University Health Network (UHN) is a multi-institutional academic hospital in Toronto, Canada with 4 primary hospital sites and 29 satellite locations served by the laboratory medicine program. We recently moved into a fully digital pathology practice.We share this five-year journey of transformation into digital pathology for the benefit of other institutions on their way to digitalization. We share the challenges faced, key lessons learned, and the best practices that we developed during implementation.We adopted a stepwise approach, starting with remote intraoperative consultation (frozen section) across different locations, then digital pathology sign-out for off-site locations and external consults. These were very useful learning experiences. The final step was to move into a fully-digital clinical practice across all sites. We decided to pursue three separate RFPs; the first one for scanners, the second for workflow solution (image management software), and the third for storage. This gave us more flexibility to get the best fit in each category. Open systems were emphasized. It is important to note that 'compatibility' between the different systems needs to be confirmed by track record experience.A key lesson learned is that pathology digitalization is an institutional, rather than departmental, project that needs support from executive leadership, department of pathology (especially pathologists and MLTs) and orchestration with other clinical departments.A number of committees and working groups were established under a dedicated change management team. Monthly open discussion sessions were held for pathologists over a year period, including external invited speakers.Careful assessment of budget is important. Estimation of the cost of smaller items is also critical. Budget goes beyond the sum of the big items. We customized a validation / education learning process modified from both the UK Royal College protocol and the CAP protocol for validation.A deep understanding of current laboratory processes must be captured as digital pathology necessitated workflow modifications, including the addition of new steps related to digital quality. Also, we paid special attention to the pathologists' office configuration.It must be noted that digital pathology transformation is a gradual process, and it is risky to claim success too early. Key performance indicators must be determined early in order to assess before and after full digitization. We are now in the phase of evaluation and follow up fine tune the process.

Learning Objectives

1. Understand the multifaceted change management needed for Digital pathology implementation.        
2. Carefully assess the multidimensional needs to implement digital pathology.
3. Understand that digital transformation is not an event but an ongoing process.