Radboud University Medical Center

Digital pathology enables Dutch pathologists to work from home

Faster learning through digital sharing of COVID-19 images

Following a well-conceived preparation and implementation phase, the pathology department of the Dutch hospital Radboud University Medical Center (Radboudumc) was in the midst of the testing and acceptance phase of Sectra’s Digital Pathology Solution when the COVID-19 pandemic hit. It became clear that the coronavirus would have a major impact on the way of working. The pathology and information management departments accelerated the project and went live with the solution in mid-March. “Since then, the pathologists have primarily been working digitally from home,” says Prof. Katrien Grünberg, head of the pathology department. Here is a look behind the scenes.

Grünberg joined Radboudumc in 2015. At that time, the department already had a scanner, but the only group working with digital images was the computational pathology research group. The diagnostic workflow was still completely analogue. The lab wanted to collaborate more intensively within the region. In addition, Grünberg wanted to take the use of artificial intelligence out of the research setting and into diagnostics. After a period exploring opportunities offered by digital pathology and following a European tender, Sectra became the selected vendor in 2018.

Live during lockdown

“We spent a year on the implementation,” says project manager Patrick van Overdijk. “We had to take that time to figure out what functionalities we wanted to use and in what way, and what impact this would have on the workflow. After all, working digitally affects just about every process in the department. Moreover, it is technically complex and requires adaptability from the end users.”

The project was in the testing and acceptance phase when the team realized that the country might also go into lockdown. “A week before Prime Minister Rutte announced the national lockdown, we were already technically ready for everyone to work virtually,” Van Overdijk explains. “We immediately discussed with our information management department how we could offer the pathologists a good work-from-home set-up. Pathology images are huge, and to send these images you need a stable connection and very high bandwidth. In addition, as it concerns patient data, this needs to be done securely. The Sectra solution runs centrally within the hospital IT environment. Pathologists log into the system remotely and can assess the images from home.”

Facilitating working from home

The project team arranged monitors, laptops, cables and other hardware that the pathologists needed in order to set up a workstation at home. They also prepared instructions. Paula Soedira supervised the project from an information management perspective. “While our pathologists used to work from home occasionally, the microscopes and glass slides remained in the hospital,” she says. “If the core of their work is also digitized, then there is less need for them to be physically present at the hospital. This way of working was new to most pathologists. Nevertheless, everyone embraced it very quickly.”

Since the lab technicians who prepare and digitize the glass slides were unable to work from home, they worked in two shifts to reduce the number of people in the lab at the same time. Susan van den Kieboom-Hageman is lab technician team leader and co-responsible for the digital pathology workflow project. “Previously, we handed out the glass slides to pathologists and residents twice a day, with the exception of the cito requests, which need to be responded to right away and were delivered immediately,” she says. “Now, we can instantly prepare the slides for viewing once they have been scanned. This has revolutionized the interaction between pathologists and lab technicians.”

Back-to-normal production

“Our home offices are still far from ideal,” says pathologist Konnie Hebeda. “In the hospital, we have a workstation with several large monitors, and we can dictate reports digitally using speech recognition. At home, we only have a laptop with a separate monitor, and we must type everything manually. However, no one has complained as it is so important that we can continue to work, and that the diagnostics process has not come to a halt. As a result, regular patient care can continue, although on a slightly reduced scale.”

On the upside, far fewer exams were being submitted at the beginning of the coronavirus crisis. “The number of exams was significantly lower than usual, particularly in the first few weeks. This gave everyone time to get used to working digitally. And now, production is almost back to normal,” Hebeda says.

Van Overdijk understood from the number of technical and functionality-related questions that their new way of working took some getting used to. “Since the digital review was rolled out so quickly, it didn’t work perfectly for everyone right away. During the first two weeks, we talked to many pathologists who had questions, but we got everything to work in the end.”

Digital sharing of images

Working digitally brought great advantages to the investigations related to COVID-19. “We were able to share images with colleagues very quickly—with other pathologists, but also pulmonologists, radiologists and other medical specialists internally,” Grünberg says. “Our multi-disciplinary team meetings now primarily take place virtually.”

External sharing of images is trickier since you need a secure connection between hospitals, and not all pathology departments are digitized. Even so, in the current situation, hospitals want to be able to exchange knowledge and experiences as soon as possible. “That is why I sometimes take a screenshot,” Grünberg explains. “That way, I can use anonymous images to show others what I have observed. I made a PowerPoint presentation with these images, for everyone in our hospital who was interested. We also shared the screenshots in a national pulmonary pathology network and internationally. There’s no faster way to learn.”

Embracing the digital workplace

Soedira enjoys seeing how not only the pathology department but the entire hospital has embraced working digitally. “Of course, the information management team has been pushing for digitization for some time,” she says. “However, this is a major change to processes and workflows, so it doesn’t happen quickly. COVID-19 has ensured that everyone is now excited about digital working methods. Sometimes things go wrong, but everyone accepts that—it is a natural part of innovation. We solve it, learn from it, and make everything even more efficient and effective. This change in mindset is creating a tailwind for all digitization projects, and certainly also for the accelerated roll-out of digital pathology.”

“The timing was indeed perfect,” Grünberg adds. “There were still some people in our department who had doubts about digital pathology. That is why, just a few months ago, the discussion centered around the speed of transition. We have left that discussion well behind us now. Instead, we are talking about optimization.”

She believes the success of the adoption is also due to thorough preparation. “The pathology and information management departments have worked together very closely over the past year. The digital pathology environment that we put in place fully meets our requirements. Thanks to our preparation and close cooperation, we were able to adapt quickly. I am very proud of what we achieved together with Sectra,” Grünberg concludes.

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