“Pathologists have the opportunity to take on a new clinical role as the integrator
of all that digital pathology information, in combination with the patient’s other clinical data collected from a wide variety of sources.”
—Dirk G. Soenksen, M.S., M.B.A., Founder and CEO, Aperio
CEO Summary: During the 1990s, the pathology profession was exploring ways to use telepathology services. But it was only in the last decade when digital pathology technology became robust enough to support a variety of clinical uses in anatomic pathology. One of the first companies to offer such digital pathology systems was Aperio Technologies, Inc., of Vista, California. Dirk G. Soenksen, M.S., M.B.A., is the Founder and CEO of Aperio. In this exclusive interview with THE DARK REPORT, he discusses major trends in healthcare that are actively reshaping the anatomic pathology profession. In part one of this two- part interview, Soenksen provides insights that will help pathologists and pathology group practice administrators develop effective clinical and financial strategies for their laboratories.
Part One of Two Parts
EDITOR: On a macro level, let’s begin by identifying the major trends in healthcare that you believe will most affect lab testing services and anatomic pathology.
SOENKSEN: What immediately comes to mind is personalized medicine and integrated clinical care. Over the next decade, both trends will open new doors of opportunity for pathologists and clinical laboratory professionals.
EDITOR: In the realm of personalized medicine, would you comment about how knowledge of the human genome is likely to play a role? After all, pathologists already perform diagnostic tests that involve the analysis of DNA, RNA, and proteins.
SOENKSEN: Consider what happens when it is possible to sequence the whole human genome in 20 minutes for less than $200. First, this makes it economical to do a whole human genome sequence for every patient. Second, this genetic information will be essential as the physician develops personalized care plans for each of his or her patients.
EDITOR: How might this change the role of the pathologist?
SOENKSEN: Certainly pathologists and other laboratory scientists will advise physicians about how to interpret genetic information, then how to develop a proactive wellness and care plan for the patient. But don’t forget that the health system will still need a pathologist to identify abnormal tissue—particularly where there is cancerous tissue.
EDITOR: Pathologists play that role in today’s health system. So what do you think will be different?
SOENKSEN: Pathologists will continue to do all the things they currently do now in diagnosing disease. Certainly the pathologist will need to identify the tissue that goes into the sequencer or the mass spectrometer and interpret the results. But where the pathologist takes on a new role is that he or she can become the integrator of all that information in combination with other clinical data collected from a wide variety of sources.
EDITOR: This ties into your view that there will be more and tighter integration of the clinical care provided to individual patients. As this happens, is the pathology profession positioned to step into the role of the “information integrator”? Will pathologists become a primary source of consultative expertise to physicians?
SOENKSEN: Yes. Recognize that many types of disparate data will flow into the patient record, including from the gross specimen, the H&E, the IHC, flow cytometry, and genetic testing. Those are data that originate in the anatomic pathology laboratory. At the same time, this data must be integrated with the full patient history, radiology, pharmacy, and other relevant information.
Pathologists have the knowledge, the training, and the experience to pull all this information together and to deliver an integrated answer to the physician. This integrated answer can first be the diagnosis. But the patient’s physician will next want guidance on selecting appropriate therapies and monitoring the patient’s progress.
EDITOR: Do you believe the pathology profession will want to step into that role as integrator and consultant?
SOENKSEN: If healthcare is to deliver personalized medicine and do it within an integrated care delivery model, then there is a clear need for a physician who can pull together all the data associated with an individual patient. It will require a specialist to assess this information in a way that helps the patient’s physician understand all the relevant parameters. I predict that this role will be filled by the pathologist.
EDITOR: Historically, the pathology profession has not been proactive about stepping into new roles. Can it transition into this clinical opportunity?
SOENKSEN: That is the right question. Can pathology become the preferred integrator of that information? It presents pathologists with both an opportunity and a challenge.
EDITOR: I want to explore another area of pathology now. with the explosion in molecular diagnostics and steady advances in genetic technologies for diagnostic and therapeutic purposes, how do you see pathologists responding to these trends in today’s marketplace?
SOENKSEN: Molecular pathology is on its way to becoming a much more important subspecialty in pathology. As that happens, pathologists must find ways to become more efficient.
EDITOR: Are you saying that the productivity of individual pathologists will need to increase in order for them to handle greater volumes of work?
SOENKSEN: Yes, because pathologists will require additional time on a single patient case. Not only to diagnose the tissue, but also to integrate disparate types of information so they can help the referring physician understand all this data and make the right decisions about the patient.
EDITOR: I’ll bet that’s a point most pathologists have not considered. As they continue to do the primary and secondary diagnosis of the tissue, they have the opportunity to pull together all the relevant data in the full patient health record, then use that information to consult with the referring physician.
SOENKSEN: That is well said. It is why the pathology profession must find ways to automate the routine and more mundane work they are doing now.
EDITOR: Do digital scanning and digital pathology systems offer a way to automate what you call the “mundane” work that currently makes up part of every anatomic pathologist’s working routine?
SOENKSEN: Digital pathology is a catalyst for automating that mundane work. we envision that the pathologist will work in what we describe as the pathologist’s “cockpit.” This is a work station with multiple screens and software that gives the pathologist access to all the pathology data and the patient’s other relevant clinical data.
EDITOR: You describe a working environment where the pathologist takes on a new role, not just in diagnosing the tissue, but also in integrating all relevant diagnostic data for the patient.
SOENKSEN: Certainly this process does start with digital access to the microscopic information for the gross specimen. The design of this cockpit is to allow the pathologist to integrate that information with other disparate sources of information into a single unified viewing environment.
EDITOR: It makes sense. Having an integrated care continuum creates the demand for a specialist—such as a pathologist—to pull together all the diagnostic and prognostic information.
SOENKSEN: That’s true. Having all this information in one place will be incredibly valuable to the pathologist and ultimately to the oncologist treating the patient. This future state of the pathologist’s cockpit should be exciting for pathologists. Yet to make this concept a reality will require strategic thinking by the pathologist community. Pathologists must understand how to process that information and move into that consultative role with physicians.
EDITOR: This concept of the pathologist as an information integrator is something that you and your Chief medical Officer, Jared N. Schwartz, M.D., Ph.D., have advocated for several years now. How do others accept this prediction?
“Molecular pathology is on its way to becoming a much more important subspecialty in pathology. As that happens, pathologists must find ways to become more efficient.”
SOENKSEN: When we talk with customers, we share our vision for where pathology will go. The vast majority of pathologists and healthcare professionals we speak with agree with this vision: there will be the need for a specialist to collect and interpret all the patient’s information.
EDITOR: Are there other physician specialities that might take on this role?
SOENKSEN: Some people do ask “if the pathologist doesn’t do it, then who will?” It’s not easy to identify another medical specialty or physician type who is well suited to perform this service.
EDITOR: That’s true, since pathologists are trained to understand the diseases and health conditions for which laboratory tests are used in diagnosis, prognosis, and patient monitoring.
SOENKSEN: It goes beyond that. Pathologists are ideally suited for this expanded role. They are trained in systems biology. It is already in their nature to integrate disparate sources of information. These attributes make them ideally suited to sit in the cockpit and provide information that is actionable for oncologists.
EDITOR: We’ve discussed your vision for pathology that is anchored around personalized medicine, molecular testing, and molecular pathology specifically. This will take a few years to become reality. Can we shift gears now and talk about what is happening today in the anatomic pathology marketplace? How do you see the traditional practice patterns of the community-hospital-based pathology group changing?
SOENKSEN: Demographics are about to hit private practice pathology with a powerful series of blows. This is already changing the supply of pathologists even as the demand for anatomic pathology testing grows at double-digit rates.
EDITOR: It is generally known that the average age of a pathologist today is 55 years old and the oldest baby boomers turn 65 during 2011. So the retirement of significant numbers of baby boomer pathologists is now a reality. what other supply-demand factors do you see?
SOENKSEN: The total number of pathologists in the United States is decreasing. That’s because the number of young physicians who select pathology already falls short of replacing the number of pathologists who retire each year.
EDITOR: Isn’t the skill mix also changing? SOENKSEN: Yes, because in recent years, pathology residents are acquiring sub-specialty expertise. meanwhile the pathologists who retire mainly have general pathology experience.
EDITOR: Why is this shift to subspecialty pathology expertise significant?
SOENKSEN: It creates a logistics challenges. For example, how do you deliver the right slide to the right pathologist quickly enough to support acceptable turnaround times?
EDITOR: That makes sense, since the sub-specialist pathologist may not be located close to where the patient’s specimen was collected and processed. What other trends are important at the moment?
SOENKSEN: Another factor is that the population is aging and this increases the number of biopsies from one year to the next. Similarly, there are more surgical procedures which may require the surgeon to collect a needle biopsy. That also is increasing the number of pathology tests that need to be performed. The third trend is the steady growth in the number of new diagnostic tests that utilize new biomarkers. These trends create pressure on community hospital-based pathology groups.
A digital pathology system makes it easy to support consultations and second opinions. It is generally an efficient way to have the right pathologist look at the right slide.”
EDITOR: Dirk, you’ve provided a great capsule perspective on the primary trends in the anatomic pathology marketplace. Now let me ask about the use of digital pathology in today’s marketplace. what factors are driving adoption of digital pathology today?
SOENKSEN: Several primary benefits can be seen by observing how pathology groups that acquire digital pathology systems use them. For example, many groups view digital pathology as a way to have the right pathologist analyze the right slide at the right time with the right tool.
EDITOR: Please explain this.
SOENKSEN: Here in the United States, we do not have a shortage of pathologists. Rather, we have an inefficient deployment of pathologists based on subspecialty expertise. That is why many groups use digital pathology systems to deliver the images of a case to the right subspecialist.
EDITOR: That would be one reason why academic center pathology labs have been among the first to acquire and use digital pathology systems.
SOENKSEN: Yes. In addition to such uses as teaching and tumor board meetings, a digital pathology system makes it easy to support consultations and second opinions. It is generally an efficient way to have the right pathologist look at the right slide.
EDITOR: That makes sense.
SOENKSEN: It does. You want a pathologist with breast tissue expertise to look at breast tissue slides. The digital pathology image doesn’t have to be shipped to him/her, nor does he/she have to drive somewhere to look at the glass slides. Because those slides are digitized, the images are available on a network or over the Internet.
EDITOR: Dirk, this is a good place to end part one of our interview. During part
two of this interview, we can discuss how the pathology market is using digital pathology technology to add value. We can also learn more about the economics
of acquiring and using a digital pathology system.
SOENKSEN: Thank you. Our discussion is about to get very interesting because of how digital pathology, in combination with new diagnostic technologies, will help pathologists offer new clinical services and meet the financial challenges from declining reimbursement.