I think we can all agree that momentum for clinical deployment of digital pathology has reached a level where primary diagnostic use of whole slide imaging is no longer our distant future – digital pathology is coming to a diagnostic department near you! But what has catalyzed this shift in perspective? Evolution of whole slide imaging hardware and software has certainly contributed to the user acceptability of digital diagnosis, but this is only part of the story. Importantly, it is no longer just pathologist enthusiasts that are driving departments towards digital – it’s our policy makers, decision makers and managers.
Let’s take a moment to consider the strategic context of histopathology services. In the United Kingdom, cellular pathology requests are increasing by 4.5% year-on-year, with specimens requiring ever more complex assessment to meet the requirements of the evidence-based cancer datasets of the Royal College of Pathologists. Coupled with increasingly challenging cancer turnaround targets, this escalating workload is already putting pressure on pathology services. The problem is compounded by an international recruitment and retention crisis in pathology. In the UK, 32% of cellular pathologists are expected to retire in the next five years, and too few candidates are joining pathology training programs. Digital pathology has the potential to alleviate some of the pressures faced by the modern diagnostic departments, offering a flexible platform for safety, quality and efficiency improvements, whilst future-proofing pathology services and allowing closer matching of reporting capacity and demand.
The principal benefits of a digitized reporting service can be broadly divided into four categories: improvements in patient safety, improvements in diagnostic workflow, improvements in workforce factors, and improvements in over-all service quality. The flexibility and agility of digital pathology systems allows for a number of improvements to the diagnostic workflow, including the ability to manipulate workload allocations by pushing and pulling of cases to respond to fluctuations in workload or case mix in a department. Rapid case tracking, archiving and retrieval, paired with faster case transfer times between the laboratory and primary and secondary pathologists, should streamline turnaround times and diagnostic pathways.
Given the strategic context outlined above, improvements in workforce factors are some of the key benefits service managers seek to capitalize on in a digital deployment. The innate flexibility of the digital diagnosis offers the potential for diverse and appealing patterns of work, freeing the diagnostician from geographical and temporal constraints on where and when they work. Digital reporting can enable optimization of the workforce, supporting those that work less than full time to maximize the hours they can offer, and providing an incentive for those considering retirement to continue to offer their services on more flexible terms.
Working arrangements more conducive to “work–life balance” are likely to appeal to the next generation of pathologists, and drive recruitment of medical graduates into the specialty. Improvements in service quality are likely to follow from the myriad workflow and workforce improvements already outlined. Improved information sharing and collaboration, in particular streamlined double reporting and rapid access to second opinion, can lead to better quality diagnoses. Accuracy and convenience of recording cancer staging parameters could drive up the quality and reproducibility of cancer dataset reporting.
Finally, we should consider patient safety, surely the cornerstone of clinical decision-making. Use of an integrated digital pathology system offers obvious advantages, with paperless transmission of digital slides directly to the pathologist lessening the possibility of a misidentification or transposition error at multiple points in the diagnostic workflow. Furthermore, digital slides offer a readily portable, instantaneously transmissible diagnostic substrate, which is not subject to the physical limitations frailties and risks of glass slides and their transport.
In conclusion, we are entering a period of potentially hazardous demand: capacity mismatching in histopathology. Timely adoption of digital pathology may allow managers more flexibility to deliver diagnostic pathology services to a population, whilst enabling pathologists to enjoy the workflow and diagnostic quality benefits of digital reporting. Our experienced digital pathology research is capturing data on the benefits of clinical digitization, developing deployment tools and protocols to aid the transition of over departments to digital practice. To hear more of the argument for clinical adoption, and explore this topic in more detail, please refer to our paper: “Future-proofing pathology: the case for clinical adoption of digital pathology.” http://jcp.bmj.com/content/early/2017/08/05/jclinpath-2017-204644.info
Dr. Williams is a PhD fellow in digital pathology at Leeds Teaching Hospitals NHS Trust and the University Leeds. Her principal areas of research interest include developing an evidence-based approach to digital pathology, patient safety and digital validation and training.
Disclaimer: In seeking to foster discourse on a wide array of ideas, the Digital Pathology Association believes that it is important to share a range of prominent industry viewpoints. This article does not necessarily express the viewpoints of the DPA, however we view this as a valuable point with which to facilitate discussion.