Digital pathology has played a role in laboratory workflows for decades. Early use of static images for teaching and tumor boards has grown to include today’s clinical applications including remote assisted fine needle aspirations and frozen sections and the use of whole slide images (WSI) for expert consultations and quality assurance (QA).
The recent FDA approval of the first digital pathology (DP) system for primary diagnosis holds promise for even greater application of this technology. Moreover, the application of image analysis and artificial intelligence tools to whole slide images (WSI) can also assist pathologists with the growing number of complex cancer cases saving valuable time and improving diagnostic accuracy.
The benefits seem clear. Your pathologists want this technology, but how can you afford the hardware, software and time investment required for a full-scale implementation? Your current processes have served you well for years. What are the downsides if you stay with the familiar status quo?
What is the downside of not using DP for your routine work?
The shortage of pathologists continues to grow worldwide. Similarly, the number of skilled laboratory professionals entering the medical laboratory field is not keeping up with the technologists leaving. With these staffing shortages, today’s laboratories must optimize their use of all resources including staff and supplies. Eliminating “rework” reduces laboratory waste and its associated costs.
Recuts are a common request of the histology lab, and the costs for preparing them add up. While sometimes deeper levels may be needed for interpretation of a specimen, many times recuts are requested for teaching sets, consultation requests or even to replace lost or broken slides. Valuable histotechologist time is expended to prepare multiple “copies” of the original diagnostic slide.
The expenses related to slide management in a histology lab are also not insignificant. The work involved for filing blocks and slides and then pulling those same slides for tumor boards, QA, review of previous patient specimens or to send out for expert opinion add up. Direct costs for preparing a five-slide case for consultation can run nearly $30 in supplies, labor and courier costs. Delays caused by having to perform this prep work and then managing the reports and materials when they are returned add more cost and can impact patient care by potentially causing delays in treatment.
From a Lean perspective, it would be more efficient if pathologists could access the cases they need from their computer workstation rather than wait for someone to retrieve slides from the file or wait for additional slides to be cut and stained. A well thought out strategy for implementing digital pathology using WSI can dramatically reduce the need for this rework.
Here’s the positive – Cost Savings w/DP
Cost savings from the implementation of digital pathology workflows have been documented in terms of improved pathologist productivity and lab consolidation. With greater access to subspecialty expertise and the resulting improved accuracy in cancer diagnoses, savings have also been demonstrated due to avoided costs of incorrect treatments. These additional savings are very real, but can be difficult to quantify, especially prior to the implementation of your digital pathology service.
Pathologists’ caseloads are also expanding and becoming more complex. By applying artificial intelligence and deep learning algorithms to WSIs, pathologists can gain efficiencies by automating the identification of specific cells or cellular components within the image. Image analysis techniques can provide precise identification and quantification of biomarkers. These applications not only reduce repetitious tasks for pathologists, but they provide consistent and accurate data to assist pathologists in their diagnostic process.
Fortunately, whole slide scanning devices are coming down in price, and with the FDA’s first approval for primary diagnosis with digital pathology in April 2017, opportunities for improving the laboratory’s bottom line with the use of this technology are better than ever. Improvements in QA workflows and access to subspecialty experts result in improved accuracy of results. Reductions in rework due to improved slide management and staff utilization result in a reduction of waste and reduced costs for the lab.
How to get started?
Integrating digital pathology into the daily workflow is hard work and requires strong leadership from both laboratory administration and from the pathologists. A pathologist champion partnered with an administrative champion is ideal to ensure that all stakeholders are engaged.
Careful planning is essential to ensuring the effective implementation of digital technology into the daily workflow. Resistance will likely be met on many fronts including pathologists, technical staff and even management.
Decisions will need to be made regarding scanning devices and software licenses. Does the laboratory go with a “Single Source” vendor that provides both necessary hardware and software for their digital pathology service? This option is often chosen as vendors will offer very attractive deals with this level of commitment. However, the arrangement can be short-sighted as it limits the laboratory’s options down the road, especially consultative relations with other hospital laboratories which may use a different scanning platform.
The other option involves choosing a scanning device or devices that meet the specific needs of the lab, and using vendor neutral software to manage the workflows, be they for consultation, analytics or quality assurance. This tactic allows the management of the images and the workflow no matter what scanner is used. It provides flexibility to view images from any source and tools to manage workflows that can integrate with the laboratory information system. It also ensures that your access to archived images is not compromised if you should change vendors for your scanning devices down the road.
Investing in digital pathology and implementing it into your daily workflow offers significant advantages. It reduces waste related to rework, provides analytic tools for pathologists, and offers improved efficiency and accuracy for pathology diagnoses.
Your laboratory and your pathologists need this technology. A smart investment up front will yield years of cost savings and improved patient care.