Challenges in implementing a digital pathology workflow in surgical pathology

The rate of digital pathology adoption had been slow until the COVID-19 pandemic served as catalyst, demonstrating the possibilities of saving time and money by converting glass slides into whole slide images (WSI) and thus making them available to all staff pathologist immediately after, regardless of where the pathologists are located, in their office, at home or travel location. Regardless of the cataclysmic proportions of this event in health care and in pathology specifically speaking, the transition is still slow. After the COVID 19 pandemic, there was an increase in interest among laboratories and pathology groups. We recognize two periods, pre COVID 19 with low interest and low conversion rates;and during COVID 19 where the interest grew exponentially but not much so the adoption. Right now, we are on this high interest, but low adoption period. Since it is not for lack of interest from pathologists and administrators, now the issue is that all these interested parties have found out that the transition process is intrinsically slow and full of challenges. In this paper we are reviewing the main challenges that laboratories are facing in the adoption process, some are obvious, other are not so much. Those challenges can be divided in financial, technical, and perhaps the most difficult to overcome, changing management. All these challenges are not insurmountable, and the key is not to tackle them when they appear, but far in advance, this is accomplished by a thorough investigation of the variables and the particular use cases of the institution and to start educating medical and non-medical stakeholders about the benefits of a digital workflow, how these benefits will definitively pay off the investment and will render the laboratory not only prepared for other disruptive event like COVID 19, but it will also make them ready for the fast growing trend of utilizing machine learning and artificial intelligence to analyze images and finetune the diagnosis.

Types and frequency of whole slide imaging scan failures in a clinical high throughput digital pathology scanning laboratory.

Digital workflow transformation continues to sweep throughout a diversity of pathology departments spanning the globe following catalyzation of whole slide imaging (WSI) adoption by the SARS-CoV-2 (COVID-19) pandemic. The utility of WSI for a litany of use cases including primary diagnosis has been emphasized during this period, with WSI scanning devices gaining the approval of healthcare regulatory bodies and practitioners alike for clinical applications following extensive validatory efforts. As successful validation for WSI is predicated upon pathologist diagnostic interpretability of digital images with high glass slide concordance, departmental adoption of WSI is tantamount to the reliability of such images often predicated upon quality assessment notwithstanding image interpretability but extending to quality of practice following WSI adoption. Metrics of importance within this context include failure rates inclusive of different scanning errors that result in poor image quality and the potential such errors may incur upon departmental turnaround time (TAT). We sought to evaluate the impact of WSI implementation through retrospective evaluation of scan failure frequency in archival versus newly prepared slides, types of scanning error, and impact upon TAT following commencement of live WSI operation in May 2017 until the present period within a fully digitized high-volume academic institution. A 1.19% scan failure incidence rate was recorded during this period, with re-scanning requested and successfully executed for 1.19% of cases during the reported period of January 2019 until present. No significant impact upon TAT was deduced, suggesting an outcome which may be encouraging for departments considering digital workflow adoption.

Digital Pathology Initiatives and Experience of a Large Academic Institution During the Coronavirus Disease 2019 (COVID-19) Pandemic.

CONTEXT.­: Pathology practices have begun integrating digital pathology tools into their routine workflow. During 2020, the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a pandemic, causing a global health crisis that significantly affected the world population in several areas, including medical practice, and pathology was no exception. OBJECTIVE.­: To summarize our experience in implementing digital pathology for remote primary diagnosis, education, and research during this pandemic. DESIGN.­: We surveyed our pathologists (all subspecialized) and trainees to gather information about their use of digital pathology tools before and during the pandemic. Quality assurance and slide distribution data were also examined. RESULTS.­: During the pandemic, the widespread use of digital tools in our institution allowed a smooth transition of most clinical and academic activities into remote with no major disruptions. The number of pathologists using whole slide imaging (WSI) for primary diagnosis increased from 20 (62.5%) to 29 (90.6%) of a total of 32 pathologists, excluding renal pathology and hematopathology, during the pandemic. Furthermore, the number of pathologists exclusively using whole slide imaging for primary diagnosis also increased from 2 (6.3%) to 5 (15.6%) during the pandemic. In 35 (100%) survey responses from attending pathologists, 21 (60%) reported using whole slide imaging for remote primary diagnosis following the Centers for Medicare and Medicaid Services waiver. Of these 21 pathologists, 18 (86%) responded that if allowed, they will continue using whole slide imaging for remote primary diagnosis after the pandemic. CONCLUSIONS.­: The pandemic served as a catalyst to pathologists adopting a digital workflow into their daily practice and realizing the logistic and technical advantages of such tools.