The ongoing digitisation of pathology is a transformative change that offers new opportunities to increase efficiency, especially in cancer care, where over 90% of all tumors are confirmed by pathologists. With this in mind, many healthcare organisations are beginning to use digital pathology technology for primary diagnostic work and not only research. As the DICOM standard for pathology becomes increasingly widespread, many health providers are now seeking ways to efficiently adopt digital pathology.

The most efficient way to digitise pathology in a manner aligned with your current imaging strategy is to incorporate it into the enterprise imaging (EI) solution, instead of creating yet another departmental IT system. When it comes to selecting digital pathology software, chief information officers (CIOs) face a challenge since only a few EI solutions have proven (as of yet) to meet the tough performance demands of viewing and storing whole slide imaging (WSI) in a full clinical production environment.

This article will provide six areas of guidance in selecting and evaluating a solution that will allow you to reap the full benefits of digital pathology by adding this discipline to your EI solution.

Digital pathology - Among the last of the ‘ologies’ to become digital

Pathologists have traditionally used microscopes to review prepared tissue samples on glass slides. With microscopes, the process of reviewing and distributing cases is largely manual and limited in that the tissue samples and specialist need to be in the same location. To increase efficiency and shorten the time to diagnosis, many labs are now in the process of digitising their pathology workflow. This is done by using batch scanners to create digital images of the slides - normally 200–300 at a time, averaging 0.5 - 1 GB per image. This creates a tsunami of data to be processed that is rapidly closing in on, and will soon exceed, the amount of data produced by radiology over the last two decades.

The need to increase efficiency in pathology diagnostics is prevalent. A study published in the Journal of the American Medical Association (JAMA) in 2019 showed that the number of pathologists in the US decreased by around 18% between 2007 and 2017, despite a corresponding increase in workload of around 42% per pathologist. Digital pathology provides new opportunities, such as the possibility to perform remote diagnostics, balance workloads or use digital and automatic image analysis tools to speed up diagnosis and improve the quality of the review. In the next couple of years, we will see many health providers taking pathology as one of the last ‘ologies’ to become digital, and the transition has already started.

Why should I add pathology to enterprise imaging?

From an IT standpoint, the most obvious gains to be achieved by adding pathology to the EI solution, in contrast to digitising pathology separately, is the ability to cut costs through the consolidation of IT systems and centralisation of integrations. A standalone set-up will not be able to generate the same benefits in terms of clinical value, nor the cost advantages from an IT perspective, as an integrated multi-ology EI solution.

From a clinical point of view, having digital pathology as part of the EI solution will unite radiologists and pathologists, enhancing their collaboration through the use of a single diagnostic system. Initially, there are big wins to be gained simply by allowing different specialist groups to access each other’s images, test results and reports. This multidisciplinary convergence is encapsulated by the term integrated diagnostics (ID), the benefits of which are described in detail in an article published in Radiology in 2017. The same article also highlights that now is the right time to unite pathology and radiology:

“This is the right time for a major move toward ID [...] One major change is that pathology diagnostics is transforming from an analog-slide-and-microscope approach to a digital workflow at a rapid pace thanks to whole-slide imaging scanners and pathology picture archiving and communication systems (PACS) for large-scale, clinical use.”

One clinical benefit of using a single multi-ology solution achieved early on is increased efficiency in the preparation, presentation and follow-up of tumor boards. For early adopters of adding pathology to the EI solution, access to clinical information and increased efficiency in tumor boards have exceeded the expectations of specialists involved in cancer care. In a case study at University Hospitals of Cleveland (OH), Dr Hannah Gilmore, Division Chief of Anatomic Pathology and Director of the Breast Pathology Service, says:

“Since the pilot, we’ve been uploading pathology and radiology images into the enterprise PACS and projecting images from both departments on one system for each monthly conference. Using one system to display the images has streamlined how the cases are viewed, annotated and presented, and has greatly increased efficiency.”

To find out more about the key elements required when digitising pathology, download the full report here or visit Sectra at HIMSS20 in Orlando next month to see their software in action at Booth #6248.