Digital Pathology — It's All About Quality

Quality is Job 1

This of course was Ford Motor Company’s marketing slogan in the early 1980s. The message was clear – in the wake of some issues, Ford was going to build in quality to its automobiles rather than make it a checkbox at the end of the process. Over the years, Ford prospered while its major domestic competitors, General Motors and Chrysler, struggled to compete with Ford as well as foreign automakers.

In time, the slogan was abandoned (in the late 1990s) but not the process. By 2008 when the worldwide financial collapse hit every industry, US automakers were not immune. Ford, of course, did not go bankrupt or require a bailout from the government as its other Detroit-based colleagues did. Ford automobiles are now among the best-selling cars and trucks in the market. 

General Motors stopped producing underselling models, such as Buick, Oldsmobile and Pontiac, while Chrysler brought in someone by the name of Lee Iaccoca to turn things around. Now while there are still changes, the “Big 3” have been producing cars people want to buy and drive. While there was recent news of GM factories closing, Chrysler is adding manufacturing in Michigan. Ford has also been adding jobs. It's the free market at work.

This isn’t intended to be a post for US automakers and their importance in our economy. Despite the fact I drive a Ford pickup truck, and have done so for many years and will continue to do so, I think it does speak to the role of quality in manufacturing.

Many years after selling my first Ford pickup truck as a resident in pathology, I began to hear about “lean engineering” and “six sigma” in laboratory medicine and pathology. Perhaps not too ironically, Henry Ford Hospital in Detroit began hosting talks and seminars on safety and quality in anatomic pathology that continue today. Batch versus continuous processing, positive patient ID at every step and minimizing the potential for errors.

For many years, I have said there are two main value propositions for digital pathology – telepathology that is, some form of remote consultation between pathologists and Image Analysis. I think the literature would support this now as it did when I first thought of it 20 years ago.

Both applications speak to quality. Improving communication, accuracy, turnaround time, adding to patient safety and quality.

In the past month, my laboratories have been through CLIA and JCAHO inspections. CAP was last year. While the questions and checklists for the inspections are different – there is one similarity – a focus of quality. Does your laboratory ensure the highest quality results through appropriate validation, testing, documentation, training, maintenance, communication, quality control (QC) and quality assurance (QA) processes?

A common question pathologists ask about digital pathology is “How do I sell this to my partners, colleagues, hospital, administration, insurers?” and so forth.

The answer is simple: Quality is Job 1, and digital pathology, above all else, improves quality.

The ability to view, archive, compare, share, annotate and analyze whole slide images adds quality at every step of the slide review process. 

Hundreds of studies have shown whole slide imaging is not inferior to the light microscope. One vendor has clearance from the FDA for primary diagnosis. Others have shown that workflow can be improved, accuracy can be enhanced and turnaround times can be improved. While there isn’t a specific CPT code for use of digital pathology in terms of direct reimbursement, as we move from volume-based pricing and reimbursement to outcome-based pricing and reimbursement – quality will be paramount.

The ability to view any slide at anytime from anywhere is a powerful application for pathologists. In all our history, we have only begun to view the advantages and opportunities it offers. Digital pathology enables improved turnaround time, diagnostic accuracy and improved collaboration. The ability to annotate and store information at your fingertips with current and prior material facilitates instant comparisons of biopsies and surgical resection material. It’s a snap at tumor boards to seamlessly review pertinent images without requiring additional effort for microscopes on a cart or PowerPoint presentations that take time and are inefficient.

In addition to tumor boards or multidisciplinary management conferences, education and undergraduate/graduate medical education can be enhanced with digital pathology, and the slides reviewed are uniform for the group of students/residents. Rare or unusual cases and cytology slides can be shared without concern about loss or breakage or lack of material to recut or prepare.

Many pathologists today will tell you they are doing more for less than they were 5 years ago. This can range from issues with reimbursements to more hospital obligations, conferences, meetings and regulatory obstacles in addition to the challenges of increasing laboratory consolidation. Most pathologists cannot work any harder, so we need to find means to work more efficiently.

Deep learning/artificial intelligence will further improve diagnostics and perhaps outcomes. Preliminary data from multiple centers show that analyzing whole slide images may be useful in appropriate diagnosis and offer additional information beyond grade and stage from the light microscopic interpretation in terms of outcome predictions.

If you value quality, and we all do, digital pathology in your laboratory should be part of your quality improvement (QI) plan.

My Ford truck has over 200,000 miles and still gets me where I need to go. I hope to have it for another 200,000 miles. Ford’s mantra wasn't used to sell cars and trucks specifically; it described the company, its people and their approach to building vehicles. The slogan was as important to the product as it was the employees. The company improved, the product improved and the market improved. The slogan was changed to “Better ideas. Driven by you.” Quality is a given. The Ford said, “Go Further”.

While laboratorians are not in the car business, we are in the quality business. You can't get through a day in the laboratory without hearing or saying “QA”, “QC” or “QI”.

Quality is digital pathology.

Better ideas. Driven by digital pathology.

Go digital pathology.