Digital Pathology Blog

An old (-er, I mean experienced) pediatric cardiothoracic surgeon once told me, “The heart is not a music box, it is a pump, why should I use a stethoscope to listen to it?” An experienced neurosurgeon once told me, “Neurologists are the tool we used to use before the CT scan” and a critical care intensivist friend has reminded me several times of the value of a stethoscope when you have arterial blood gases, central venous pressure monitoring, and ventilator settings you can adjust for optimum care.  

Some time ago I came across some videos and a TED talk by Dr. Zubin Damania aka ZDoggMD. Born of Indian parents, educated at the finest colleges, medical schools and residencies, he felt his career had hit a wall. He felt he wasn’t making the impact he’d planned to when he first entered the medical field as a physician. So Dr. Damania transformed himself into an entrepreneur, motivational speaker and social media cult figure.

A friend of mine recently put me on to some old, and not so old, articles about radiology services being outsourced, including this story entitled “Who’s Reading Your X-Ray?" in The New York Times, published more than a decade ago, and another article a few years old from NBC News entitiled “Is a doctor reading your X-rays? Maybe not”.

Current technologies can enable real time access to expert pathology specialists for expert case review and are particularly valuable for patients in areas where specialists are in short supply. But other barriers to widespread adoption of these technologies remain. One of the key issues that must be addressed to spur that adoption is remote licensing for specialists.  

For my nearly 30 years of working in health care - in some form or another – I’ve repeatedly heard one guiding principle: run lean. What does that mean? Lean methodologies have been applied and adapted across just about every type of industry. Banking, construction, health care, government, manufacturing, engineering, design, back office administration and more. It is not just for the more "industrial" sectors; it can and has been applied across a diverse range of industries. There are lean programs for supply chain, administration, management, product development, manufacturing and others.

I arrived for my away rotation early. I was scheduled to be at the Office of The Chief Medical Examiner (OCME) in Baltimore for the month of July. My first rotation of second year of residency would be spent away from the gross bench and chemistry analyzers. The month was actually fine with me – the OCME office handled deaths from all over the state of Maryland including Baltimore city and county, so there would be a mix of the usual inner city homicides, suicides, drug-related deaths, as well as farming, motor vehicle, and boating accidents at the peak of summer in Maryland. And the OCME was walking distance to Oriole Park and Camden Yards and the Orioles were scheduled to play nearly 20 games that month at home. One of the best smelling ball parks in the country would offset the smells of decomposing bodies pulled from the water or burning buildings. 

Pathologists frequently mention “I consulted on this” or “I sent this case off to a consultant” or “We were consulted about…”. But what does it mean? It is frequently puzzling for clinicians or patients. Does that mean my tissue specimen went to another laboratory? Does that mean slides or images from my case were seen outside the institution? Who gets consulted? Who pays for this?

In medical school, the pathologists would come to lecture during second year, and while they had their own subspecialty or research interests, they would often tell us “Pathology is a lot of fun. All of the interesting cases in the hospital wind up under the microscope and you are respected among your peers.”

According to the College of American Pathologists (CAP) 2013 data, approximately 80 percent of the world’s pathologists are based in the United States. This concentration causes an increased need to access, share, and diagnose images remotely.

In nearly every conversation we have with major hospital centers and pathology labs, the question comes up about how to initiate 2^nd opinion pathology referrals from outside the US. Everybody wants to know: how can we work with China…or India…or other areas of the world where pathology is dramatically underserved? Most US expert centers have a healthy referral business, with slides arriving via mail and FedEx daily/weekly. Going digital in pathology would provide the means to increase referral business by streamlining and accelerating the process, from image acquisition to diagnostic report.