1 / 16

Milwaukee Pathology Hub and Spoke Model

Milwaukee Pathology Hub and Spoke Model. Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov. Milwaukee Pathology Hub and Spoke Model. Iron Mountain VAMC. Tomah VAMC. 220 mi. 170 mi. Milwaukee VAMC. 60 mi. North Chicago VAMC. Overview.

betty_james
Download Presentation

Milwaukee Pathology Hub and Spoke Model

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Milwaukee Pathology Hub and Spoke Model Bruce E. Dunn, M.D. Milwaukee VA Medical Center E-mail: Bruce.Dunn@med.va.gov

  2. Milwaukee Pathology Hub and Spoke Model Iron Mountain VAMC Tomah VAMC 220 mi 170 mi Milwaukee VAMC 60 mi North Chicago VAMC

  3. Overview • Since 1998, ~4.7 Milwaukee pathologist FTEE have provided service in anatomic, clinical and administrative pathology to the Milwaukee VAMC hub and to the spoke sites at Iron Mountain, Tomah and North Chicago VAMCs • Prior to 1996, a total of ~11 pathologist FTEE served these four sites

  4. Clinical Activity: Summary • Iron Mountain • In- and outpatient general surgery • Tomah • No surgery. Skin biopsies and resections only • North Chicago • Outpatient surgery only • Milwaukee (Diagnostic and educational hub) • In- and outpatient general and specialty surgery • Tertiary VA referral center • All sites • Anatomic pathology, clinical laboratory, blood transfusion

  5. Total Anatomic Pathology Workload Summary FY01 • Surgical pathology – 5950 cases (2.38 FTEE) • Cytology/FNA – 2910 cases (0.83 FTEE) • Bone marrows – 150 cases (0.30 FTEE) • Autopsies – 70 cases (0.28 FTEE) • Neuropathology (0.125 FTEE) Total Pathologist FTEE (3.915 FTEE)

  6. Additional Pathologist Activities at Hub and Spoke Sites • Clinical Pathology • Resident Training (2 slots at Milwaukee only) • Administrative Functions • Medical Executive Committees • Blood Product Utilization Review • Surgical Case Review • Laboratory Proficiency Testing Review • Laboratory Procedure Review

  7. Need for Pathologist Consolidation • Increased cost-effectiveness • Retirement of pathologists at Iron Mountain, Tomah and North Chicago VA Medical Centers between 1996 and 1998

  8. Strategies for Consolidation of Pathologist Functions • Telepathology – hybrid dynamic/store & forward system • Milwaukee pathologists travel to spoke sites for selected clinical, administrative and educational functions • Increased oversight role by lab managers • Voice-activated dictation by pathologists

  9. Telepathology: Hub and Spoke Model NRM RM Tomah Iron Mtn DR GS POP POP DR NRM Milwaukee Voice-Activated Dictation GS POP Interface to VistA DR Scanner WAN Printer KEY RM - Robotic microscope NRM - Non-robotic microscope GS - Grossing station DR - Document reader POP - Point of presence WAN - Wide area network VistA -VHA info system Multi-site conferencing NRM North Chicago GS POP VHA WAN Internet

  10. Telepathology Equipment: Summary • Iron Mountain • Robotic microscope with grossing station and document reader • Tomah • Non-robotic microscope with document reader • North Chicago • Non-robotic microscope with grossing station • Milwaukee (Diagnostic and educational hub) • Non-robotic microscope with grossing station, document reader, scanner and printer. Voice-activated dictation • All sites • VistA Imaging and multi-site conferencing (mid-2002)

  11. Applications of Telepathology at Iron Mountain VAMC • Surgical pathology • Primary diagnosis including frozen sections • Documentation of gross and histopathology • Consultation with clinicians • Autopsy pathology • Clinico-pathologic correlation conferences • Clinical pathology • Microbiology consultations (smears and cultures) • Hematology • Review of peripheral blood smears • Continuing education

  12. Applications of Telepathology at Tomah VAMC • Clinical pathology • Microbiology consultations (smears and cultures) • Hematology • Review of peripheral blood smears • Continuing education

  13. Applications of Telepathology at North Chicago VAMC • Surgical pathology • Documentation of gross and histopathology • Consultation with clinicians • Clinical pathology • Microbiology consultations (smears and cultures) • Infectious diseases conferences and consultations • Hematology • Review of peripheral blood smears • Continuing education

  14. Applications of Digital Imaging at Milwaukee VAMC • Surgical pathology • Documentation of gross and histopathology • Autopsy pathology • Documentation of gross and histopathology • Clinical pathology • Documentation of interesting cases • Hematology • Documentation of interesting cases • Continuing education

  15. Spoke Site Autopsy Performance • Iron Mountain – Milwaukee pathologist travels • Tomah – autopsies performed at Madison (by Madison pathologists) • North Chicago – Milwaukee pathologist travels

  16. Summary of Pathology Networking Activities in VISN 12 • Standardization of equipment and procedures • Consolidation of batched/esoteric testing • Telepathology • Provide access to distant pathologists and technologists • Provide a single diagnostic standard of care • Reduced personnel and “all other” expenses • Focus: resource sharing rather than independent labs and employees (interdependence)

More Related