Enterprise imaging without pathology—are you kidding?

The search for an enterprise imaging platform

If not already implemented, enterprise imaging platforms are included in almost all healthcare providers’ future plans. The most cost-efficient way of implementing such a solution seems to be to expand the existing radiology PACS into an enterprise imaging system that also includes other departments’ images, such as cardiology, dermatology and various non-DICOM images. What is now clear is that the most image-intensive department of them all, pathology, is undergoing digitization and is increasingly being included in enterprise imaging discussions.

Advancements in immunotherapy and patient-targeted treatments will drive pathology digitization. However, what many people forget is that a platform for storing images is not enough: the system also needs to handle the workflow, provide the ability to view images with high performance and offer the right functionality necessary for diagnostic reviews, consultations and image analysis.

Many providers are digitizing pathology as we speak. To avoid expensive migrations and integrations, poor workflow and unsatisfied users, it is crucial to select an enterprise imaging system that adequately supports pathology from the very start.

Why is pathology special?

There is a reason why pathology is being digitized almost two decades after radiology. Digital pathology images are large, very large, and demand a totally different technique to be viewed with high performance.

For pathologists to let go of their microscope and use a digital solution, the image viewing must be instantaneous without any pixilation or lag. In addition, the workflow, case overview and functionality need to provide a unified user-friendly experience.

If the pathology support in the enterprise imaging platform does not offer these capabilities, pathologists will not go digital.

From a global perspective, Sweden is the country that has come furthest in the adoption of digital pathology. All regions now have scanners and about a third have enterprise imaging solutions or pathology PACS implemented, fully capable of supporting a diagnostic workflow. But Swedish providers have not come this far without hitting certain stumbling blocks. The Swedish adoption journey can provide us with insights into what an enterprise imaging platform should be capable of when it comes to pathology.

What to look for on the “pathology side”

There are five main components to look for when evaluating an enterprise imaging platform’s ability to deliver an efficient digital pathology solution:

1. Pathology-specific functionality: Viewing speed is key for pathologists. There must be no pixilation or lag in the image at all. The best way to judge if the viewer provides high usability and is fast enough is to let your pathologists try it. Other must-haves are the ability to easily share images for consultations and add and prepare cases for tumor boards, as well as access to radiologists’ images and reports for diagnosis alignment.
2. Scanner neutrality: Pathology DICOM (sup 145) is not yet harmonized or widely implemented. Hence, in addition to DICOM, support for the major scanner vendors’ proprietary file formats will be necessary. Some vendors claim their enterprise imaging platforms can store all kinds of images, but few allow them to be viewed with high performance.
3. Vendor’s experience and project management: The digitization of a pathology department doesn’t just involve a replacement of technology, it is also about change management. Ask for references to make sure the vendor has the required experience and a track record of delivering successful digital pathology installations. In these “first-of-a-kind” projects, it is often the vendor that is the driving party when it comes to orchestrating all activities.
4. Workflow: An enterprise solution for routine pathology does not consist solely of storage and a viewer. The system’s workflow is the glue and must offer a unified user-friendly experience and create a good case overview in order to realize the promised efficiency gains. For example, the enterprise imaging platform needs to offer intuitive worklists, MDT tools, user administration, etc. in a similar way to a radiology PACS.
5. Image analysis: Often the main reason for pathologists to go digital is to automate cell counting and other tedious, expensive and boring tasks. The system must also be able to incorporate well-integrated image analysis tools to assist in critical decision points, such as gradings that will affect the treatment decision. Again, usability and speed are key, and this can best be judged by asking existing users of the system.

Be prepared, pathology’s digitization will come—sooner than you think

Advancements in immunotherapy and patient-targeted treatments will push for the digitization of pathology in order to cope with the increased complexity and workloads. The investment in an enterprise imaging platform is substantial and selecting a solution that does not meet the requirements for digital pathology can be an expensive mistake. These five check points will help you ensure you are well prepared to incorporate an efficient digital pathology workflow when the time comes for your organization.