screen is displayed as "dailyholdaction".

5. Further review and status validated a review of all sentinel lymph node cases pending. The screen is displayed as "sentlnd".

6. Report of all mammary cases sent to ER/PR. The screen is displayed as "beasterpr".

7. Report of all breast implant samples retained indefinitely. The screen is displayed as "diagnostic".

8. Report of all non-malignant breast cases reviewed. The screen is displayed as "break".

9. Report of all non-malignant prostate cases reviewed. The screen is shown as "prostraten".

10. A pathologist over 20 minutes reviews the reports for all refrigerated cases for the threshold or more than 4 refrigerated specimens. The screen is displayed as "frozl".

11. Report of all selected slides with problems. The screen is displayed as "dailyslide pro".

12. Reports of all cases still remaining, classified by the pathologist. The screen is displayed as "dailyholdmd".

A report may have one or more pages. Regardless of which page is the last page, it is designated as the page with the quality assurance indicator for that case. The quality assurance report includes: the last page of each case is transmitted to the quality assurance report database on a monthly basis as a separate record. In some cases, there may be multiple reports. It is also possible that, in a case with multiple reports, one case has multiple quality assurance reports.

While the methods and systems of various embodiments of the present invention have been described in connection with pathology reporting embodiments, other embodiments are also contemplated. These methods and systems can be used by anyone who completes a form, and can use the "shorthand" method. For example, law enforcement personnel may use a handheld input device to generate a traffic ticket or survey report. The computing engine may also automatically perform a background check on the driver's license number or vehicle tag number, or in accordance with the command code indicator. Quality management metrics (e.g., the time required for each survey and the number of surveys per reporting period, among others) may be automatically tracked. Updates between or among investigators may allow for improved efficiency in the investigation reporting process.

In another example, the contract administrator may start with a service contract template having a standard language. By entering some values within the designated spaces, the calculation engine may add other contract terms based on these terms. Quality management metrics (e.g., the time required for each contract negotiation and the number of versions per contract, among others) may be automatically tracked.

The foregoing disclosure and description of the invention are illustrative and explanatory thereof, but within the foreseeable scope thereof, the invention is defined by the appended claims.

Claims (9)

1. A system for generating a report, comprising:

a first module configured to receive data and one or more commands from a voice input device;

a second module configured to access a database and store the data and one or more commands in the database; and

a third module configured to generate a report based on the report template;

wherein the report template comprises a plurality of fields, each corresponding to one or more locations in the database; and

wherein the report includes:

at least a subset of the data related to one or more fields of the template;

a value retrieved from the database by the third module in response to at least one of the one or more commands, which is related to one or more fields of the template; and

one or more quality management indicator fields determined by the third module based on the reporting template or fields populated within the reporting template and added to the reporting template;

wherein the quality management indicator field comprises one or more of: a quantity of quality management indicator data entry field, a mandatory error check field, a limit entry field, a description field.

2. The system of claim 1, wherein the system further comprises: a module configured to store the data in one or more selected locations in the database in response to the one or more commands.

3. The system of claim 1, wherein the system further comprises: a module configured to store the data in one or more selected locations in the database based on an internal configuration.

4. A method of creating a report, the method comprising:

using a voice input device to input a recording of one or more observations, wherein the recording comprises one or more commands on how to present the one or more observations in the report;

a computing device receiving the recording from the voice input device and storing the recording in a database;

the computing device extracting the one or more commands from the record and arranging the record regarding the one or more observations in the report based on the one or more commands according to a report template;

the computing device determining and adding one or more quality management indicator fields to the report template based on the template or fields populated within the template; and

generating the report;

wherein the quality management indicator field comprises one or more of: a quantity of quality management indicator data entry field, a mandatory error check field, a limit entry field, a description field.

5. The method of claim 4, further comprising:

adding the stored material to the report in response to a request in the record.

6. The method of claim 4, further comprising:

in the event there is no request to add the stored material in the record, adding the stored material to the report.

7. The method of claim 4, further comprising:

one or more observations are placed in the report.

8. The method of claim 4, further comprising:

the computing device retrieves one or more items in one or more databases in response to one of the one or more commands, wherein the one or more items are added to the report.

9. A method of generating a report, comprising:

receiving a report template identifier from a voice input device;

receiving a report template from a first database corresponding to the report template identifier;

receiving a first command from the voice input device, the first command including instructions to navigate to a first data item field of the report template;

entering data into the first data entry field;

receiving a second command from the voice input device, the second command comprising a first code;

retrieving a first record corresponding to the first code from a second database, wherein the first record includes a command to insert quality management data from the second database into the reporting template;

executing the command to insert a quality management indicator field into the reporting template;

generating a report according to the report template; and

automatically transmitting the report to a predetermined recipient;

wherein the quality management indicator field comprises one or more of: a quantity of quality management indicator data entry field, a mandatory error check field, a limit entry field, a description field.