Digital Networks in the United States

Labs in the United States have been relatively slow to adopt digital pathology compared with Europe and Asia – but the pace of change appears to be accelerating.

As the digital pathology conference offerings grow across the States, more laboratory medicine professionals are coming together to share their experiences, inspiring new waves of regional digital networks.

One early adopter is HNL Lab Medicine in Pennsylvania. Sajjad Malik – surgical pathologist and Medical Director of Digital Pathology – was tasked with setting up HNL’s digital system from scratch. Here, we share the story of how the plan came together.

Drivers
 

Introducing such a major change to the pathology workflow requires a strong motivation and vision. In HNL’s case, the vision started in the anatomical pathology department: to empower its professionals to be the best surgical pathologists possible.

There was also, perhaps, an element of FOMO (fear of missing out) involved, as Malik explains: “It is my belief that with the inception of AI and its incorporation into our daily practice, there will be a gap between pathologists who utilize this technology and those that do not. Ultimately, those working with AI assistance will be more efficient and provide the best care for their patients.”

As a committed AI convert, Malik believes that, once labs catch onto its innate advantages, AI will become part of routine pathology practice. But he also acknowledges another good reason to get ahead of the digital game: “We were also motivated by the possibility of working remotely and recruiting pathologists to join our practice in the future.”

Research
 

With the motivators for change well established, next came information gathering. Malik started reaching out to experts in both the private lab and academic communities. 

“For starters, Sam Terese, the President of Alverno Labs – one of the first private labs in the US to digitize its practice – was instrumental in our understanding of digital pathology and providing us a framework for how we could implement it at HNL,” continues Malik. “He invited us to his lab and we were able to see firsthand how the digital system was being used. Terese and his team shared with us some of the struggles they went through so we could avoid making the same mistakes.”

Malik also sought advice from other experts in the digital field, including friends of The Pathologist Matthew Hanna, Giovanni Lujan, Anil Parwani, and Ulysses Balis, “All of these individuals provided great support and helped us along the way,” he says. 

Planning
 

The information gathered by Malik and his team fed directly into the creation of a business plan and a project team, which included management, pathologists, histologists, and the IT department.

Next came the procurement decisions. “After demoing a multitude of scanners and viewing systems, we had weekly meetings planning out our next steps,” recalls Malik. “This process took about one year before we felt comfortable committing to our vision and starting to implement it.”

To find out about the team’s vendor selections, you can contact HNL directly.

Barriers
 

In the US, private labs are sometimes slower to adopt new technologies than institutional labs due to the large initial investment for which no reimbursement is available. In HNL’s case, this barrier was overcome by having, in Malik’s words, “a visionary CEO.” 

Put simply, Martin Till believes that implementation of the latest technologies will improve the laboratory, says Malik.

Another major barrier to implementing digital pathology is having sufficient IT resources to build and maintain the necessary data management structure. “We are fortunate to have experienced IT managers who were able to take on this responsibility,” explains Malik.

Rollout
 

Three years after conception, HNL’s digital pathology system has been installed, validated, and rolled out across anatomical pathology.

“So far in our early adoption of digital pathology we have benefitted from being able to share cases seamlessly within our department,” reflects Malik. “And although it is too early to measure any efficiency gains, I can see the potential that it has to ultimately reduce our turnaround times.”

Jillian Grau, Vice Chair of Anatomical Pathology at HNL, is one of the pathologists using the system. She says that one of the main advantages of going digital is the convenience of having a multi-hospital based system including pathologists at various locations. This has improved efficiencies in slide distribution – which no longer need to be physically transported – resulting in improved patient care reflected in shorter diagnostic turnaround times. Grau adds, “Digital slide availability allows for pathologists with specific training/expertise to be available as consultants for other pathologists within our regional system.”

But there have been some teething problems along the way: “With any pathology laboratory information system integration, IT challenges are the most pervasive frustrations,” says Grau. “Security is of the utmost importance and, with a variety of different vendors involved in storage, design, and functionality, the process can be tedious,” she adds.

Next steps
 

Malik and team now plan to ensure all members of the anatomical pathology department are comfortable using the digital platform. They will then begin to phase out the use of glass slides, with a few specific exemptions.

After that, Malik says the team will work on incorporating hematopathology and cytology into the digital platform – a process he anticipates will take 6–12 months.

The final part of the process will be incorporating AI tools into the digital system. Malik is already on the case – researching and trialing algorithms on the market to find those most likely to benefit HNL’s practice.

Inspiring
 

So has this enormous project been worth the investment of time?

Malik believes so: “This is the most exciting project I have ever taken on in my professional career. It has been very rewarding to start something that didn’t exist in our lab and make it the new standard.

“Although digital pathology is well established in some institutions, we are still considered one of the early adopters, and I believe our implementation can be an inspiration to many other laboratories across the country.

“One thing that I learned from doing this project is how amazing the pathology community is – in particular those who are trying to establish digital pathology as a norm. I am so happy to be a part of that community now, and hopefully HNL’s achievements will inspire others to take the next step in revolutionizing anatomical pathology.”