J Clin Pathol: first published as 10.1136/jcp.38.10.1106 on 1 October 1985. Downloaded from J Clin Pathol 1985;38:1106-1113 Microtome: histopathology day book based on a microcomputer system D ROBERTS-JONES, J McCLURE From the Department ofHistopathology, University Hospital ofSouth Manchester, Manchester SUMMARY The development of a histopathology day book based on a microcomputer is described. The system has the capacity to search on file records for details of previous specimens from current patients. It also possesses a SNOP/SNOMED input and search system that can aggregate data for analytical and other purposes. The system is relatively inexpensive and is user friendly. It has been developed within and is exclusively devoted to the requirements of a histopathology department and is designed to permit expansion to a multiuser system. The acquisition, storage, and retrieval of informa- gynaecological cytopathology) to a busy major tion are important functions of any pathology teaching hospital and receives some 12 000 speci- laboratory. In haematology, biochemistry, and (to a mens (excluding necropsy material) every year. lesser extent) microbiology laboratories results are Therefore, although initially satisfactory, in time the largely in the form of numerical data, and for several archive became oversized and somewhat cumber-copyright. years computers have been used to accumulate, some, especially the component that dealt with data store, and manipulate these data. In histopathology retrieval. It was particularly difficult to determine computers have also been used but to a much lesser whether previous biopsy material had been received extent than in the related disciplines. Part of the from the patients whose current specimens were reason for this is the fact that histopathological being handled. The advent of endoscopic biopsy reports are written in complex language. Although techniques has resulted in many specimens being this can be summarised by an encodement process obtained from patients over time, and archival mat- using the SNOP/SNOMED systems, automatic erial is constantly needed to confirm diagnosis and http://jcp.bmj.com/ encodement facilities' are not generally available assess the efficacy of treatment. and, when they are available, looking up the We did not have access to mainframe or mini appropriate manual is prone to error and can be computers or the capital to devise a system capable tedious. of using these, but we were interested in microcom- The computers used in histopathology puters and our examination of the existing laborat- laboratories have generally been mainframe or mini ory system was to determine if a microcomputer sys- computers and have been geared towards generating tem could be developed that would improve the effi- on September 24, 2021 by guest. Protected reports (word processing) and compiling statistical ciency of part or all of the existing procedures. This information. Such systems are expensive and require report concerns our analysis of the historical system the services of professional programmers. Often and the development of a system based on mic- they are shared with other laboratories or hospital rocomputers, with particular reference to design records systems, or there is a connection to a reg- philosphy, hardware, data retrieval, and techniques ional computer by an expensive telephone link.28 of analysis. In 1983 we undertook a critical examination of the information storage and retrieval systems then in THE HISTORICAL SYSTEM use in the histopathology department of this hospi- Fig. 1 shows how the historical system worked. A tal. The systems were entirely manual and based specimen accompanied by a request card was essentially on a traditional day book comprising a received in the laboratory and given a laboratory ledger and card index. The department provides a accession number, comprising two digits indicating comprehensive diagnostic service (including non- the year and the maximum number of specimens received in a given year. The patient's personal Accepted for publication 22 May 1985 details, specimen number, clinical consultant, and 1106 J Clin Pathol: first published as 10.1136/jcp.38.10.1106 on 1 October 1985. Downloaded from Microtome: histopathology day book based on a microcomputer system 1107 of the database to determine the details of previous material from current cases and with the capacity to perform analyses and generate statistics. Although a microcomputer had been used as a word processor to generate histopathology reports,9 we decided not to pursue this further for the time being. Material and methods The hardware used in establishing the microcompu- ter system comprised the following: Apple II Europ- lus 48K microcomputer; floppy disk drive and con- troller card; Epson MX80 FT/III printer; Grappler 64K printer buffer card; Z80 second processor card (2MHz); 80 column card; amber phosphor high resolution monitor; Microsoft 16K RAM card; and Fig. 1 Flow chart illustrating historical data recording and a retrieval system. Corvus Winchester disk drive (5Mb). The microcomputer, printer, and cards were sup- plied by Fairhurst Instruments, Wilmslow, Cheshire, the histopathologist were then recorded in a ledger. and the disc drive was loaned by Dr S Lucas, Faculty Data such as the date of issue of the report and of Medicine Computational Group, University of disposal of preserved wet tissue were recorded later. Manchester. The description of the gross specimen made at cut The software used to develop the system com- up was recorded on the request card, which was prised: Microsoft basic interpreter (MBASIC); Mic- stored in an alphabetical file. Data from the request rosoft basic compiler (BASCOM); and a Keele card were transferred to the final report issued to the codes CLIP (Winchester Backup Utility). Prog- copyright. responsible clinical consultant and a copy kept in a rammes operate under CPM version (2.2). numerical file (based on accession number) in the laboratory. The day book and alphabetical and Results numerical files were accumulated on a yearly basis. In addition, the responsible pathologist encoded Each morning the system is activated and the the diagnosis using the SNOP and, latterly, the operator is requested to insert a password, the date, SNOMED systems. The accession number was then and the initials of the responsible histopathologists. http://jcp.bmj.com/ recorded in a card index file under the headings of Input of new data can then be started. On receipt of (T)opography and (M)orphology (hybrid retrieval a new specimen and its accompanying request card file). Another alphabetical cross index file was also the laboratory accession number is ascribed and the maintained, which was based on the initial of the data are recorded in the microcomputer system. patient's surname but included forename, medical Essentially, these are the patient's personal details records file number, and accession numbers of all and some details of the specimen. After macroscopic material from that patient. This file was designed to examination, cutting up of the and specimen, the on September 24, 2021 by guest. Protected permit retrieval of details of both previous and cur- processing of tissue blocks details of the number of rent biopsy reports from the same patient. The blocks taken, the number of slides issued to the his- laboratory had one clerical officer who gave acces- topathologists, and the issue of the report are sion numbers to the specimens and searched the recorded. The system automatically dates these alphabetical cross index file for previous accession events. numbers, a process that was cumbersome and time During input of a new record the operator is consuming, particularly when the work was per- prompted to complete each data field in a preset formed by less skilled and experienced staff. order. The operator is then given the chance of edit- ing any field before committing the data to file. DESIGN PHILOSOPHY When extending an existing record the operator It was evident from our analysis that the information selects the field that needs amending (Figs 2-4). For in the day book could form a potential database, and the surname the system accepts letters A to Z and a we thought that a microcomputer system could be hyphen only (the field is truncated to a maximum of devised relatively easily to perform this task. What 14 characters). For the forename it again accepts A advantages, if any, would an electronic day book to Z but is set to seven characters. If numerical data have? We needed a system that would allow a search are added to this field then the program assumes J Clin Pathol: first published as 10.1136/jcp.38.10.1106 on 1 October 1985. Downloaded from 1108 Roberts-Jones, McClure Fig. 2 Laboratory number, accession date, and initials of responsible pathologist(s) are automatically supplied by the system when the patient's personal data are entered. copyright. Fig. 3 Data input is now complete. Data for any number of additional specimens for this patient may now be added. All data to left ofvertical line will be remembered by the system. http://jcp.bmj.com/ ..m on September 24, 2021 by guest. Protected Fig. 4 Complete record of fictitious patient. Dates are automatically ascribed. J Clin Pathol: first published as 10.1136/jcp.38.10.1106 on 1 October 1985. Downloaded from Microtome: histopathology day book based on a microcomputer system 1109 that the specimen is from a laboratory animal and Table 1 Structure ofcompleted record indicated by the subsequent program flow is modified. The number ofbytes ascribed to each component (total number patient's medical record number is accepted in any ofbytes = 128) printable characters to a maximum of seven; the age Record lock is accepted as numerical data in the range 0 to 120. Accession date 2 a Surname 14 If zero is entered the program requests the date of Forename 7 birth. Gender is entered as M or F or 0 (unknown).