title: Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service.
abstract: BACKGROUND
  Advances in digital pathology are accelerating integration of this technology into anatomic pathology (AP). To optimize implementation and adoption of digital pathology systems within a large healthcare organization, initial assessment of both end user (pathologist) needs and organizational infrastructure are required. Contextual inquiry is a qualitative, user-centered tool for collecting, interpreting, and aggregating such detailed data about work practices that can be employed to help identify specific needs and requirements.
  
  
  OBJECTIVE
  Using contextual inquiry, the objective of this study was to identify the unique work practices and requirements in AP for the United States (US) Air Force Medical Service (AFMS) that had to be targeted in order to support their transition to digital pathology.
  
  
  METHODS
  A pathology-centered observer team conducted 1.5 h interviews with a total of 24 AFMS pathologists and histology lab personnel at three large regional centers and one smaller peripheral AFMS pathology center using contextual inquiry guidelines. Findings were documented as notes and arranged into a hierarchal organization of common themes based on user-provided data, defined as an affinity diagram. These data were also organized into consolidated graphic models that characterized AFMS pathology work practices, structure, and requirements.
  
  
  RESULTS
  Over 1,200 recorded notes were grouped into an affinity diagram composed of 27 third-level, 10 second-level, and five main-level (workflow and workload distribution, quality, communication, military culture, and technology) categories. When combined with workflow and cultural models, the findings revealed that AFMS pathologists had needs that were unique to their military setting, when compared to civilian pathologists. These unique needs included having to serve a globally distributed patient population, transient staff, but a uniform information technology (IT) structure.
  
  
  CONCLUSIONS
  The contextual inquiry method helped reveal similarities and key differences with civilian pathologists. Such an analysis helped identify specific instances that would benefit from implementing digital pathology in a military environment. Employing digital pathology to facilitate workload distribution, secondary consultations, and quality assurance (over-reads) could help the AFMS deliver more accurate, efficient, and timely AP services at a global level.
authors.affiliation: Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Jonhan
authors.initials: J
authors.lastname: Ho
authors.affiliation: Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Orly
authors.initials: O
authors.lastname: Aridor
authors.affiliation: Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Glinski
authors.affiliation: Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Saylor
authors.affiliation: Department of Pathology, San Antonio Military Medical Center, Joint Base San Antonio, San Antonio, Texas, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Pelletier
authors.affiliation: Department of Pathology, San Antonio Military Medical Center, Joint Base San Antonio, San Antonio, Texas, USA.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Selby
authors.affiliation: Department of Radiation Medicine, Air Force Institute of Technology, University California, San Diego, La Jolla, California, USA.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Davis
authors.affiliation: Institute of Gastrointestinal Pathology and Digestive Disease, AmeriPath, Inc., Cleveland, Ohio, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lancia
authors.affiliation: Department of Pathology, Auburn Memorial Hospital, Auburn, New York, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Gerlach
authors.affiliation: Department of Pathology, 96 Medical Group, Eglin Air Force Base, Fort Walton Beach, Florida, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Newberry
authors.affiliation: Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Anthony
authors.affiliation: Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Liron
authors.initials: L
authors.lastname: Pantanowitz
authors.affiliation: Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Anil V
authors.initials: AV
authors.lastname: Parwani
keywords: Air force; anatomic pathology; consultation; contextual inquiry; digital pathology; informatics; workflow; workload distribution