Pathology Across State Lines and National Borders

WE ARE SWIFTLY APPROACHING THE DAY when community hospital-based pathologists will be able to serve hospitals and physicians located across state lines with the same ease that they serve hospitals and office-based physicians in their own cities and regions.

In the same vein, at least two major academic pathology groups in the United States have announced formal agreements to provide anatomic pathology services to laboratory partners in China. In Washington State, a pathology group has a formal service relationship with a rural hospital in Alaska that uses digital pathology to support remote intraoperative consults.

Digital pathology is the primary enabler of this new pathology service delivery model. Many experts predict that digital pathology will be a disruptive technology. I concur. Traditionally, pathologists have worked in close proximity to the histology laboratory. Specimens arrive at the lab, are processed by histotechnologists, then the glass slides are walked down the hallway to the waiting pathologist for his/her diagnosis.

Digital pathology disrupts this long-established service model of anatomic pathology. Whereas it has always been relatively expensive and time consuming to ship glass slides from point A to point B, there can be almost immediate access to a whole slide image via the Internet. There was also the issue that the glass slide was the primary record of the patient’s case. Thus, the originating pathology laboratory needed to keep close control over those glass slides for professional, legal, and regulatory reasons.

By contrast, the digital pathology image can be permanently archived and digital copies can be accessed by authorized members of the patient’s care team. As you will read on pages 10-14, Northwest Pathology of Bellingham, Washington, is using a digital pathology system to support intraoperative consults [frozen sections] for a hospital in rural Ketchikan, Alaska. This is one of the earliest service relationships in the United States where a local pathology group in one state uses digital pathology to provide regular clinical services to a hospital client in another state—without the need to have the pathologist onsite at that location. This unique arrangement has brought benefits to both parties. This is a first-mover example in anatomic pathology that demonstrates why more and more pathology work is going to flow across state lines and even across national borders.