The demands being placed on NHS histopathologists have increased dramatically over recent years. In the near future, this will have to be reflected in the functionality of the informatics systems that histopathologists use. The key element of these systems is the Laboratory Information Management System (LIMS). There is a wide range of LIMS in use within the NHS and it is probably fair to say that the ideal system has yet to emerge. The functionality of many existing systems, as far as histopathologists are concerned, is severely compromised by their extreme age or by the fact that they have primarily been designed to support the needs of pathology disciplines that deal with high volume requests, rather than histopathology departments.

In future, there will be an increased need for the automatic extraction of data from traditionally textual histopathology reports. These data will have to be entered directly into relational databases in a way that allows national comparisons to be made. There will be a need for hypertext links for both the pathologist and the report recipients, including clinicians, patients, management. who must all be regarded as stakeholders in the design of LIMS.

There are many poor systems in current use. The current situation, in which there are large numbers of suppliers, many of whom are unable to support the rapid development of their products, is likely to change.

The Royal College of Pathologists' Working Group on Cancer Services has considered what should be regarded as minimum requirements of LIMS in relation to the histopathology reporting of cancer specimens, and has made the following recommendations for use by commissioners and suppliers.

1. Histopathology computer systems should be compatible with associated laboratory management systems, local clinical database systems and hospital patient administration and information systems.

2. Computer systems must be capable of secure, accurate and confidential recording of patient and pathology information, and allow varying levels of user access.

3. Systems should allow for the direct entry of patient details and pathology-reporting data items using proformas or, for example, templates with pick-lists with defined choices (as specified in the Royal College of Pathologists' datasets for reporting cancer) and help screens. A 'free text' option must also be available. The templates should be in HTML or similar format to allow linkage with hypertext help files or images.

4. Systems should allow interrogation of a patient's entire pathology data record, enabling current and previous requests and reports to be linked.

5. Pathology reports should contain all of the core data items contained in the Royal College of Pathologists' datasets for reporting cancer.

6. Recording and retrieval of coded information according to SNOMED must be included.

7. All units of measurement should be uniform and standard (for example, all distances in millimetres), according to Royal College of Pathologists' datasets for reporting cancer.

8. Systems must allow the generation of a final authorised pathology report in both electronic and printed format. Mechanisms should restrict the issue of incomplete reports or those containing inconsistent data in different parts of the report.

9. It must be possible to generate both full text reports and synoptic reports in the datasets for reporting cancer format from the same data/text entry. The synoptic report contents should be in a format that is automatically transferable to a stand-alone relational database.

10. It must be possible to undertake an audit trail of any changes made to authorised reports.

11. Derived fields should be calculated from entered data wherever possible (e.g. a final pTNM stage should be calculated from previously entered information).

12. Systems should allow core data items and/or reports to be captured and transmitted electronically in a secure, confidential form, using agreed protocols to local clinical management systems, cancer networks and regional cancer registries.

13. Systems should allow intelligent interrogation of databases for laboratory data/workload analysis and the generation of report lists for use by multidisciplinary management teams, audit, and research.

14. Systems should support a continuing programme of development to allow updating of core data items (including the introduction and deletion of data items), in line with advances in knowledge and regular reviews of the Royal College of Pathologists' datasets for reporting cancer.

15. There must be the facility to store and retrieve graphical images linked to cases.

16. Systems should allow the download of anonymous data for audit purposes. For certain key data items (e.g. tumour and dysplasia grading, positivity of clinical cytology or incidence of common diagnoses), pathologists should be able to benefit from automatic audit and benchmarking.

Revised April 2006