By GREGORY OSMOND, MD, MPH
The case for digital transformation in dermatopathology is strong. With a 98.8 percent intraobserver concordance between whole-slide images and traditional microscopy, instant access to a patient’s pathology history, shorter diagnostic times than traditional microscopy, and the ability to access FDA-approved data from HIPAA-compliant cloud environments without any geographic restrictions, it seems a foregone conclusion that digital diagnosis represents the future of dermatopathology.
So what is preventing dermatology clinics from taking advantage of the demonstrable benefits of digital imaging? By examining the costs, labor, software, and storage space requirements, we will discuss some of the barriers to digital pathology that clinics experience as well as how to overcome them.
Cost of Pathology Scanners
One of the things preventing most clinics from digital pathology is the up-front cost of technology. For example, the price of a state-of-the-art pathology scanner can reach $300,000, while the cost to implement a digital pathology system can be in the millions, depending on the size of the health system.
Because of this price, most dermatologists find it impossible to up-front the cost of digital imagery. But you don’t have to own a scanner to integrate high-resolution, wide-field images of your glass slides into your electronic medical records.
Digital dermatopathology partners provide slide preparation and professional interpretation services, but in conjunction can carry the burden of hardware, implementation, labor to digitize, and software maintenance to ensure you have easy and affordable access to view digital pathology images. By providing digital pathology workflows to multiple practices, they are able to use economies of scale to lower specimen costs and pass the savings along to you.
Labor to Process Slides
Some believe that replacing traditional microscopy with whole slide imaging will tax their clinic’s already full workload. However, collaborating with a laboratory that also employs digital pathology means you are not using valuable time and staff resources to manage traditional glass slide workflows.
Transitioning to 100 percent digital pathology saved LabPON laboratory in the Netherlands over 19 hours on a typical day. And after Granada University Hospitals transitioned from traditional microscopy to digital pathology for primary diagnosis, they reported a 21 percent increase in the number of cases signed out by pathologists in a year.
In a recent Clinical Lab Manager article, Isis Ricaño-Ponce, PhD, explained, “Digital pathology reduces the need to manually perform certain tedious everyday processes like sifting through boxes for glass slides, setting up the microscope to match previous settings, and searching for a specific spot on the slide.”
Software to Create and Access Images
In April 2017, the FDA authorized marketing the first digital pathology system for primary diagnostic use. Since then, studies indicate a major discordance rate of only 0.4 percent between whole-slide imaging and microscopy. Keep in mind that whole-slide imaging also eliminates the degradation of sample issues associated with sharing glass slides.
Currently, licensing and implementation costs are challenging because there are only a handful of digital pathology scanners on the market, including Aperio (Leica) and Philips. Laboratories that provide digital pathology services can absorb many of the fixed costs and provide you with an affordable option with simple access to view, interpret, and manage your digital biopsy images.
Memory/storage space for images
The idea of purchasing and maintaining the software to store your whole slide imaging is understandably intimidating. Afterall, an individual digital pathology image can be a gigabyte or bigger, which is 10 times the size of radiology images. Cataloging thousands of patient slides annually would require a daunting (and costly) amount of memory.
Second, there is no software or storage fee. Incorporating whole-slide imaging into your practice doesn’t necessitate any on-site storage or significant software investments. Because digital dermatopathology services solutions are web-based, all you need to instantly access, view, and manage your digital slides is a normal internet connection.
Your goal is to produce optimal results for your patients, fine-tune diagnostic processes, and streamline your staff workflow. By dispelling misconceptions of costs, labor, software, and storage space, digital pathology service providers are ready to help you introduce the benefits of digital pathology into your practice.
PathologyWatch is the groundbreaking leader of digital dermatopathology services. Through two programs, ValueWatch and BusinessWatch, dermatology clinics and hospitals can improve operational efficiency by speeding up workflow and enhance patient outcomes by utilizing the PathologyWatch expert professional team and partner laboratory services. This can facilitate best-in-class reads and, in some cases, enable additional revenue to the practice by in-housing pathology. With an intuitive and easy-to-implement digital pathology solution that includes access to top-tier dermatopathologists and a streamlined clinical workflow that interfaces directly into the EMR, PathologyWatch brilliantly combines state-of-the-art technology and clinical decision making to deliver unprecedented patient care.
Gregory Osmond, MD, MPH is a board certified pathologist and dermatopathologist. He completed pathology residency (AP/CP) at Duke University where he developed an interest and expertise in digital pathology while completing a GME concentration track in Health Policy, Law & Ethics focused on innovative business models and regulation associated with digital pathology. This was followed by dermatopathology fellowship in the combined Harvard program (MGH, B&W, BID). In recent years he has been involved with multiple pathology-related technology platforms and companies. He received a BS degree from Brigham Young University in Neuroscience, Master degree in Public Health (MPH) from the University of Utah, and MD from Duke University. He also has a significant interest in the implementation and utilization of diagnostic services in underdeveloped settings.