Reference laboratories play a vital role in modern patient care, making specialized testing rapidly available for a wide variety of healthcare institutions. Digital pathology is changing the way that reference laboratories work, enabling them to extend services and reduce turnaround times, providing unprecedented opportunities for global sharing of pathology images and data, as well as opening up new revenue streams. In the first of a two part series, Dr. Eric Glassy, formerly medical director of Pathology, Inc., and Dr. Clay J. Cockerell, president and owner of Cockerell Dermatopathology take a look at why this technology is being adopted by reference laboratories, what benefits it has for both patients and healthcare organizations, and how they view the future of digital pathology.
Question: Tell us a little about your organizations?
We started Pathology, Inc., in 2001 as an anatomic pathology reference laboratory, focused predominantly on women’s health. We later added clinical lab testing services, flow cytometery, and molecular pathology. We also provided histology services to hospitals, biopharma, and universities.
Cockerell Dermatopathology is a reference lab that performs about 1,000 biopsies daily. That’s where 90% of my work is concentrated. We also have a fellowship program that was launched in the 1970s to educate younger pathologists and dermatologists on what we do.
Question: What led to the decision to adopt digital pathology?
We began using digital pathology at Pathology, Inc. in 2005. One main driver was responding to the competitive pressures of larger reference labs that offered virtual immunohistochemistry to clients.
Our main lab was located in Torrance California and we had a really excellent immunohistochemistry department with numerous clients in southern California. Some of them were a couple hours-drive away and they all wanted to review the special stains early in the morning. So even though we did all the stains at night, we couldn’t deliver the glass slides to them by 7:30am. We solved the problem by digitally scanning the IHC slides. Clients could then review the cases digitally, and not have to wait for the glass slides to show up several hours later.
Once we had the system, a whole lot of other opportunities presented themselves such as computer-assisted immnohistochemical analysis, tumor board conferences and clinical trials .
We first adopted digital pathology in 2014. At that time, for Cockerell Dermatopathology, there was the idea that this was something up and coming, that we wanted to be on the cutting edge of.
We have a number of dermatologists that like to get a copy of their own slide and so we thought instead of giving them a section of the slide we would simply send them a scanned copy of the slide. That’d be something very valuable for them.
We’ve also begun looking at doing some telepathology globally. There is a demand for dermatopathology services in a lot of countries overseas, as they don’t really have the expertise yet. We’ve had discussions with some operations in India and in the UAE to start some work with them, and there’s also the possibility of doing work in China, Brazil and other coun tries. It’s the opposite of outsourcing, they’re actually insourcing to us. They don’t have trained skin pathologists, so if they are doing a biopsy they can scan the image, send it to us, and we can give them an opinion on it. It’s in its infancy, but we see that as a major potential benefit for this technology in the future.
Question: Can you describe how digital pathology is used at your reference lab?
At Pathology, Inc., it was used was for virtual immunohistochemistry, image analysis, secondary case reviews within our own group, client digital consultations, tumor board presentations— which were very well received when we rolled them out —as well as clinical trial work.
Another use that was revenue generating for the lab was a TC-PC (Technical Component / Professional Component) split. Pathologists from other institutions would have us do the immunoperoxidase stains for breast markers (ER, PR, HER2, Ki67). We’d do the stains and then scan the slides. The external pathologist could perform their own computer assisted interpretation and the billing would be a split between the lab (technical) and pathologist (professional).
As far as the workload in our laboratory, there are probably 50-60, maybe even 100, slides that get scanned in daily that are sent to physicians that wish to look at their own slides and upload them up to an accessible folder. We also use them for education conferences once every week, 40-50 slides monthly. But it is being used daily.
Question: What is the value of digital pathology seen at your lab?
In a reference lab, it all comes down to customer satisfaction and quality work. Our mantra was “concierge service” that kept the client happy and also attracted new physicians. Digital pathology was front and center when we met with prospective clients to show them that we were a cutting edge lab that emphasized personalized service. We were sometimes asked to respond to RFPs for new pathology services at hospitals outside of Los Angeles. Part of the presentation to those hospitals was to outline the advantages of digital pathology. My pathology group has multi-specialty expertise and digital pathology allows for efficient, rapid and cost-effective case sharing. It demonstrates that the lab and the pathology group are at the forefront of pathology.
It definitely saves us money when we don’t have to send slides to a doctor. These cost-savings include: shipping, labor, prep, and supplies. But it’s mostly the intangible benefits that I find most effective. The fact that we can use this for teaching is extremely impactful. It’s very convenient and valuable when we scan in the slides; anyone can look at them from anywhere around the world and see the same image that everyone else is seeing.
Slide sharing is also very beneficial to the patients. The fact that you can get a lot of different people looking at the slides from all over the country – and even all over the world in some cases – is very reassuring and cutting edge. It’s innovative to send an image from somebody in India to the U.S., and the person can get their slides reviewed by an expert that has looked at millions of slides, which may not be available to them in their own country. It’s really amazing.
Question: What does the future look like for digital pathology?
The digital future is bright and we anticipate even faster adoption. There is the opportunity to insource cases from countries outside the US that are experiencing a shortage of subspecialty pathology expertise. That’s helping to drive digital pathology adoption worldwide.
There are things that you can do with a virtual slide that you just can’t do with a glass slide. Because of that, whole slide imaging will continue to be a disruptive technology that will eventually be embraced as routine and an essential tool in our pathology practices
It will basically make a lot more people available to see these slides all over the world. Doctors won’t have to be tethered to a microscope to look at these slides and make a diagnosis. It’s going to expand the access of pathologists to this work. Digital pathology is an up and coming technology, and I think it’s going to be used, more and more, in the future.
With adoption of digital pathology, US reference labs are finding new ways to expand their services, increase client satisfaction, and help to deliver personalized care for patients. Novel technologies are enabling these labs to stay on the cutting edge of pathology, while opening new revenue streams globally.
Join us next month for the second part of the series, where we explore how digital pathology is being used to enhance patient care in Integrated Delivery Networks (IDNs) and Academic Medical Centers (AMCs).
This post is sponsored by Leica Biosystems.