Pathologists and medical lab managers can study radiology’s adoption of digital images for useful lessons, says one innovative radiologist
DATELINE: CHICAGO, ILLINOIS—During Pathology Informatics 2012, a record crowd gathered last week to explore how new technologies are reshaping both clinical laboratory informatics and anatomic pathology informatics. If there was clear consensus on any single point, it was that every medical laboratory needs a very robust informatics platform to serve the new integrated care models, including accountable care organizations and medical homes.
This will be particularly true for pathology groups because of the growing acceptance of whole slide images and digital pathology systems used to capture those images and make them available to pathologists. On that count, one speaker at Pathology Informatics 2012 had a powerful message that was well received by all in attendance.
Pathology Profession Needs to Transition to Digital Pathology
“Pathologists tend to look at how digital images transformed radiology and assume that pathology can follow that same path of adoption,” declared Paul J. Chang, M.D., Professor of Radiology, Vice Chair, Radiology Informatics, and Medical Director of Enterprise Imaging at the University of Chicago Department of Medicine. “That misses an important point! The transformation is not about the use of digital images. Rather, it is the transformation in workflow that is enabled by use of digital technologies.
“Radiology’s adoption of digital imaging has much to teach pathology,” continued Chang. “Pathologists have the opportunity use that knowledge to leapfrog radiology’s lengthy learning curve and move directly to the optimal use of digital imaging. However, pathology has many challenges before it can achieve this goal.”
Chang’s presentation was titled “The Electronic Revolution in Radiology: A Leapfrog Opportunity for Pathology,” and it can be viewed in its entirety at the Pathology Summit 2012 website. He spoke enthusiastically, even as he took the pathology profession to task for its status quo.
Much Randomness in Anatomic Pathology Workflow
“Pathologists are at the whim of randomness,” observed Chang. “For example, on a daily and weekly basis, patients just ‘show up’ in the pathology lab. By that, I mean tissue specimens flow into pathology labs across the country and—until the specimens are logged in—the pathology lab does not know the types of cases it will be processing and diagnosing during that shift. That is not true in radiology. Patients have scheduled appointments for each type of imaging procedure, and radiologists know the mix of cases they will be reviewing in advance.
“I call attention to this unplanned aspect of anatomic pathology because it strikes to one core difference between radiology and pathology today,” he noted. “Workflow in radiology is well-established and it is the workflow that supports optimal productivity and quality in how images are read and reported out.
“Compare that to anatomic pathology,” Chang said. “Surgeons are scheduling their patients, but the laboratory information systems (LIS) used by pathology labs won’t integrate with those scheduling sources. Think of how different it would be if pathologists could see, days in advance, both the number of surgeries and types of surgeries that will be generating tissue specimens. It would allow more precision in planning workflow, along with having the right resources available to process that shift’s mix of cases and tissue specimens.”
Chang’s primary message to the Pathology Informatics audience was this: It is not about the use of digital images in making diagnoses. Rather, it is about how the use of digital images unlocks a much more efficient workflow—one that supports higher productivity of the entire laboratory while making it easier for pathologists to review cases, make more accurate diagnoses, and communicate more effectively with the referring physicians.
Not About Digital Pathology, But Digital Workflow
To this point, Chang was quite clear. “It shouldn’t be about digital pathology,” he emphasized, “it should be about digital workflow. Pathology laboratories must have integrated workflow. However, your LIS is broken when it comes to workflow. The laboratory information systems used by pathology groups today cannot support the workflow requirements necessary to accommodate digital pathology images.
“It is also important to recognize that pathology has only one chance to get this right,” added Chang. “It needs to develop effective solutions for digital imaging workflow, otherwise hospital CIOs will take over the digital workflow solutions and get it wrong!”
Chang reminded his listeners that radiology had gone down this same path. Thus, pathology can study radiology’s adoption curve for digital imaging and use those lessons to leapfrog the pathology profession over radiology’s mistakes. By so doing, pathology could move directly to optimal workflow solutions.
Protocols for Tissue Processing Are Needed to Support Digital Pathology
“Keep in mind, however, one important difference in workflows of radiology and pathology,” advised Chang. “In radiology, the digital image is the beginning of the process. In pathology, the digital image comes at the end of a lengthy series of events. In this regard, to achieve ideal digital imaging outcomes, pathologists will need to be assertive about developing protocols for tissue biopsy collection, packaging, and transport to the laboratory.”
Chang also had much to say about how anatomic pathologists should make strong efforts to pull together all relevant clinical information to support their review and diagnoses of each case. He noted that in his radiology practice, an integrated informatics solution pulls relevant patient information out of the parent institution’s electronic health record system and brings it into the radiology information system.
He recommended that pathologists work toward that same goal. He used the terms “radiology cockpit” and “pathology cockpit” to describe a workstation that brings together all the digital images, workflow data, and clinical information required for the radiologist and pathologist to review the case and issue a report.
Chang’s genuine enthusiasm for the future of digital imaging in anatomic pathology was tempered by the challenges noted above. The anatomic pathology profession will require deep engagement by the pathology LIS vendors to develop the informatics capabilities needed to support digital imaging and new pathology workflows that utilize digital imaging in ways that increase lab productivity, while allowing pathologists to increase the accuracy and precision of their diagnoses.