Pioneering Digital Pathology
Getting the right slide to the right pathologist at the right time – no matter where
In 2000, I was chosen to head the pathology department at Canada’s largest academic medical center. It was a merger of three large hospitals, so we built a new consolidated lab space, set up subspecialty diagnostics of the highest caliber, and started a biobank.
With the consolidation coming to fruition in 2004, we realized we had a problem – one of our hospitals needed intraoperative frozen section coverage, but not enough for a full-time pathologist. It was too far away from our consolidated lab (especially in Toronto traffic!), so we had to find a creative solution to deliver the service. We bought a robotic microscope that we used to view slides from their laboratory at a distance. We struggled with that for a couple of years before we learned about the existence of scanners that could generate whole-slide images for frozen sections. That was our first foray into digital pathology – and, as soon as we could do it a mile away, we knew we could do it anywhere.
Canada had a major shortage of pathologists at the time, so I was asked to help cover hospitals that were quite far away. When they asked us for help, I told them that we weren’t going to be a transient service that just helped out in times of need – but they could partner with us. Over the next five years, we built a large, complex multi-hospital digital pathology system with a consolidated laboratory information system. I spent a lot of time working with industry to build the best system we could with the solutions available at the time.
By 2010, our system worked exceptionally well. In a fortunate turn of events, that’s when the Vice President of my academic center became the CEO of a complex of four hospitals in Oshawa, Ontario, a heavily populated area some distance from our main hub. He brought in high-throughput scanners and worked with us to pioneer digital pathology for primary diagnosis. In most cases, we never even saw the glass slides. Ultimately, we were able to provide 24 hospitals in Ontario with access to full subspecialty pathology – including liver, kidney, and lung specialists (even endocrine specialists!) – which was a great achievement.
I left Toronto in 2018 and moved to Cleveland, Ohio, to help University Hospitals implement digital pathology to integrate service in multiple hospitals in the northeast part of the state. As an American, I thought it was time for me to become familiar with the US system and the FDA restrictions inherent in it. Now, three years after I moved to Ohio, the digital pathology setup is ready.
I have been fortunate; my superiors have been very invested in pathology and understood its importance. In Toronto, the CEO of the hospital I worked in was a cancer surgeon who understood that having the right pathologist look at the right slide for the right patient at the right time was critical. These kinds of relationships with executives and industry partners have made my journey into digital pathology not only possible, but infinitely rewarding.
Consultant in Endocrine Pathology, University Hospitals Cleveland Medical Center and University Health Network (Toronto) and Professor of Pathology, Case Western Reserve University, Cleveland, Ohio, USA.