Making it past the minefield: A pragmatic post-implementation assessment of digital pathology

Background: Digital pathology is often presented as a milestone, but in reality, it is a journey and long-term success depends on cultural adaptation, continuous refinement and meaningful performance measurement. Two years ago, University Health Network, a large multi-centre academic laboratory network in Canada, completed a stepwise transition to fully digital pathology. This study assessed post-implementation success, focusing on cultural change and practical metrics for sustainable digital pathology operations.

Methods: A pragmatic post-implementation assessment used surveys, interviews, workflow audits and key performance indicators. Turnaround time, workload, scanning metrics and operational issues were assessed through the laboratory information system and implementation monitoring. Qualitative feedback from pathologists and operational teams were used to evaluate adaptation, barriers and areas for further improvement.

Results: Implementation was successful, with a rescanning rate below 0.01%, average scanning times of 50 seconds for biopsy slides and 90 seconds for large resections. Routine cases are scanned within four hours and rush cases within 20 minutes. However, success depended on more than technical deployment. Cultural change remains to be work in progress, including resistance to workflow redesign, variable readiness across sites and the need for ongoing training. Continuous monitoring identified bottlenecks, usability issues, loading delays, integration problems and quality control needs. Practical metrics and feedback loops enabled refinement, troubleshooting and scalable improvement across the network.

Conclusion: Digital pathology success requires more than scanners and software. It depends on cultural change, continuous evaluation and meaningful metrics that translate digital transformation into measurable operational gains. A pragmatic post-implementation framework can support stable and scalable digital pathology practice.

Learning Objectives:

1. Recognize the role of cultural adaptation in post-implementation digital pathology success.
2. Identify practical metrics for evaluating digital pathology performance after go-live.
3. Explain how continuous evaluation supports sustainable digital pathology implementation.