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Inside the Lab Digital and computational pathology, Software and hardware, Technology and innovation

Beyond the Dam and the Floodwaters

sponsored by Leica Biosystems

By Colin White

It’s no secret that change is hard. And, as someone whose job involves introducing novel technology for scientific and medical endeavors, I know just how hard it can be.

Over the decades, I’ve studied the work of experts including well-known authors Clayton Christensen (The Innovator’s Dilemma), Geoffrey Moore (Crossing the Chasm), and Chip and Dan Heath (Switch) in an effort to better understand factors that prevent and propel change at individual, organizational, and societal levels, and to learn about frameworks to ease and advance change. These authors’ work tackles how difficult it is to effect change and acknowledges that change involving innovation is much harder to realize.

Their perspective rings especially true when I consider the state of digital pathology – a topic that tends to evoke strong reactions from pathologists and the lab community.

The dam and the floodwaters 
Even a cursory online search for “digital pathology” unearths numerous articles depicting the forces preventing or propelling adoption and use. Authors frequently reference the metaphor of a “dam” of entrenched beliefs and practices under pressure from a “floodwater” of pro-digital market forces. These are a complex interplay of global forces including rising rates of cancer worldwide, escalating diagnostic workloads, aging and dwindling pathology workforces, and increasing patient expectations regarding access to health information.

I’ve started to see cracks in the proverbial dam walls, inviting a watershed moment for our industry.

I envision the dam as anchored by two large pillars – value-based concerns (such as time to return on technology investment) and operational concerns (such as turnaround time or reliability) – that are buttressed by change-related concerns (such as familiarity and comfort with existing technology or skepticism about the performance of new technology). In the last 12 to 18 months, I’ve started to see cracks in the proverbial dam walls, inviting a watershed moment for our industry. These fissures are the result of persistent pressure from the floodwaters, which has only intensified during the COVID-19 pandemic. As Liron Pantanowitz observed in the Journal of Pathology Informatics, the pandemic has been a technology stress test, allowing us to collect real-world data and gain a better understanding of digital pathology’s promise.

Now, it’s time to advance our conversation beyond the dam and floodwaters and explore two important downstream topics: building a solid digital foundation and watching for emerging swells to feed the floodwaters.

Fortifying the IT backbone 
Conventional wisdom suggests that healthcare organizations transitioning to the digital realm should first focus on clinical considerations – but real-world experience indicates otherwise.

Successful institutions start by fortifying their IT backbone to support an end-to-end digital pathology workflow: scanning, storage, distribution, viewing, and sharing. Furthermore, they prioritize work related to ecosystem, standardization, and scope.

  • Ecosystem: Effective digital adoption requires the pathology community to look outside their specialty to build a diverse ecosystem unified by a shared purpose. This ecosystem should include stakeholders with functional expertise in enterprise technology, security and privacy, data management, and data science. The Digital Pathology Association is one of the organizations leading this work. Although it’s not easy to coalesce a cohesive ecosystem, the benefits associated with doing so are many. Ecosystem leaders will be well-positioned to jointly create and support validated workflows and efficient implementations, as well as document outcomes and benefits at department and enterprise levels.
  • Standardization: Noted UK pathologist Darren Treanor has commented that “standardization and interoperability are vital for the successful adoption of digital technologies in healthcare.” I agree. I’m fortunate to work for Leica Biosystems, a company partnering with other industry leaders to champion the creation of global data standards, including the Digital Imaging and Communications in Medicine (DICOM) standard for digital pathology. DICOM is a decades-old global standard in medical imaging that translates well to pathology and supports the integration of digital pathology into routine practice. This work, along with efforts by Integrating the Healthcare Enterprise and updated guidance from the US Food and Drug Administration, increase pathologists’ confidence and trust while setting the stage for a sustainable approach to digital pathology.
  • Scope: A vital component of an effective digital strategy involves sizing the amount of change to a specific organization’s culture and needs. Attempting to transition an entire department in one monumental shift is unlikely to succeed. Models to consider include the Heath brothers’ approach to “shrinking the change” or Moore’s approach to “landing a beachhead.” Whichever model best suits your organization, I suggest finding opportunities for phased improvements to common pain points, measuring those small wins, documenting the process and outcomes, and sharing the findings broadly. I take inspiration from the work of the digital pathology team at Leeds Teaching Hospitals NHS UK Trust, which has published a virtual playbook in the Leeds Guide to Digital Pathology.

A new era of patient engagement 
The World Health Organization identifies digital health technologies as a means of strengthening health systems and supporting patients to live healthier lives. I wholeheartedly agree, which is why I call out this topic as an important emerging swell that will add to the floodwaters compelling digital adoption.

Digital pathology has the potential to support the delivery of equitable healthcare to all patients. Once we‘re engaged in the digital realm, we will have a greater ability to tap into broad networks, move information around, and enhance patient care.

Engagement with patients can shift to bring about better healthcare and – more importantly – better health.

Related to this is the ability to involve patients more deeply in managing their health. Though early days for such efforts, thought-provoking work by Eric Topol (The Creative Destruction of Medicine; The Patient Will See You Now) and Bob Wachter (The Digital Doctor) invites us to consider how engagement with patients can shift to bring about better healthcare and – more importantly – better health. We can look to other specialties when crafting responsible policies around data transparency and patient access to health data to yield meaningful patient advocacy and engagement.

Recently I had the pleasure of speaking with Frank Gannon of the Baylor School of Medicine on the podcast Digital Pathology Today – and the topic of patient engagement was raised. Gannon aptly remarked, “What’s really exciting about this is for the treating physician to be able to show a patient, ‘This is what the cancer looks like,’ or, ‘This is what your infection looks like,’ so patients are better able to understand and become more involved in their treatment.” Cancer would no longer be an unseen mystery, but something easily visualized so patients knew what was going on inside their bodies. In addition, Gannon commented, “Better-informed patients able to help in their decision-making is something we all look forward to.” 

Toward the horizon 
Gannon’s words echo my personal sentiments. I consider it my great privilege to collaborate with pathologists to bring novel technologies to the mainstream. Certainly, it is my life’s work to bring to reality Leica Biosystems’ patient-centered mission of “Advancing Cancer Diagnostics. Improving Lives.” 

As hard as change can be, I believe the payoffs of a transition to digital pathology will be well worth the effort. I equally believe that, working as an ecosystem, we can make it easier. The potential of better patient care awaits.

Digital Pathology at Baylor College of Medicine
A crucial early step in Baylor’s adoption of digital pathology was establishing an IT backbone structured to address the institution’s needs for infrastructure to generate, move around, annotate, report on, and share images.

“Information technology was where we decided to start, which may seem a little atypical for pathologists,” said Francis H. Gannon, who co-leads Baylor’s clinical pathology practice, Community Pathology Associates. “However, the analogy that I use is that it‘s equivalent to building a stadium. It’s a captivating proposition to build a new stadium but, if you don’t have the roads and the plumbing, it’s just a big, expensive building sitting there.”

Working with Leica Biosystems, Baylor Pathology identified and addressed foundational IT considerations including selecting a project technology leader; partnering with the enterprise and laboratory IT teams; determining networking, storage, and security needs; comparing requirements to tools, budgets and timelines; and prioritizing specifications for short and long term.

Gannon elaborated, “Simply put, we transformed the way we think about and implement IT connections, transference, and bandwidth. Doing so allowed us to move forward to the point that, by 2022, Baylor Pathology will be a fully digital anatomic pathology service, including hematology.” 

Francis H. Gannon currently serves as the Vice Chair of Operations for the Pathology and Immunology department at Baylor College of Medicine, Houston, Texas, USA.

Colin White is Senior Vice President and General Manager of Advanced Staining & Imaging at Leica Biosystems, Melbourne, Victoria, Australia. 

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