Debating digital pathology? Consider the risk of not doing it

Times have changed—and fast—for the pathology industry. The doctors who study disease can now immediately see and analyze digital images of biopsy slides and securely share those files with other experts. The practice has come a long way from the days of ordering physical slides and stooping over microscopes, from waiting on files from another hospital or feedback from another continent. 

Yet, with innovation comes aversion to perceived risks. For leaders in the healthcare industry, there can be reluctance to change and the adoption of new processes. That need must be balanced with the benefits of technology solutions that are faster and offer greater efficiency. 

As lab managers and other providers weigh concerns on both sides, they seek answers to some of their high-level questions related to digital pathology: What problems will we be able to solve? Who will benefit? What safeguards need to be in place?

Experts in pathology and in technology solutions are also asking these questions. The latest thinking points to ethical and practical considerations of adding digital workflows to the practice of pathology. 

Determining the Ethical Imperative

To govern and manage any health services organization means to, above all, protect patients and further their interests. It’s a tremendous responsibility, compounded by economic pressures, staffing issues, and decision fatigue in the face of so many technology options.

In the field of pathology, the question of whether or not to adopt digital solutions comes down to this: What is best for patients? One physician who is also the medical director of IT, business development, and support services at a major US lab provided an exciting perspective in a recent podcast hosted by Digital Pathology Today.

“Once a tool has been shown to improve decision making … there’s an ethical obligation to use that tool,” he said, offering the example of a cardiologist who won’t use an echocardiogram because they don’t understand the details and they’d rather use their stethoscope. Such is the case for digital pathology solutions as well. It’s a tool providers will be compelled to use because its benefits offset any internal resistance to change.

The following are among the principal advantages of digital pathology for physicians and lab managers to consider as they focus on patient welfare.

• Whole slide images (WSI) are securely stored in the cloud and physical slides are offsite to be adequately preserved, reducing risk.
• Slides and blocks can be managed by experienced pathology storage professionals, freeing up time and space for staff.
• Real-time WSI scanning maintains an auditable chain of custody.
• 24/7 online ordering, tracking, and reporting through a secure web-based portal supports accessibility.
• Artificial intelligence (AI) assists the pathologist by viewing scanned digital images, enabling rapid pattern recognition.
• Integration with electronic medical records links tissue samples to related data.
• Cloud capabilities along with web access and viewing technology allows pathologists in other locations to aid physicians in their work.

In addition to the business benefits—efficiency, accuracy, and risk reduction—leading researchers see digital pathology and AI solutions as supporting the development of solutions to promote quality of life for patients worldwide. They connect digital pathology capabilities with helping to meet the UN’s Sustainable Development Goal focused on equitable health and well-being. 

“Digital pathology has the potential to be useful in low- and middle-income countries … it allows pathologists to share images and information more easily with other medical professionals, even if they are in different parts of the world,” according to research from the Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital, Harvard Medical School.

The report continued: “Data sharing can be particularly beneficial in countries where there may be a shortage of qualified pathologists ... Additionally, digital pathology can help to reduce the cost of tissue analysis, which can be a significant barrier to access in low- and middle-income countries.” 

Validating a Digital Solution

Though educated opinion clearly shows the benefits of digital pathology , lab managers and hospital decision-makers are wise to invest ample time in considering the pros and cons. They must thoroughly evaluate vendors and carefully design new workflows.

Healthcare leaders will want to be sure the solution they select is safe and effective. Before implementation, laboratories should validate any new process—comparing digital with traditional methods to verify adherence to all requisite standards. 

A relatable use case supporting digitization comes from Birmingham Children’s Hospital in the United Kingdom, where 40,000 medical records were scanned, digitized, and hosted much the same way as digital pathology whole slide images. Once files are scanned, an advanced optical character recognition system matches the file to the patient’s unique hospital number. This enables the creation of other metadata fields to complete the record. The files are then uploaded and accessible to a strictly controlled group of accredited staff through a secure web-based portal. 

Birmingham’s hospital management has reported significant benefits, including faster access to vital information, increased speed and quality of patient welfare decision-making, and improved staff productivity and space utilization. Information security has also been enhanced via a full chain of custody and governance through a complete audit trail.

Like digitizing patient records and any other aspects of a digital transformation, digital pathology solutions will require significant time and financial investment. However, signs point to a hearty return on that investment through improved workflows, increased efficiency, and reduced impact of human errors. 

As the authors of one study noted, “We anticipate that these time-savings will have a major improvement on pathologist productivity at a time where pathology services are strained, and serve as a point from which to build other user interfaces to enhance pathologist productivity.”