title: The 2013 symposium on pathology data integration and clinical decision support and the current state of field.
abstract: BACKGROUND
  Pathologists and informaticians are becoming increasingly interested in electronic clinical decision support for pathology, laboratory medicine and clinical diagnosis. Improved decision support may optimize laboratory test selection, improve test result interpretation and permit the extraction of enhanced diagnostic information from existing laboratory data. Nonetheless, the field of pathology decision support is still developing. To facilitate the exchange of ideas and preliminary studies, we convened a symposium entitled: Pathology data integration and clinical decision support.
  
  
  METHODS
  The symposium was held at the Massachusetts General Hospital, on May 10, 2013. Participants were selected to represent diverse backgrounds and interests and were from nine different institutions in eight different states.
  
  
  RESULTS
  The day included 16 plenary talks and three panel discussions, together covering four broad areas. Summaries of each presentation are included in this manuscript.
  
  
  CONCLUSIONS
  A number of recurrent themes emerged from the symposium. Among the most pervasive was the dichotomy between diagnostic data and diagnostic information, including the opportunities that laboratories may have to use electronic systems and algorithms to convert the data they generate into more useful information. Differences between human talents and computer abilities were described; well-designed symbioses between humans and computers may ultimately optimize diagnosis. Another key theme related to the unique needs and challenges in providing decision support for genomics and other emerging diagnostic modalities. Finally, many talks relayed how the barriers to bringing decision support toward reality are primarily personnel, political, infrastructural and administrative challenges rather than technological limitations.
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Baron
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Dighe
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, MA ; Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, MA ; Department of Systems Biology, Harvard Medical School, MI.
authors.forename: Ramy
authors.initials: R
authors.lastname: Arnaout
authors.affiliation: Division of Pathology Informatics, University of Michigan Health System, MI.
authors.forename: Ulysses J
authors.initials: UJ
authors.lastname: Balis
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: W Stephen
authors.initials: WS
authors.lastname: Black-Schaffer
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University School of Medicine, GA ; Department of Biomedical Informatics, Emory University School of Medicine, GA.
authors.forename: Alexis B
authors.initials: AB
authors.lastname: Carter
authors.affiliation: Cleveland Clinic, Center for Pathology Informatics, Pathology and Laboratory Medicine Institute, OH.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Henricks
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Systems Biology, Harvard Medical School, MI ; Center for Systems Biology, Massachusetts General Hospital, MA.
authors.forename: John M
authors.initials: JM
authors.lastname: Higgins
authors.affiliation: ARUP Laboratories, UT ; Department of Pathology, University of Utah School of Medicine, UT.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Jackson
authors.affiliation: Regional Reference Laboratories, Southern California Permanente Medical Group, CA.
authors.forename: Jiyeon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: Veronica E
authors.initials: VE
authors.lastname: Klepeis
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: Long P
authors.initials: LP
authors.lastname: Le
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: David N
authors.initials: DN
authors.lastname: Louis
authors.affiliation: Department of Pathology, Harvard Medical School, MA ; Department of Pathology, Brigham and Women's Hospital, MA.
authors.forename: Diana
authors.initials: D
authors.lastname: Mandelker
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Mermel
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA ; Department of Surgery, Massachusetts General Hospital, MA.
authors.forename: James S
authors.initials: JS
authors.lastname: Michaelson
authors.affiliation: Department of Pathology, Immunology and Laboratory Medicine, MO ; Department of Genetics, Washington University School of Medicine, MO.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Nagarajan
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: Mihae E
authors.initials: ME
authors.lastname: Platt
authors.affiliation: Department of Pathology, Harvard Medical School, MA ; Department of Pathology, Brigham and Women's Hospital, MA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Quinn
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rao
authors.affiliation: Department of Laboratory Medicine, University of Washington School of Medicine, WA.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Shirts
authors.affiliation: Department of Pathology, Massachusetts General Hospital, MA ; Department of Pathology, Harvard Medical School, MA.
authors.forename: John R
authors.initials: JR
authors.lastname: Gilbertson
keywords: Clinical decision support; genomics; interpretive reporting; machine learning; test utilization