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

Digital Pathology to Achieve the Quadruple Aim

The dialogue around digital transformation in pathology is growing louder – a sentiment echoed at this year’s USCAP Annual Meeting (which was itself virtual). This trend is hardly surprising considering that the past year has been momentous for digital pathology. Adoption crossed an inflection point when several major organizations, including the Joint Pathology Center, Mayo Clinic, and Israel’s largest health maintenance organization, announced plans to modernize – and others, such as LabPON and the UK’s National Health Service, increasingly scaled their implementations. All of these developments happened in the midst of an unexpected surge in demand brought on by the COVID-19 pandemic.

Yet despite the enthusiasm around digital transformation, we often overlook a critical aspect of this journey. A recent article in the Harvard Business Review states that “digital transformation is more about talent than technology (1).” In other words, it’s about empowering your team by using digital solutions to unlock new sources of value. Although much has been said about the scanners, technologies, and process changes required for digital transformation, the pathologist’s experience and necessary cultural shift rarely feature in the conversation.

Humanizing digitization
Let’s start by considering what matters most to pathologists. From my experience, three factors – quality of care, efficiency, and wellbeing – are at the top of the list. Pathologists are passionate about delivering high-quality care and about the impact they have on patient outcomes. They also recognize that they have limited time to read cases and feel the strain of growing workloads and increasing case complexity. A steady decline in the pathologist population combined with rising biopsy volume has led to a 43 percent increase in cancer cases per US pathologist between 2007 and 2017 (2).

This looming shrinkage of the pathologist workforce also casts a spotlight on physician wellbeing. Burnout is real. Over one-third of pathologists report feeling overworked (3); primary drivers are too many bureaucratic tasks and too many hours in the laboratory. Such a high burnout rate is unsustainable – once again calling attention to the need for efficiency – and can even lead to errors that impact quality of care.

I doubt I am the first to point out that the rationale for going digital should align with the “quadruple aim” in healthcare (4). This model starts with the well-known triple aim, which states that optimizing the healthcare system depends on improving the patient experience, lowering costs, and bettering outcomes. All of these can be achieved, in part, through efficiency and quality of care – factors that matter to pathologists and laboratory management alike. The fourth critical pillar? Improving physician satisfaction (or wellbeing), which is necessary to deliver the other three aims.

Improving the pathologist experience

Care is easier to facilitate, collaboration is easier, and consults are more accessible [with digital pathology].

Digital pathology can improve the pathologist experience in many ways. Take quality of care as an example – subspeciality care is easier to facilitate, collaboration is easier, and consults are more accessible, all because sharing images eliminates the complexities of mailing glass slides. Image analysis applications and, increasingly, other artificial intelligence solutions drive diagnostic accuracy and precision. And we’re just beginning to scratch the surface with AI – I anticipate that, over the coming years, we’ll see a tremendous leap forward in how it supports diagnostic decision-making and workflow optimization.

Traditional analog workflows also have inherent inefficiencies related to handling glass slides. Digital pathology replaces these processes with intelligent workflows – for instance, supporting network integrations with distributed sign-out so laboratories can better manage workload-to-staffing ratios. And once again, AI delivers improvements; workflow applications are beginning to enable case sorting, triaging, and tumor detection, among other use cases.

Physician wellbeing comes into play when we consider the impact of these efficiency gains. They enable pathologists to work more productively, reducing burnout by helping them to cope with growing demands. More recently, we’ve heard a lot about digital pathology enabling remote operations and worksite flexibility during the pandemic. Even as pathologists increasingly make their way back into the laboratory, they will want to balance being physically present in their department with the benefits that they have come to appreciate from being offsite. From gaining back time typically spent commuting to the ability to read cases on demand during a free evening, digital pathology empowers pathologists to achieve the work-life balance they want.

Hearing the pathologist’s voice
We are seeing a shift in the pathology community’s attitudes toward digital pathology as pathologists increasingly see firsthand how technology can help them achieve what matters most. Because pathologists are the primary users of digital pathology, accelerating this transformation requires a cultural shift centered on allowing their voices to guide future strategies and solutions.

And that begins with addressing their many valid concerns and making the pathologist a key stakeholder in change management. For example, pathologists may wonder what problem digital pathology is trying to solve. Perhaps they haven’t had much exposure to digital solutions or are looking for clarity on the rationale for adoption. Often, a little education goes a long way. Socializing the change, articulating the “why,” and acknowledging the cultural shift enables pathologists to provide meaningful input on goals, roadmaps, success criteria, and software selections that will ensure a successful digitization effort.

From here, the pathologist’s voice should be used to design human-focused solutions that put them at the center, fitting into and enhancing their workflows. A tangible way to illustrate this is through the pathologist’s workstation. The new digital office should feature an image management platform that sits at the core and integrates the entire ecosystem. This digital setup not only drives powerful efficiency and quality gains and enables worksite flexibility, but also allows easy collaboration with colleagues. Pathology is, after all, a team sport. In the end, it’s not about a technology-powered workstation, but about using that technology to improve the pathologist’s experience.

Digital transformation is a process – and although it heavily involves technology, it starts with people.

Digital transformation is a process – and although it heavily involves technology, it starts with people. I truly believe now is the time to hang up your microscope and embrace the benefits that digital pathology affords – but it’s important to acknowledge that even positive change involves some adjustment. By putting pathologists at the center of this change, we can help drive improvements in their experience and our practice – all in commitment to excellent patient care.

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  1. B Frankiewicz, T Chamorro-Premuzic, “Digital transformation is about talent, not technology” (2020). Available at:
  2. DM Metter et al., “Trends in the US and Canadian pathologist workforces from 2007 to 2017,” JAMA Netw Open, 2, e194337 (2019). PMID: 31150073.
  3. L Kane, “‘Death by 1000 Cuts’: Medscape National Physician Burnout & Suicide Report 2021” (2021). Available at:
  4. T Bodenheimer, C Sinsky, “From triple to quadruple aim: care of the patient requires care of the provider,” Ann Fam Med, 12, 573 (2014). PMID: 25384822.
About the Author
Monica Santamaria-Fries

Digital Transformation Officer at Proscia Inc., Philadelphia, Pennsylvania, USA.

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