In this episode of PathPulse, we’re joined by Dr. Syed Hoda, a self-described ordinary pathologist who faced an extraordinary challenge. With no prior experience in informatics or digital pathology, Dr. Hoda was tasked with spearheading the transition to a fully digital workflow at NYU Langone. His mission was to create a real, functional system for everyday pathologists like himself.
Dr. Hoda’s journey offers invaluable insights for anyone in the field. He’ll share why he believes now is the time for digital pathology, what it takes to get an entire team comfortable with a fully remote workflow, the critical, often-overlooked role of change management in a successful implementation, and how the transition has increased med students’ interest in pathology at NYU.
This is more than a story about technology; it’s about a complete transformation of a practice. It’s proof that going fully digital is not only possible but also achievable from the ground up. Don’t miss this firsthand account from a practicing pathologist.
Dr. Syed Hoda is the Director of Bone and Soft Tissue Pathology at NYU Langone, a clinical professor at the NYU School of Medicine, the Director of Surgical Pathology at the orthopedic hospital, and the Director of Digital Pathology on the clinical service side at NYU Langone Health.
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Transcript:
James Thackeray: Welcome back to PathPulse, the Digital Diagnostic Podcast. I’m your host, James Thackeray, and we’re continually exploring the frontiers of digital diagnostics and the brilliant minds driving this new evolution in pathology. Today, we’re diving deep into the practicalities of a complex digital transformation in pathology. We’ll discuss the hurdles, the profound benefits, and what it truly takes to move forward a future where we don’t have glass slides all the time into more of a digital era.
It’s an honor to welcome Dr. Syed Hoda, clinical professor and Director of Digital Pathology at NYU. Dr. Hoda has been a long-time advocate of digital pathology and is currently leading NYU’s significant digital transformation, which is incredibly exciting. And we’re excited to get into the details of that. So welcome to the podcast, Dr. Hoda.
Syed T. Hoda: Thanks so much, James. I’m super happy to be here.
James Thackeray: Great. Why don’t… let’s start with you, give us a little bit more of your background, and then start in and maybe overview your digital pathology journey. I mean, we can kind of high-level it at first, and then I promise we’ll get into the details there.
Syed T. Hoda: Yeah, for sure. So I am Syed Hoda. I’m the Director of Bone and Soft Tissue Pathology at NYU Langone, a clinical professor at the NYU School of Medicine, the Director of Surgical Pathology at the orthopedic hospital, and also the Director of Digital Pathology, now on the clinical service side at NYU Langone Health. So I have been practicing for about 15 years as an attending, and teaching and directing my services.
I actually originally got into Digital Path in about 2009. I was a resident at Northwell, also in Long Island. I went to a conference called CAP Futurescape, which was a very short-lived, now-defunct conference that CAP had started back in the day, talking about the future of the specialty. I think it lasted for two or three years.
It’s funny that I went to that conference and some of the same people who are still talking about Digital Path were there, like Liron Pantanowitz and Anil Parwani and the, you know, Aperio was like a new company that like, you know, Leica hadn’t even bought it yet. It was like its own thing. And, you know, they were all talking about digital path stuff, and it seems so fantastic as like a young trainee.
And I went back to my residency and presented what I saw at Futurescape, and that’s when reality hit me, is that people were not ready for it at all. I remember presenting and, like, there were doctors walking out. They were totally uninterested in the topic. It was just too space-age for them. So that really set off, James, my pursuit at trying to figure out why that’s the case, and also making it a goal that I wanted to move us towards that direction.
James Thackeray: That’s great, great overview. I know Dr. Crawford at Northwell has always seen that vision of digital pathology as well and has been working towards implementation there as well, so that’s a common tie that we have. I was reading an interview that you did earlier with The Pathologist, and you said something to the effect that the time is now officially here.
So, walk me through that because we’ve been kind of on this journey as well for a long time, thinking back, we’ve been around, our company’s been around for 15 years. And so I think there was a time we thought, it’s here. And then it’s like, it’s not quite here. And now it’s here. And then it wasn’t quite, but I do, I feel the same way, but I’m interested to hear the background on that statement.
Syed T. Hoda: Well, I think there’s a number of reasons why, and you know, James, to be honest, the time was here like a while ago. The problem was, is the landscape of pathology. Like you and I, like you see, there’s different angles of looking at this, right? Like, I am an ordinary pathologist. By any means, I am a, when I say ordinary, I get to my job, mean, I wake up every morning, and my job is to diagnose patients as a pathologist, right?
So I was not involved in any companies, I was not involved in any organizations outside of where I work. And so I feel like the alignment of my mind was to make it a real functional tool for people like me to use. And there are other interests that people have, like institutions will have a certain different interest, corporations and companies, and startups will have a different interest. The peripheral industries will have a different interest, right? So trainees will have a different interest.
So when those start to align, when the industries are developed to a certain extent, the institutions are becoming aware of it, the trainees are wanting it, and the pathologists start to realize that there’s some incentive for them to do that, like to help their work, then I feel the time becomes now, right? When we don’t have all of those wheels functioning properly, it’s not possible.
So I think the companies were ready a long time ago, like I would say in 2009, 2010, I felt that all the companies were ready to go. But that’s why you’re all ahead of the times usually, right? Like you’ve got the technology ready to go, but who’s gonna actually buy it and use it and implement it and evolve it into a functional utility? That’s really the question.
James Thackeray: Yeah. And you saw, that’s great, because I agree. And I think what you saw early on was certainly… there are certain academic centers that were developing this, and even in those earlier scenarios, I don’t know if I would have called it “practicing digital pathology”. I would have said, “Well, that’s more research or almost tumor board-esque use of what could be something that could be done in a clinical daily use.”
But now, I feel like you’re right. I feel like the technology was there before, the market felt like it was ready to shift, but it took maybe some learnings, some “school of hard knocks” to get us to this level, where now we’ve learned some things along the way. We’ve learned as an industry to partner together, I think a little bit better to make it, to your point, more functional for the pathologist, which I think is critical. But yeah, I couldn’t agree more.
Take me through the journey thus far, because you’re coming into this very fresh. I mean, you’ve thought about it for a long time, but the actual implementation is just coming to fruition now. So coming fresh off of that, if you were to talk about hurdles and how would you set expectations for another institution that’s just at the beginning of the journey, and what to watch out for, not watch out for, but to look for.
Syed T. Hoda: Yeah, I mean, so much to talk about here. Before I do that, I just want to say that thing you said about institutions dabbling in it and starting it, you know, time and time and time again, you’ll hear somebody saying, “Oh yeah, we’ve had digital pathology for like about six years, seven years, nine years,” whatever.
But if you dig deeper into it, usually they say it’s for educational purposes. They have it for scanning. They have it for, you know, it’s like a hobby almost. They have it like almost like a hobby. It’s not set up for serious workflow.
Like I’m helping some institutions now, outside of my own, try to refocus what they wanted out of this. And what I realized is that even the places that were really early on never set it up for a workflow that would work day to day for somebody like me to walk into work and use it to its full capacity.
And so there was a disconnect, and I don’t blame the early adopters. The early adopters were in the period where there was no precedent for a lot of things, right? So they had to get it up and running, but they didn’t exactly know how to do it. And that’s kind of, when you say I’m very early on, you know, I literally came with no experience. I’ve never implemented digital pathology. I have never even looked at a scanner in person, like, enough to know. No informatics background—I am genuinely an ordinary pathologist doing this.
So for me, every question was basic and real. You know, like when I asked the original questions, like it would have to be from somebody like me, like, “How would it work for somebody like me?” So I think that was an advantage because I didn’t have any industry links. I didn’t have any experience in anything. So I’m coming in brand-new, and I asked people like you all, you know, “What do I do to get this done, and so I can do this kind of work?”
That’s where that dialogue begins, right? Where we try to create solutions that work. And so the challenge is, like, for example, the places that are setting up one scanner to do a little bit of dabbling. I think that was the old model of trying to get on board, to get people used to it, to say we have it, you know, and it was kind of symbolic. Like, it was a symbolic digital pathology implementation.
I guess what we’re showing is that there is an alternate here. And the alternate is to dive in, like fully. And I don’t think that this model really took off for most places because of a lack of resources, a lack of organization.
And I’ll tell you, James, that the most important thing that I’m telling people right now, is A, your hospital administration or institutional or lab administration has to be involved early on in this conversation at the core.
And the IT teams have to be involved early on. If you really want to make a sustainable solution, it’s got to be those two really on your side, not like fighting you for it, but like on your side, trying to improve their, you know, patient care or research care or whatever they’re doing. It has to be done through–with alignment.
And if you invest that alignment, like it’s worth putting in two, three years of alignment investment in order to get to a place where you can now dive in. Rather than getting one little scanner in a lonely room and then calling that the diving in and now negotiating for more, it gets harder.
Because what have you done with the one scanner? “Oh, not much,” right? “So what are you going to do with five more scanners if we get you five more? How do we know you’re going to actually use it in the way that it’s supposed to be used? So that’s what I’m proposing.”
James Thackeray: That’s great. And I love, you know, this old model versus new model. And I couldn’t agree more. And I understand what you’re saying about ordinary pathologists. I’m sure you’re an extraordinary pathologist, but you’re coming at it from a very practical, “How do I use this tool clinically in my day-to-day use?” And I think that’s, it is, it is unique because I think, and without offending those that are on the circuit of speaking about digital pathology, because I think that’s, they’re pioneers in themselves.
But they sometimes have had a different “why” that they went digital. From, you know, whether it was they created the software for more research perspective, or they had an initiative with pharma to do something else, whatever it might be. I think your view here is incredibly important. And I think it will resonate with our listeners quite a bit.
Syed T. Hoda: And I want to make clear that those people, those people who’ve influenced this transition are hugely important to us. I’ve learned from all of them, I’ve spoken to a lot of them, like they really helped guide like a lot of the things that we didn’t know answers for.
But I think, at some point, there has to be a kind of normalization. They’re, you know, experts like being an expert, for example, in bone and soft tissue pathology, when I teach it to students and residents, like, there has to be a different, I don’t talk the same way than when I talk to my other bone and soft tissue colleagues, right?
Like, there’s a different, there’s like people on the service line, and then there’s people above the service line in a kind of expert database, right? So I think those are experts in the digital pathology realm, but then there’s people like me who are novices who’ve been put into kind of leadership roles to develop things for novices like myself. So I think that’s a different perspective.
James Thackeray: 100% and agree. I totally agree. The role that those pioneers played is why we’re here today. But I do think it’s taking what was… how it started and getting a new model out there.
And that’s critically important, especially, I think, when you start to think of, and maybe that’s where we go here, the lack of diagnostic resources worldwide, you know, the lack of pathologists in general worldwide, kind of the aging population that we have within pathology.
All of that suggests that we need technology to kind of take us to this new level. So maybe we go there a little bit and tell me what your early experience has been in the digital world, like clinically diagnosing, maybe pros and cons, let’s just be real about what you’ve seen thus far and where you see it going.
Syed T. Hoda: Well, James, early on, our focus was laser targeting the concept of using it daily for all clinical workflow. That was the immediate goal. That’s still the goal as of right now. Maybe in about a month, a month and a half, we are going to transition into phase two.
But we are, every single point we ever discussed about digital pathology at NYU was geared towards making the most usable, integrated, workable solution that required no microscope to use.
And so every question we asked was about that. Every customization we did to Epic Beaker, which is not an easy IT solution to navigate for this kind of thing, was geared towards that. All of the hardware we purchased, all of the customized setups in each office we put in, all geared towards that. did not discuss AI yet.
I mean, we’ve discussed it, but we have not implemented any AI until everybody felt totally comfortable in a digital platform. The reason why is that we want them to have goals. They all wanted to use AI, but we want them to be proficient and comfortable in what they’re doing before they move to the next phase.
Same with remote sign out. We want them to be remotely signing out. And that’s beneficial for many reasons, including some of the things you mentioned, like workforce shortages and stuff.
We wanted everybody to reach level one before we moved on to the others. And I think that kind of focus, I could not find in any, I had many, many conversations leading up to our launch last September, and I couldn’t find an institution that had done it with that as the focus first.
And I don’t blame them for having other focuses, but for us, that’s what I felt was the most important thing. There’s a lot of resistance built into pathologists. And I think that we should be realistic about it. Like I’ve had to manage it with my own teams to talk to people. There’s change management involved, which, if you’re in a company, you understand what that means. There’s a huge amount of change management here, and telling doctors what to do and how to do their work is like one of the great challenges of healthcare, so.
James Thackeray: That’s such a great perspective. I think, too, especially for those of us that are non-pathologists, right? We often overlook the challenge of change management in a specialty where people, pathologists, have become so good at what they do, so efficient, so process-oriented in the way that they do their work, regardless of the subspecialty of pathology, right? Within pathology.
And so I couldn’t agree more. I think we sometimes, well, this just “Come on. You can work from your house. You can integrate AI,” all these great things that futuristically or sometimes are, I think they are there today. But you’re also taking someone who has really done the most with what they have to make it efficient and become very good at it, and now saying, this looks quite a bit different. So, how have you gotten, how has that, I know this is phase one into phase two, how has the change management part of it gone specifically with your pathologists?
Syed T. Hoda: It has been for me a very eye-opening experience. Again, I mentioned I’m not a company or business person in any way. So for me, the first time I heard about change management was in a leadership meeting I was doing like a couple of years ago, a course I was doing, a leadership course. And they mentioned, they’re like, “Have you ever heard of change management?” I said, “No, I never heard of it.”
And that’s one of those things that you’ve never heard it, you don’t know what it is. And once you start learning it, you understand that that is how a lot of things have grown in the industrial world and in the healthcare world, even, to getting groups of people to align on a certain goal.
And so luckily, this is another place where my institution didn’t let me down. They had a change management expert as part of the MCIT team. And me and him would meet several times a week, talking about messaging, about how we discuss things, about.. We had town hall meetings organized, like to let people voice their concerns. We had small group sessions done. We had polling through, like, different things. We had so many ways that pathologists could express themselves about the changes about to come long before that we even launched the digital pathology. And we would have, we had an entire retreat day, of like a full day of presentations. We invited speakers from other institutions.
And I’ve been telling people to do this, like invite company people, invite outside speakers, have them get used to the idea, the conversations, and et cetera. How are they supposed to ask questions if they have no idea how any of it goes? So, you know, we did all that, James, and yeah, there were some hard moments.
I remember walking out of one of the meetings and telling him like, “That was a really rough meeting.” And he goes, “What are you talking about? That was great.” And I said, “Why?” And he said, “People were complaining, and you want that. You want to hear what people are complaining about. You want to hear what people have discomfort about.” Because he’s like, “That’s the only way you can address those issues. If you hear it, if you, if you just go through the silent world of thinking ‘I’m the leader and I’ll make this happen,’ what’s going to happen is it’s going to go live and then they’re going to complain about it. And then you never address their complaints.” So I learned a lot about preparation for groups of people. Um, and that’s, that’s my change management perspective.
James Thackeray: It’s so valuable, so valuable. Probably if I were to say, I don’t know, I’m just taking the collective whole of people we’ve interviewed and people we’ve integrated with and groups that we’ve integrated with, probably the most, certainly at a larger institution level, the most overlooked is the change management. Like, that is a true barrier to entry, and the way, just the way you’ve even talked about it, suggests how well you guys have done it, even if it takes some time, but to get others involved in the process is such a key element of this. So that’s exciting.
Syed T. Hoda: Yeah, so I remember we spoke to a place, you know, a private lab, when we were still looking into this concept. And they said, yeah, they implemented digital pathology. It was kind of a mixed response. Some of the people didn’t like it. Some of them liked it. And then they set a hard deadline of when everybody’s supposed to start using it and not use the glass anymore. And they said, I think they said almost half their pathologists left before that deadline, which is basically a nightmare scenario.
You know, like that’s essentially what we’re never wanting to happen, especially in this climate of shortages and workforce issues. Like, you know, it would be our nightmare scenario. So, you know, we learned a lot from those conversations. I don’t know the details of how much change management they did or whatever, but I think it’s so important to let, make it a predictable feeling to know, to gauge what your group is thinking.
James Thackeray: That’s so great. So great. I appreciate that. Let’s transition just a little, and it can kind of help us summarize a lot of this, I think, or at least allow you to summarize it for us. So, as you kind of see this digital transformation, and you’re now a key element or key part of this whole transformation, how does it change the field of pathology?
I guess outside of the obvious, what it enables you to do, but maybe more high-level, what does it enable pathology as a specialty to become? Does that make sense? Do you know where I’m kind of going with it?
Syed T. Hoda: It’s, it’s I I would say I cannot understate or overstate this enough. It has changed the entire perception of our department, I think. I mean, I go to the lunchroom and there’s like because it was such a big deal here was discussed in the institution, and it’s a large transformation. And our Dean was a radiologist. So he really encouraged this, said “Radiology did this 15 years ago,” and we all know that radiology has been great. Like it’s done great since it went off.
And so for us, it changed the entire perception of pathology. I mean, we have more medical students rotating through our specialty than ever before, exponentially more. Like we used to get one every few months. Now we have like three or four on every week, which is like, you know, unheard of in a medical school to have this much interest. We have, you know, our tumor boards are done. Radiology and pathology are treated very equal. Like we bring up the cases the same way they do. We’re no longer, like, living in this kind of outdated model.
We don’t take days and days to pull out things from storage and pull out, you know, like that perception of us being kind of a slow-moving specialty really changed. And I can’t say it enough, like how big of a difference it makes in the way the perception is. And you know, perception may be looked at as something superficial, but it’s really not.
Like, you know, the reimbursement rates, the way the authority that the lab has in a hospital setting, the clout that pathology and that side of patient care has and research has and et cetera—it brings value to all of it to suggest that we put in a lot of effort to modernize to a standard that’s really a high modern standard of medicine. And that makes us look like we’re putting in effort for patient care. And I think that’s a huge thing for our specialty.
James Thackeray: That’s so well said. And it’s almost that the specialty, it’s the tool that is enabling the specialty to be what it really should be and has been. But it even elevates it more where you really are overseeing the whole diagnostic journey. But it puts you at the same table with everybody else.
I think that’s as much as anything else as we kind of integrate into molecular companies and all the different subspecialties that this impacts, not subspecialties, but different areas where this all comes together, it allows you as the pathologist to really manage all of that and not just one little section, which I think a lot of people’s perception is of what pathologists do.
Syed T. Hoda: Yeah, I mean, it really caps, you know, it takes the lid off the potential cap that was kind of there, right? Like, you know that the amount of technology capabilities that are going to evolve out of this kind of transformation are endless at this point. We have no idea where it’s going to take us. But how would we ever even think about moving towards that if we don’t take the little cap off and move into that space?
So this is where I think it’s so crucial to identify that we have to be comfortable with that transition. And to me, adopting a digital workflow means that we’re comfortable with moving into the future. If we’re not adopting it, it means we’re hesitant and we’re not going to move into the AI.
This is what I keep saying over and over again, James, and it offends some people. I have had pathologists say you don’t need to be on a digital platform to use AI. I have always disagreed. I think it shows hesitance. And if your leadership is showing hesitance, it’s not going to happen in the way that it’s going to be meaningful for patients, meaningful for doctors, meaningful for companies, et cetera. I think this is taking the lid off to allow it to happen.
James Thackeray: So well said. That’s a great summary of the conversation that we’ve had. I think we’d love to have you back to kind of go even deeper as you kind of go down this transformation within your institution. It’d be great.
Thank you so much, Dr. Hoda. This has been enlightening, and I love it. It is a unique perspective. Again, I hope that you continue to be out in the educational world because I do think your perspective as a functioning pathologist and the “why” behind going digital for you is what the majority of pathologists are trying to figure out. So I really appreciate it.
Syed T. Hoda: Thanks so much for having me. It’s such a pleasure. Such a pleasure.
James Thackeray: Yeah, thank you.
