How Goldfinch Laboratory Scaled a Start-Up Lab with a Dream, a Shoestring Budget, and Digital Pathology
Goldfinch Laboratory was created in 2023 by a small pathologist group with a dream: to bring world-class subspecialty pathology expertise to rural midwestern patients through the power of technology.
In under two years, they’ve been able to grow their practice to the point that they now produce over 400 slides per day and offer a wide variety of pathology services, including dermatopathology, gastrointestinal pathology, urologic pathology, breast pathology, bone and soft tissue pathology, and gynecologic pathology.
To find out how digital pathology has impacted their success, we sat down with Dr. Tiffani Milless to discuss Goldfinch’s journey from zero to digital on a shoestring budget.
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Q: When did you and your team know you wanted to make the switch from traditional pathology to digital pathology? What led you to this decision?
A: My cofounders and I have always believed that to be the best in our field, we need to be constantly learning, growing, and expanding our concept of how we can do the best for our patients and providers. When digital pathology was first being implemented in the field, we weren’t clear how it could benefit our practice, but we were eager to learn more about it because we are always excited by new advances in our field. Eventually, Goldfinch was born out of a belief that we could improve the quality of care of our community through innovation, and our digital ideas began to take shape.
All four of us owners are specialized in dermatopathology, but we believed that we could expand both regionally and within other subspecialties using the model of providing subspecialty care and expertise to all patients, especially those in rural areas.
Traditionally, in pathology, there’s a common belief that in order to fulfill access to care obligations, you need to be a general practitioner. And so a lot of our competition are general pathologists trying to do their best in situations where they’re often practicing alone and working to handle all different tissue types and situations.
But we believed that through technology and in a new practice where we were all aligned, we could do things a little differently, and it’s really helped us to achieve some of those goals.
Q: Once you decided to go digital, what was the first hurdle Goldfinch had to overcome?
The first thing we decided to do was choose a scanner and a viewer—we were well aware that those two decisions should be made in concert. So, we began getting in contact with different companies and participating in product demos to weigh our options.
At the time, the market seemed to be pretty narrow and most of the scanners that we were seeing were really big—mostly meant for academic institutions or very large, hospital-based practices. And the upfront cost was a couple hundred thousand dollars. The associated software, too, was closed software and that also seemed very cost prohibitive for a lab our size.
But going digital was our dream, and even though it didn’t seem financially feasible, we knew it was exactly what we needed.
Over time, we found other companies in the market space that were introducing smaller-scale scanners and we saw more open technology coming out for image platforms.
The real game-changer for us was finding solutions that offered volume-based payment models, because as a startup, it was essential for us to limit some upfront capital costs to offset the costs of things like outfitting our lab. Being able to incur those costs gradually allowed us to clear that first big digital adoption hurdle.
Q: What were some crucial elements that led to your success?
One of the most helpful things we did was work with a vendor that was dedicated to helping us find the best, most cost-effective, and efficient solution for us. Choosing a scanner, an LIS, and eventually a viewer were all really big decisions, and after experiencing some demo exhaustion from talking with all of the different options and having to make decisions about every single piece of our lab equipment, we knew we wanted to rely on the opinions and the advice of someone who truly knows digital pathology.
We did a lot of research with people that had already gone digital, but it was difficult finding what we believed to be a comparable lab because most of the people with experience had worked in either very large scale commercial labs or academic centers—we couldn’t find many labs like our startup that were trying to do this on a shoestring budget and smart small with the capacity for growth.
So, we also needed to rely on consultants. We had numerous lab consultants, but when we were introduced to Lumea, it really appealed to us because we felt like we could benefit from all of their expertise and knowledge due to their unique position and lengthy history in this industry.
It was really helpful to get some clear-cut recommendations from someone that understood exactly what we needed as we started out and as we grew our practice. The person that we worked with was not only a well-seasoned laboratory expert, he was a digital pathology expert as well. That was huge for us.
Q: Which digital solutions did you end up choosing for your lab?
We decided to go with Hamamatsu’s NanoZoomer scanner and Lumea’s viewer for our lab. We really liked that the NanoZoomer would pair well with our new stainer/cover slipper. The slide racks could be loaded into the scanner without having to remove and insert each individual slide. This interoperability and minimization of tech time was critical for us to establish a lean, streamlined process. We were also impressed by the way NanoZoomers are able to connect and work in concert. Rather than buying a large scanner upfront with a high capacity beyond our needs, we’re able to add NanoZoomers as our volume increases, and they can all be scanning in concert for optimal efficiency and gradual capital expenditure.
Lumea’s software was a perfect fit for that scanner and the needs of our lab. They already had an existing integration with LigoLab, were scanner agnostic, and gave us the customization and flexibility we needed to achieve our vision for Goldfinch. Their team was helpful and responsive, and we were up and running, from decision to implementation, in just four weeks. We’ve also experienced enhanced workflow efficiencies with Lumea (their zoom function, for example, is very helpful and intuitive) and the ability to perform remote consultations is an essential function for us.
Q: Which benefits of digital pathology have surprised you?
We were definitely expecting to experience benefits like growth potential, remote potential, and the ability to contract pathologists outside of our geographical area.
But a personal unexpected benefit for me has been having the ability to be present in important parts of my life with increased flexibility. As a startup lab, it’s really important for us to be present in the lab as we train staff and respond to critical, time-sensitive medical care. But as a mom to young kids, finding a good work-life balance is always a struggle. Having digital pathology has really revolutionized my ability to find this balance. After my kids go to bed, I don’t have to drive back to the lab to continue signing out cases. I can look at a case if a colleague needs my opinion or provide my thoughts on something even when I’m off. It’s a great way to have my microscope be at my fingertips wherever I am in a lot of ways.
Q: What advice would you give to other small practices that want to go digital?
First, I would advise anyone that wants to go digital to remember that no matter how forward thinking you are, there’s definitely a learning curve associated with digital pathology adoption—it’s different than using a microscope. For example, just like microscope choices, your hardware options are really important and personal! You need to figure out what kind of monitor is best for you, and what kind of mouse, and if you want to use an iPad instead of a traditional computer. The sky is the limit with how you build out your digital pathology workspace and each person needs to test what works for them.
And second, it’s a major change management initiative to implement digital pathology. So the shift needs to start with your culture.
We were very intentional in curating a culture of innovative, energetic people that are excited about change, growth, and coming to work every day thinking “We’re going to do better than yesterday. Maybe that’s going to be a little bit different, but I’m okay with that and I’m going to be flexible.”
So if you’re going to go digital, you should know that process change and training people is going to be one of your biggest upfront investments, and it’s important to have a patient mindset and start small. It’s been a gradual process to get everyone in our lab comfortable and learning a new way of doing things.
We also encourage everyone to speak up and share their experience so we can all learn from each other. Digital adoption isn’t going to be easy for people that are very rigid, old school, and unwilling to change. It requires flexibility, curiosity, and a willingness to grow and look at things differently.
To learn more about Goldfinch Labs, you can visit their website at www.goldfinchlaboratory.com.
