Collaboration Critical

At a Glance

• Healthcare services are under increasing pressures to take a collaborative approach to patient care
• Digitization supports cross-disciplinary working and can present other benefits, including regionalized working, efficiency, consistency, to name a few
• Many pathology services are forced to use traditional, inefficient approaches, but are continuously under pressure to deal with rapidly rising workloads with reduced resources
• Looking to successful role models and being aware of certain pitfalls will support pathology departments’ smooth transition to digital and a more efficient, multidisciplinary way of working

Transporting a patient’s sample by courier so that it can be seen at another hospital is a reality that faces pathology departments today. It is a consequence of the analog nature of pathology, but it also highlights how this crucial discipline often works in relative isolation to other parts of healthcare.

An historic reliance on slides and microscopes that restricts the flow of information and opportunities for collaboration could, however, be coming to an end. Moves are being made that will change how pathology departments function to place them at the heart of the healthcare enterprise. How? Pathology is widely expected to be the next big digitization in healthcare service departments around the world. Certainly in the UK’s National Health Service (NHS) it is inevitable. In fact it is happening now.

Many pathologists no longer wish to transport samples in jiffy bags. They want the means to function regionally and to be able to quickly access the visual information they need, wherever their location, in order to carry out their diagnostic function, which is in increasingly high demand.

Pathology is embarking on a transformative journey through digitization, one which will help it to modernize, address diminishing resources and respond to today’s need for integrated, sustainable and joined-up healthcare. And modern technologies mean that barriers to adoption can now be overcome.

Why is digitization needed?

There are a huge range of benefits that can be achieved through digitization and the business case is very strong. So, what are they?

1.Regionalizing pathology workflows

Departments now have a strong desire to regionalize their workflows, this is driven in particular by the distinct lack of resource and specialist skillsets in pathology. But at present, hospitals have very little or no means to support this, which is why pathology departments still resort to couriers or even the back of taxis on some occasions, to move samples from one site to another. Digitizing pathology offers the very real means to solve this challenge by allowing digital images to be shared. Not only would this improve workflow, but it would also mean that not every hospital would need to have a particular sub-specialist, e.g. a neuro-pathologist, onsite. Such a collaborative approach also allows for ready access to peer review and to quickly draw in a second opinion when needed.

2. Maximizing the value of MDTs

In some instances pathologists do not display slides during multidisciplinary team (MDT) meetings and instead present their own assessments and conclusions. Displaying slides may not be convenient or even practical, but failing to share this basic information with clinical colleagues is counter to the collaborative nature of MDTs and the value that is drawn from them. Pathology can improve this important clinical engagement by displaying digital images during meetings.

3. Efficiency

Digital images can be sent directly to sub-specialists, or other hospitals, without any lead time or costs for glass transportation or handling. This not only improves efficiency, but it also removes the risks of slides being damaged or lost. Further, greater access to sub-specialists than a pure reliance on in-house generalists can also increase the accuracy of diagnosis, ensuring treatments for patients are optimized.

4. Consistent reviews

The use of image analysis algorithms means that the reviews can be more consistent, reducing variation in quality.

5. Access to historic information

Access to historic samples and referrals is also made much easier with  digital pathology.

6. Greater intelligence, analytics and performance measurement

From a business perspective there is a substantial benefit to understanding how pathology is working locally and regionally. Digital solutions can measure outputs and performance of services, for example: the volume of images analyzed; efficiency; turnaround times; the quality of service provided by a hospital or by an individual pathologist. Key performance indicators can be set locally, regionally or nationally, allowing benchmarking against other hospitals. This is an opportunity to improve the performance of hospitals and individuals. But without this intelligence, pathology is missing a key opportunity to avoid any potential problems having an impact on the patient.

7. Patient access

Digitizing pathology enables patients to access their own imaging and pathology information, and this could help them input into their own healthcare. This is a big part of the patient record that is missing without digitization.

8. Attracting new talent

Some pathology departments are embarking on digitization to attract young people into the profession. At present the discipline is not always seen as a progressive, exciting area by people entering the healthcare profession. However, collaboration enabled by digital transformation has the potential to make it a far more engaging environment.

9. Remote reporting

Remote reporting by digitization means that pathologists can work from multiple locations – including from their home – and have an improved work-life balance.

10. Ergonomics

Pathologists commonly develop neck injuries because of the time spent at the microscope. Improved ergonomics has been the driving force behind some pathology departments’ decisions to implement digital solutions.

11. Education and training

The ability to share digital images makes training much more practical; it’s far more effective than having multiple students standing at a microscope.

Avoiding the pitfalls

This is a new journey for many departments – one that has many clear benefits as well as pitfalls – so it’s useful to look to other specialties that have undergone similar transitions. Although a very separate discipline with its own needs, radiology embarked on its digitization journey some 15 years ago in the UK NHS and even further back elsewhere. Digital technology is now fully integrated and supports the efficient and smooth running of radiology departments around the world.

It’s important, however, to recognize some of the pitfalls that could make the transition a difficult one.

• Getting into a single-vendor deadlock

Departments should avoid solutions that are not interoperable. Some early pioneers have chosen solutions that lock them in with a specific vendor, restricting regional and national collaboration. Instead of simply looking to solve immediate problems, pathology must look beyond the department to the wider enterprise and to other hospitals across their region or even their country. This is fundamentally about integrated healthcare.

• Anticipating access demand

It’s important to consider the scale of access to pathology files that will be expected following digitization. For example, patient access. This will be inevitable and is a key part of many government policies on healthcare, and so it needs to be taken into account when choosing appropriate solutions.

• Data security and system back ups

Some departments contemplating digital pathology have yet to consider basic requirements, such as data security, and are reliant on the microscope as a back-up. Consultation and collaboration with the IT department is essential.

A world first in Sweden

Sten Thorstenson, a senior consultant pathologist at Linköping University Hospital, began using digital technology to review histopathology samples as early as 2006. However, as far back as 1999, he attempted to reduce the amount of time pathologists were spending traveling between the Swedish cities of Kalmar and Västervik to transport pathology slides. He began using a frozen section scanning procedure for patients undergoing surgery in Västervik and digital telepathology technology to send the images to the reviewing pathologist in Kalmar, eliminating the need to have a pathologist on site. By 2008, he and his colleagues became the first in the world to begin implementing digital pathology across the entire department, with parallel access to microscopes and slides.

Since January 2014, he has performed his reviews exclusively with digital technology, without using paper referrals or slides and microscopes. He presents primary diagnoses to the pathology department at Linköping University Hospital, but works from home in Kalmar, more than 200 km away.

A range of benefits are being realized by Thorstenson’s team. Pathologists no longer need to spend lengthy amounts of time at a microscope. Reviews are more consistent, with fewer variations in quality between experienced and less experienced pathologists. Earlier samples and referrals are easier to access, and the risk of samples being difficult to locate has been reduced. Improvements continue as new technologies become available.

“Digitization has created entirely new opportunities for us to cooperate between clinics,” he says. “Not least of all, better diagnostics can be achieved through access to sub-specialists. Provided you are using a good, fast image viewer combined with a suitable human interface device, such as a 3Dconnexion mouse, you can also save time preparing samples – switching slides in the microscope, selecting the right lens, focusing, etc. – in a digital review than when using a conventional microscope.”

Many hospitals in the UK and around the world are now undergoing, or have completed, pilot programs in preparation for full digitization.

Pressures are mounting

Healthcare services are facing repeated calls for a joined-up approach around patient care, which now requires the ability to seamlessly share information that follows the patient. Combined with the resource pressures faced in pathology and the many opportunities that come with digitization, there is a growing recognition that the discipline must modernize and move into the digital era.

Digital pathology not only presents a strong business case, but is a business requirement for the future to support the sustainability of the discipline at the heart of the enterprise.