Each year more pathology practices are using digital pathology systems in their workplace. Part of the recent increase was due to the need to work off-site during the COVID-19 pandemic. Other reasons for the transition to digital pathology include the promise of powerful artificial intelligence tools and efficiency savings. The question is, how can someone transition to a fully digital workflow, and is it even worth the effort?
Richard Lash, MD, is an experienced pathologist who earned his degree at the University of Michigan Medical School. He trained at the Cleveland Clinic and held various leadership positions in academic and national laboratories. In this article, he shares his expert opinions on digital pathology based on his clinical experience as an early adopter.
Why go digital?
It is important to understand your objectives when transitioning to digital pathology. What problem(s) is it designed to solve? Is the benefit material and measurable? How will clinics, labs, and pathologists be affected by the changes, both positively and negatively? Finally, what are the required hardware and software components, and are they compatible?
There are many well-documented benefits of digital pathology. These include addressing a physically dispersed workforce, handling remote intraoperative consultations (“frozens”), facilitating education (both intra- and inter-institutional), expediting expert consultations, and occasionally reducing overall turn-around time. The more impactful and perhaps more elusive promises of digital pathology are actual workflow efficiency gains, AI-assisted improvements in quality, and enhanced molecular testing (through effective test management and/or identification of AI-driven morphologic surrogates for molecular testing). As products that address these latter drivers become more widely available, there will be even greater momentum to incur the cost and manage the process changes required to “go digital”.
Lumea is a company that has taken a truly unique approach to digital pathology, starting with revolutionizing tissue handling at the time of biopsy. Such innovations help improve clinic workflow, allow for better tissue quality, maintain orientation, and even enable automated grossing for certain tissue types. They have also conferred substantial efficiencies for laboratories and pathologists’ signout (diagnosis) and provided more detailed reporting with highly discrete data capture. The latter can allow for automated quality assurance, better AI development, and research.
Signout on the Lumea module can occur anywhere on a single screen, even a tablet, without the pathologist tethered to a conventional digital cockpit. There is now even the ability to simultaneously view multiple tissue levels and special stains side by side with location and zoom tracking capabilities. These are the types of innovations that are impossible to contemplate with glass slides.
What is required to transition to a fully digital workflow?
There are four technologies pathologists need to go digital.
1) First is a whole slide image scanner. If you need help deciding which one is best for the size and volume of your practice, refer to our list of the top 10 slide imaging companies. The list has basic information about size, capacity, and scanning speeds. It also has links to the company websites where you can learn more.
2) Next, you will need slide viewing and case management software. Some digital pathology companies offer a combined tool, while others require integration. Lumea+, for example, uses integrations to incorporate our leading-edge tech and proprietary consumables with any existing LIS. This upgraded system provides a seamless transition from traditional to digital pathology.
3) The third item is a high-quality computer. You can use this as a replacement for or in addition to your microscope. Your computer screen will need to meet certain specifications for diagnostic use. Here is a comprehensive list of what to look for in a computer.
4) Finally, plan for image file storage. You can save costs by tiering access to stored files. Tiers are usually based on the time from the date of scanning and should be based on the likelihood of retrieval and the time sensitivity of the request. For example, you may want immediate access for 4-6 weeks and can accept a 24-hour delay for older cases. Remember that even glass slide access is rarely immediate.
After you have the essentials, consider using artificial intelligence tools. You can use these tools for screening (triage and/or help to focus on key diagnostic fields) or quality control (identifying something you may have missed). Regardless of use, ensure it is a validated application, appropriate for your practice, and cost-effective. If you are interested in learning more about different AI applications, see this article on the top 10 AI companies for digital pathology.
What can I do to help ensure a successful transition to digital pathology?
Understanding and planning for the key factors above will get you on track for success. Do the math to fully account for all the anticipated costs and whether the expected tangible and intangible benefits will offset those costs. Do your best to assess whether your system is as future-proof as possible. Account for the expected growth of your practice and the possible obsolescence of hardware and software.
Another idea is to transition over time. Digital pathology applications that integrate with your existing LIS, like Lumea+, enable gradual transitions. If you are interested in learning more about Lumea’s product lines, request a free demo.
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