100+ digital pathology implementations: 10 lessons learned, 1 essential conclusion

1. Automated distribution of slides increases productivity

In digital workflows, while scanning slides adds an additional step to lab procedures, it eliminates the need for manual sorting, which is required for case distribution. This has been shown to be the case both for the main workflow for new cases and for other scenarios, such as fetching priors, processing additional stains, and preparing for tumor boards.

Automating slide verification before allocation enables significant efficiency gains and automated allocation of cases for digital quality control.

2. Automated case allocation streamlines processes and cross-lab collaboration

Digital pathology workflows are revolutionizing case management by enabling automated case distribution. Case allocation can be automated based on predefined criteria, directing cases to either a specific pathologist or a team, based on factors such as subspecialty or workload capacity. Case allocation rules can also be set to consider the level of experience, optimizing resident workflows and ensuring optimal utilization of both resident and attending pathologist expertise.

This is not limited to one physical location. Multi-lab groups can implement this across geographic locations, allowing multi-lab groups to leverage expertise across the globe, eliminating geographic limitations.

3. Emerging AI support optimizes expert utilization

The incorporation of artificial intelligence (AI) into digital pathology workflows significantly enhances case allocation efficiency. AI can preprocess cases by analyzing features such as tumor size and staining patterns, aiding in more refined triaging. This enables urgent cases to be prioritized and ensures that each case is directed to the most suitable pathologist or team.

AI not only improves the speed and accuracy of case allocation, but also ensures that critical cases receive prompt and specialized attention, thereby optimizing the overall diagnostic process.

4. Complete and immediate case access increases patient safety

When selecting a case in a digital pathology workflow, the images for the entire case become instantly accessible on a secondary monitor, alongside the patient’s referral and anamnesis. This streamlined process—unimpeded by delays or additional login requirements—not only speeds up case selection compared with traditional procedures, but also enhances the diagnostic experience.

A high-performing enterprise imaging platform has been shown to reduce setup time significantly. The immediate availability of various types of images (gross, dermatology, radiology) and other medical data enriches the understanding of the patient’s medical history, facilitating quicker and more comprehensive case reviews.

Digital access also eliminates the risk of slide mix-ups within or between cases, bolstering both the reviewer’s confidence and overall patient safety. These advantages—improved diagnostic accuracy and efficiency—underscore the pivotal role of digital workflows in modern pathology.

5. Additional orders made easy, reducing overall workload

With digital access, images from prior cases are instantly available, reducing the need to request physical slides. However, this shift brings about new types of requirements:

• Fetching physical slides: In instances where a digital slide is unreadable, there may be a need to retrieve the physical slide.
• Re-scanning for quality: If the digital quality is inadequate, an option to order a re-scan is necessary.
• Advanced scanning needs: Situations may arise where multi-layer (z-stack) scanning or higher magnification is needed to observe finer details.

In addition, the digital format enables more precise and efficient ordering of further tests:

• Ordering additional stains from the image: This approach reduces the risk of requesting additional stains from the incorrect block, thereby saving time and resources by avoiding unnecessary procedures.
• Precise molecular testing: Molecular tests can be ordered with detailed information derived from the image, enhancing the quality of the tests and streamlining internal processes.

These changes highlight the evolving nature of lab work in the digital era, with the focus shifting to more specialized requests and precision-based tasks, thereby enhancing overall efficiency and accuracy in pathology practices.

6. Digitized slides simplify internal consultations

Digital slides facilitate simultaneous remote viewing of cases by colleagues, enhancing collaborative diagnosis and simplifying internal consultations, both ad-hoc and scheduled. Reviewers no longer need to be in the same location, sitting side by side in the same room or even at the same multi-head microscope to help a colleague. Nor is the number of ocular lenses on the multi-head microscope a limiting factor. Everybody with digital access can view the case simultaneously, interact with one another with a shared field of view, and show annotations and points with the mouse curser.

Conversations take place over the phone, Teams, Zoom, or chat, allowing for more efficient and accessible consultations regardless of the participants’ locations. This advancement not only saves time but also fosters a more collaborative and integrated approach to case reviews and discussions in the field of pathology.

7. Digital transmission of cases to external consultants shortens lead times

Both inbound and outbound external consultations have been proven to shorten lead times since there is no need to use a courier for digital images. The money spent and man hours needed for logistics have been shown to be reduced significantly due not only to the digital image itself, but also to the transmission of the referral and written report.

The quality and effectiveness of inbound and outbound external consultations have also improved markedly thanks to the enhanced interaction capabilities offered by digital platforms. The ability to annotate images and interact dynamically allows for more detailed and clear communication between the sender and the consultant. This digital interaction not only facilitates a better understanding of the cases, but also enriches the consultation process, making it possible to address queries and share insights more effectively.

8. Digitization has increased the speed and quality of reporting

Structured reporting—facilitated by digital forms and access to digital images with precise annotations, quantification scores, and AI results—can give the reader a better understanding and increase standardization across the entire reporting process. Standardization not only streamlines the reporting workflow for pathologists, making it quicker and more efficient, but also aids in clearly conveying conclusions to the reader.

The use of structured forms ensures consistency in the information presented, allowing for easier interpretation and comparison of reports. This shift towards structured reporting in the digital realm represents a significant improvement in both the quality and efficiency of pathology reporting.

9. System integrations enable efficient statistics and reporting to registries

The use of structured data in digital pathology facilitates the automation of various administrative tasks. This includes critical functions such as submitting reports to cancer registries, generating quality tracking reports, compiling management statistics, and processing billing information.

The key to unlocking these efficiencies lies in the seamless integration of different systems. Interconnected systems allow for more efficient data management and contribute to a more streamlined, comprehensive approach to administrative tasks in the healthcare domain.

10. Digital access to cases improves both teaching and research

The advent of digital pathology has notably enhanced the educational and research aspects of the field. With a vast array of cases now instantly accessible for teaching purposes, the scope for both personal and peer training has expanded significantly. Educators and trainees can access a diverse range of cases, far exceeding the limitations of traditional textbooks. This accessibility allows specific cases to be compiled for targeted internal training sessions, thereby enriching the learning experience for peers, residents, and students alike.

Within research, digital images have unlocked new possibilities. Immediate access to images, along with the ability to extract and utilize them simultaneously, has significantly broadened the scope of research activities. Particularly impactful is the integration of AI into research, which not only expands current research methodologies, but also promises to feed back into clinical practices, potentially enhancing both efficiency and quality of patient care. This integration of digital imaging into education and research represents a major step forward in the evolution of pathology.

Identified individual benefits for the pathologist: work-life balance, sub-specialization, and ergonomics

Digital pathology also offers several tangible benefits for the individual pathologist, including work-life balance, sub-specialization opportunities, and improved ergonomics:

• Supporting sub-specialization: Digital pathology allows pathologists to delve deeper into sub-specialties. Access to a broader range of cases from various labs within an enterprise enables more focused specialization, which may not be as feasible with physical glass slides.
• Achieving work-life balance: The flexibility to read and analyze cases from home or other remote locations has been a significant boon. This flexibility not only improves the work-life balance for pathologists but also benefits labs by potentially increasing available work hours, as pathologists can contribute outside traditional office settings.
• Improving ergonomics: Pathologists have reported ergonomic improvements due to digital pathology practices. The ability to vary body positions more frequently, especially when it comes to neck and shoulder posture, reduces the physical strain associated with long hours of microscope use.

These advancements underscore the positive impact of digital pathology on the personal and professional lives of pathologists, contributing to a more sustainable and specialized practice in the field.

One final and essential conclusion

One clear, overarching conclusion can be reached from the insights gained through over a hundred digital pathology implementations: successfully digitizing pathology imaging is not only about scanning slides or the standalone implementation of advanced technologies like AI. True success lies in integrating these technologies into carefully implemented workflows that drive organizational change. With this in mind, we believe that the key to success centers on three core aspects: workflow, workflow, and workflow.

If you are planning a change project involving digital pathology workflows, we recommend visiting experienced labs and seeking guidance from knowledgeable vendors in the field. Learning from those who have navigated this path can be invaluable in your journey.