Full Pathology Digitization Is Becoming Feasible

Pathology Visions 2007 Conference attracts pathologists, biotech, and pharma executives

CEO SUMMARY: Advances in computer hardware, software and support systems such as scanners are bringing the era of full pathology digitization closer to reality. Last week, in San Diego, California, an enthusiastic crowd of several hundred gathered to learn how laboratories, hospitals, and researchers are taking the first steps to digitize different areas of pathology services and laboratory operations. No single path toward digitization emerged from the more than 39 sessions.

DIGITIZATION OF PATHOLOGY IMAGES AND INFORMATION has long been recognized as a necessary achievement if the pathology profession is to maintain pace with the drive to create a universal electronic health record (EHR).

Two decades ago, it was Bruce Friedman, M.D.’s annual meeting in Ann Arbor, Michigan on laboratory informatics (now called LabInfoTech and held each winter in Las Vegas, Nevada) that provided a forum for innovation in laboratory and pathology information systems. Last decade, it was Michael J. Becich, M.D., Ph.D.’s annual meeting on pathology imaging and informatics that heightened attention on pathology imaging (called Advancing Practice, Instruction and Innovation through Informatics [APIII] and conducted each fall in Pittsburgh, Pennsylvania).

In this decade, it is Dirk Soenksen’s Pathology Visions conference in San Diego, California, which is becoming an additional resource for advancing the cause of digitization and informatics integration in anatomic pathology. Soenksen is CEO of Aperio Technologies, Inc., which manufactures a digitized pathology imaging system.

At Pathology Visions 2007 last week, there was a fascinating spectrum of topics and presentations on the digitization of pathology images and information. These talks ranged from using digital pathology images for standardization and remote consultations to how the evolution of PACS (picture archiving and communication systems) might be a model to predict how digital pathology will develop and the use of telepathology to make primary diagnoses of frozen sections.

General Electric’s Views

One speaker who captured the close attention on many in the crowd was Giri Iyer, General Manager of Strategic Relations of General Electric Healthcare. Because GE is a major player in radiology, its views on digitization of pathology images were of keen interest. Iyer outlined a market adoption curve that identified the pharmaceutical industry as being the first to implement and use digitized pathology images. He stated that this process is underway now.

Iyer predicted the next step in adoption would be as technology reduced current scan times and produced a digital image of a quality that had parity with that of glass slides. In his view, this is likely to be achieved in 2008 and 2009.

This would be followed by FDA approval of technology and systems which are designed to support the workflow of pathologists and which offer useful algorithms. This would occur in 2009 and 2010 and reference laboratories would likely drive the use of such systems in clinical applications.
In Iyer’s view, it is not until 2010 and beyond that digitized pathology systems would go mainstream. In order for this to happen, not only do such systems need to enhance pathologists’ workflow, but they must also have a demonstrated return on investment (ROI) and a documented clinical capability.

Iyer stated that “evolution in the industry will be driven by image digitization in a way that has a common denominator: If physicians do not have to look for a piece of paper, a glass slide, or a piece of film—if all this information is in one computer in digital form, then short term gains in clinical value and efficiency will drive acceptance and adoption.”

Progress in pathology informatics and digitization is happening at accelerated pace. Strong attendance at LabInfotech, APIII, and Pathology Visions demonstrates the widespread interest in this topic.

Digital Information and Digital Images Change the Learning Habits of Today’s Medical Students

WHAT MAY INTRIGUE pathologists and laboratory directors are the learning habits of the current generation of medical students. These students use digital information in unique ways that they will carry with them into clinical practice.

At Pathology Visions 2007, Andrew J. Connelly, M.D., Ph.D., Assistant Professor of Pathology at the Stanford School of Medicine in Palo Alto, California, discussed these new study patterns in a presentation called “Experience with Virtual Slides at Stanford Medical School.”

Major reforms in how medical students are taught in each year of their education is occurring in tandem with a switch away from paper-based educational materials (like course synopses and textbooks) in favor of digital media. Connelly discussed how digital pathology images plays an important role in supporting these new study patterns of medical students.

“Our experience is that virtual [digitized] slides are uniform, high quality, and easily distributed,” noted Connelly. “They can be linked in useful ways to other digital content that is relevant to the medical student. One consequence of our increased use of digitized pathology images is that we find students are less proficient with a microscope. However, we don’t anticipate this will be a problem as digitized images gain wider use.”

According to Connelly, medical students are using digital information in the Internet as a basis of study in the following order:

1)First resources are the course content Web site, which includes objectives, syllabus, and problems.
2)On-line textbooks, which must be free.
3)Google to hunt for the best content, which must be free and, if a log-in is required, they are likely to pass up the page.
4)Wikipedia.org.
5)Send instant message (IM) to fellow students who are also on-line.
6)Go to library.med.utah.edu/WebPath/webpath.html as suggested by course materials.
7)Visit www.path.uiowa.edu/virtualslidebox.

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