Digital pathology is often associated with large academic centers, but community laboratories are increasingly exploring its potential. At the South Bend Medical Foundation, a century-old nonprofit lab, leadership support, local collaboration, and a forward-looking culture helped move digital pathology from an aspirational idea to an operational reality – bringing new opportunities for recruitment, subspecialty collaboration, and innovation.
Here, pathologist and digital pathology advocate Derrick Forchetti reveals the story of the community lab that's leading the way in next-generation lab practice.
All about South Bend Medical Foundation
The organization was founded in 1912, when a group of South Bend physicians decided to set up a local laboratory rather than sending specimens to the Indiana state capital, which was several hours away. They opened the lab in the basement of a downtown hospital and recruited a pathologist to run it – interestingly, a woman, which was quite unusual for that time.
In the 1930s, the lab moved out of the hospital and shortly thereafter became a nonprofit member corporation, whose physician members also serve on the board of directors. As a nonprofit community foundation, its core mission is to provide high-quality laboratory services to the community.
That mission drives the members to offer sophisticated laboratory services that might rival those of big-city commercial labs. In addition to anatomic pathology, it also operates a blood bank, which is a significant charitable benefit to the local community.
How has the South Bend Medical Foundation's mission influenced its approach to innovation?
The organization has historically had a strong culture of innovation and development. Even decades ago, there was a mindset of looking ahead and trying new things. For example, in the 1950s there were efforts around vaccine development and contributions to early cytology screening initiatives. There were also projects related to public health, like work on milk pasteurization.
Technologically, the lab also adopted systems early. The organization implemented a fully computerized laboratory information system in 1988, which was quite forward-thinking at the time.
While we’re not a large or widely known institution, we’ve always had a progressive mindset. I think our nonprofit status helps with that. Because we don’t have shareholders demanding continuous profit growth, we have a little more flexibility. As long as we remain financially stable, we can invest in improvements or initiatives that benefit the community.
When did digital transformation begin at the Foundation?
One of the first major changes happened shortly after I joined the organization – more than 20 years ago – when we went completely paperless, moving everything to an electronic system. At the time, that was a big step.
Our first real step toward digital pathology came in 2017, when we purchased our first slide scanner. At that point, there was interest in potentially using it for primary diagnosis. But shortly afterward the executive who had been supporting that effort left the organization, and the initiative lost momentum. For several years the scanner was used mostly for limited purposes, such as preparing cases for tumor boards.
What ultimately pushed the organization to move forward with digital pathology?
Personally, I had been interested in digital pathology for a long time. The first scanner I saw was when I was a resident in 2001. After seeing that technology, I kept asking, “When are we going to start doing this?”
The real turning point came about three years ago when a new president joined. He had previously worked in academia at the University of Louisville, where digital pathology was already being used. He was a strong advocate for bringing that capability here.
That executive support made a huge difference. Before that, digital pathology had mostly been something we talked about. Once leadership was behind it, the project gained real traction.
What factors influenced that decision to move forward with digital pathology?
One of them might have been that they finally got tired of hearing me talk about it. But more seriously, I think leadership increasingly sees digital pathology as the direction the field is heading.
Anticipating that this is likely how pathology will be practiced in the future, the question becomes whether to adopt it now or wait until later. Our chief operating officer once put it in a way that stuck with me: he said he doesn’t necessarily want to be the first one through the door, but he’s comfortable being the second.
Another important factor is recruitment and succession planning. As some of our pathologists retire, we’ll need to bring in new people. Increasingly, candidates expect digital pathology to be part of the practice environment. In fact, during interviews we’ve had applicants ask directly whether we use digital systems.
What are some of the biggest challenges faced by community laboratories when adopting digital pathology?
Cost is certainly one of the biggest barriers. Even though we were ultimately able to justify the investment, the upfront expense is significant. For-profit organizations or smaller pathology groups may find it difficult to justify that level of capital spending.
The other challenge is cultural: there isn’t always a lot of enthusiasm for change. Personally, I’ve been very excited about digital pathology, but I realize that may not be typical. Many pathologists in community practice simply want systems that are reliable and straightforward. They already have a full workload, so the idea of introducing a new technology – along with the learning curve and workflow changes that come with it – can feel like an unnecessary complication.
So, beyond the financial investment, one of the real hurdles is helping people see the long-term benefits and getting them comfortable with a different way of working.
What opportunities has digital pathology created for your organization?
Adopting digital pathology signals that the laboratory is investing in modern technology and not standing still. That perception matters. It helps reassure the physicians and hospitals we serve that we’re committed to staying at the forefront rather than becoming outdated.
Digital pathology has also allowed us to maintain subspecialty expertise in ways that would have been difficult otherwise. For example, we previously had a dermatopathologist on staff who eventually moved to California. Rather than recruiting someone locally right away, we were able to continue providing that expertise remotely.
Now, a dermatopathologist who lives hundreds of miles away signs out our skin cases digitally. Digital pathology makes that type of distributed practice much more feasible.
How would you describe the mindset required for digital transformation in the community setting?
I don’t think you can look at digital pathology purely through a traditional return-on-investment calculation. If you reduce it to a spreadsheet and say, “This adds a few dollars to every case,” then it may not look like it makes financial sense.
Instead, the question should be broader: what opportunities does digital pathology create? Rather than simply replicating what we already do with a microscope, the real value is in asking what could we do with digital that we can’t do today. Can it help us work differently, collaborate more effectively, bring in new expertise, or open up new business opportunities?
When Walt Disney first proposed building Disneyland, many people questioned the idea. They thought amusement parks were dirty, outdated places that didn’t make much money. But Disney wasn’t trying to build just another amusement park – he wanted to create something entirely different.
In a way, digital pathology is similar. If we approach it as simply replacing the microscope with a digital image, then we’re missing the point. The real potential is in how it can transform the way pathology is practiced. Thinking about it in those terms – how it changes the field rather than just replicates existing workflows – is the mindset that helps make the investment worthwhile.
How did pathologists in your group respond to the transition to digital pathology?
As you might expect, there was some resistance at first. One of our most senior pathologists – who jokes every year that he’s going to retire but is still here – was probably the most vocal opponent. He told us very directly, “I will never do this. As soon as you start doing digital pathology, I’m quitting.”
But something interesting happened once the system was in place. I remember one day he was frustrated because a case hadn’t been scanned yet. He needed the digital slide – either to review it remotely, share it with someone, or present it at a conference. I don’t remember the exact situation, but he was asking, “Why isn’t this scanned yet?”
That was the moment it really struck me. Here was the person who had been most strongly against digital pathology, and now he was annoyed when the slide wasn’t available digitally.
Looking ahead, what new opportunities could digital pathology create for community-based laboratories?
One area I’m particularly excited about is the ability for smaller groups or community practices to participate in research and tool development. Traditionally, that kind of work was mostly limited to large academic centers. But digital pathology opens the door for organizations like ours to get involved as well.
For example, we’ve already started exploring some collaborations locally. We connected with an engineer who was interested in computer vision projects, and we also have a nearby university with computer science students who are enthusiastic about healthcare applications. Once pathology data becomes digital, it becomes much easier to engage people like that in research projects. In some cases, they’re simply excited by the challenge and want to work on interesting problems.
That creates opportunities for community laboratories to experiment with developing their own machine learning tools – not necessarily for primary diagnosis, but as decision-support or workflow aids.
What kinds of tools or applications are you most interested in developing?
We’re currently exploring some relatively simple tools that could help pathologists work more efficiently. One example is a quality control project where we’re looking at whether an algorithm could screen lymph node slides and flag areas that might contain metastatic tumor.
The goal is to highlight areas that the pathologist may want to examine first – essentially serving as a guide to direct attention more efficiently.
That kind of application reflects how I see digital pathology evolving. It’s not about replacing pathologists, but helping us work smarter and more effectively.
How do you see the relationship between pathologists and AI evolving in the future?
My view is that pathologists and machines together will always perform better than either one alone. Digital tools can help us process information more quickly or identify patterns that might otherwise take longer to find. But the interpretation and clinical judgment still belong to the pathologist.
The real opportunity is the synergy between the two. Digital tools can help us work more efficiently, reduce oversight, and improve accuracy. Ultimately, that means we can deliver answers faster and with greater confidence for patients and their physicians.
In the end, that’s what matters most – using technology in a way that helps us provide better care.
What advice would you offer to other labs embarking on a digital transformation?
Adopting digital pathology was truly a team effort. It required strong support from our executive leadership, and it depended heavily on the work of our histology and support staff. They’re the ones doing the day-to-day work – preparing slides, managing the scanning workflow, and making sure the system runs smoothly. None of this would be possible without them.
If I played any role, it was mostly in advocating for the idea and keeping the conversation going. But the reality is that digital pathology became a success here because many different people contributed to making it happen.
Hopefully our experience can serve as a positive example for other groups that may be considering a similar transition – and maybe show that adopting digital pathology isn’t quite as intimidating as it might seem at first.
Newsletters
Receive the latest pathologist news, personalities, education, and career development – weekly to your inbox.
