Pathology goes digital—what can we learn from radiology’s journey? 5 tips from UK radiologists

Radiologists have transformed their way of working, from processing plain film to today’s large set of digital modalities that include nuclear medicine, ultrasound, mammograms, PET and fluoroscopy among others. Pathology’s transition from glass slides to digital images is likely to provide an equivalent transformational change. Pathology is more sub-specialized and involves a higher degree of manual tasks than radiology. Accordingly, it is likely that the benefits of using digital techniques will probably have a greater positive impact on pathology than they had on radiology.

This article summarizes a survey that Sectra sent out to UK radiology customers asking what one piece of advice they would give pathology departments about to embark on a digitization project.

Their top five pieces of advice are:

1. Choose a vendor-neutral solution
2. Ensure system robustness
3. Ensure there are clinical references that testify to good support and vendor relationship
4. Ensure you have internal engagement
5. Focus on the workflow

Choose a vendor-neutral solution

The value of a vendor-neutral solution is typically discovered over time. Many early adopters within radiology selected an end-to-end system with a PACS solution that only integrated with modalities of the same brand. These sites were locked to select components from that single vendor, which proved to be very costly when new equipment and new integrations were required. In contrast, a vendor-neutral solution allows for selection of the most appropriate and cost-efficient software or equipment to suit each specific use case.

To implement and maintain cost-efficient integrations it is important to make sure the solution supports such common industry standards as XDSi, DICOM and HL7. A solution that follows standards also allows for a long-term data management strategy and to keep the doors open for a potential change of vendor.

• “Use generic protocols and be as vendor-neutral as possible.”
• “Make sure you have a clear strategy and solutions for long-term management of your data.”
• “Keep it simple and use a solution that supports standards.”

Ensure system robustness, good support and vendor relationship

Radiologists know that system downtime is incredibly expensive and has a major impact on their effectiveness and patient outcome. The value of a robust solution, together with good support from the vendor, is something that radiologists still maintain is an absolutely top priority when selecting a PACS. The best way to find out about robustness and support performance is to ask the vendor for a reference.

• “Ensure you have a well-tested product seen live in a clinical working environment and the supplier service back-up is robust and responsive.”
• “Visit any site where it is already in use to understand the problems.”

Digitization is something the organization undertakes together with its vendors, which makes a good working relationship crucial.

• “A successful IT relationship starts and is based on people and their relationships. If that is done well from the outset, the contract can be left collecting dust on the shelf.”

Internal engagement and preparation

The internal preparation, planning, staffing, organizational commitment and training cannot be highlighted enough as these components are absolutely key to ensuring successful digitization. The majority of advice given referred to these internal factors, indicating that these areas caused trouble for many involved in radiology during digitization. Even if you select the best vendor with the most appropriate solution, the digitization project will not succeed unless the internal prerequisites are secured. Below we have listed some of the quotes under each category.

Proper preparations

• “Prepare, prepare, and prepare again!”
• “Plenty of preparation and planning.”

The right staff

• “Have enough staff with IT experience.”
• “Have a solid team from within pathology and IT to run the system.”
• “Make sure you have a PACS manager and project lead in place.”
• “Identify a computer/network-savvy person to be the technical lead for the pathology team.”
• “Employ an experienced PACS manager. They are difficult to find but worth their weight in gold during evaluation and the set-up period.”
• “Employ an IT project manager to liaise with tech teams and vendor.”

Organizational buy-in

• “Make sure the whole organization is on board.”
• “Set up a user group and ensure key people attend.”
• “Get enthusiastic supporters to “sell” the concept.”
• “Get engagement from clinical leads in the department who like IT and can bring along and encourage their colleagues who aren’t as keen on the new technology.”
• “Ensure engagement from all key stakeholders to manage expectations and ensure the solution delivers for the service. Involve all stakeholders as early as possible.”

Comprehensive training

• “Training, training and more training.”
• “The product can be the best in the world, but useless if the end users do not know what it can do or how to use it.”

Focus on the workflow

One should not underestimate the opportunity for change in workflow that digitization brings. When radiology digitized, many early adopters made the mistake of replacing the technology, but tried to keep the workflow, which has not proven successful. Instead, digitization is much more about changing the way of working with the aim of utilizing the benefits that the new technology offers in the best possible way.

• “Really look at workflow and do not become entrenched in past procedures.”
• “Don’t try to just emulate the analogue workflow using a digital replacement, but exploit the benefits offered by having pathology imaging available in a digital form.”
• “Think of everything. Then think of everything else. Discuss with colleagues up and downstream. Make face to face contacts.”
• “It’s all about the workflow and doing things in the correct order.”
• “Consider the changes to workflow and where time is saved and also where it will take longer to achieve aims.”
• “Have a robust workflow in place to enable your system to reflect the way you want to work from the very start. However, don’t assume a like-for-like work pattern.”

Establishing high quality integrations with other systems is the key to achieving an effective workflow. The system should allow for tasks to be performed in the right order, be intuitive and minimize the number of mouse clicks.

• “Aim for full integration…”
• “The importance of integration between trusts and sites and with other systems.”