HIMSS names SMC a ‘world leader’ in digital pathology and awards the South Korean Healthcare provider Stage 7 DIAM status
Anatomic pathologists and clinical laboratory managers in hospitals know that during surgery, time is of the essence. While the patient is still on the surgical table, biopsies must be sent to the lab to be frozen and sectioned before going to the surgical pathologist for reading. Thus, shortening time to answer for frozen sections is a significant benefit.
This effort in surgical pathology is part of a larger story of the digital transformation underway across all service lines at this hospital. For years, SMC has been on track to become one of the world’s “intelligent hospitals,” and it is succeeding. In February, SMC became the first healthcare provider to achieve Stage 7 in the HIMSS Digital Imaging Adoption Model (DIAM), which “assesses an organization’s capabilities in the delivery of medical imaging,” Healthcare IT News reported.
As pathologists and clinical laboratory leaders know, implementation of digital pathology is no easy feat. So, it’s noteworthy that SMC has brought together disparate technologies to reduce turnaround times, and that the medical center has caught the eye of leading health information technology (HIT) organizations.
“The digital pathology system established by the pathology department and SMC’s information strategy team could be one of the good examples of the fourth industrial revolution model applied to a hospital system,” anatomic pathologist Kee Taek Jang, MD (above), Professor of Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center told Healthcare IT News. Clinical laboratory leaders and surgical pathologists understand the value digital pathology can bring to faster turnaround times. (Photo copyright: Samsung Medical Center.)
Anatomic Pathologists Can Read Frozen Sections on Their Smartphones
Prior to implementation of its 5G digital pathology system, surgeons and their patients waited as much as 20 minutes for anatomic pathologists to traverse SMC’s medical campus to reach the healthcare provider’s cancer center diagnostic reading room, Healthcare IT News reported.
Now, SMC’s integrated digital pathology system—which combines slide scanners, analysis software, and desktop computers with a 5G network—has enabled a “rapid imaging search across the hospital,” Healthcare IT News noted. Surgical pathologists can analyze tissue samples faster and from remote locations on digital devices that are convenient to them at the time, a significant benefit to patient care.
“The system has been effective in reducing the turnaround time as pathologists can now attend to frozen test consultations on their smartphone or tablet device via 5G network anywhere in the hospital,” Jean-Hyoung Lee, SMC’s Manager of IT Infrastructure, told Healthcare IT News which noted these system results:
TAT decreased from 20 minutes to 10 minutes.
Transferring scans of large frozen tissues up to three gigabyte in size is now possible through the 5G network.
Additionally, through the 5G network, pathologists can efficiently access CT scans and MRI data on proton therapy cancer treatments. Prior to the change, the doctors had to download the image files in SMC’s Proton Therapy Center, according to a news release from KT Corporation, a South Korean telecommunications company that began working with SMC on building the 5G-connected digital pathology system in 2019.
DIAM is an approach for gauging an organization’s medical imaging delivery capabilities. To achieve Stage 7—External Image Exchange and Patient Engagement—healthcare providers must also have achieved all capabilities outlined in Stages 5 and 6.
In addition, the following must also have been adopted:
The majority of image-producing service areas are exchanging and/or sharing images and reports and/or clinical notes based on recognized standards with care organizations of all types, including local, regional, or national health information exchanges.
The application(s) used in image-producing service areas support multidisciplinary interactive collaboration.
Patients can make appointments, and access reports, images, and educational content specific to their individual situation online.
Patients are able to electronically upload, download, and share their images.
“This is the most comprehensive use of integrated digital pathology we have seen,” Andrew Pearce, HIMSS VP Analytics and Global Advisory Lead, told Healthcare IT News.
SMC’s Manager of IT Planning Seungho Lim told Healthcare IT News the medical center’s goal is to become “a global advanced intelligent hospital through digital health innovation.” The plan is to offer, he added, “super-gap digital services that prioritize non-contact communication and cutting-edge technology.”
For pathologists and clinical laboratory leaders, SMC’s commitment to 5G to move digital pathology data is compelling. And its recognition by HIMSS could inspire more healthcare organization to make changes in medical laboratory workflows. SMC, and perhaps other South Korean healthcare providers, will likely continue to draw attention for their healthcare IT achievements.
Representatives from almost 50 different clinical laboratories, professional associations, and societies came together this week to align efforts to expand the supply and retention of qualified laboratory scientists
FORT WORTH, TEXAS—Last week, representatives from a broad cross section of clinical laboratories, lab and pathology associations, public health laboratories, and lab regulatory bodies gathered specifically to identify ways to expand the number of skilled lab professionals.
COLA organized the “Workforce Action Alliance Summit,” a one-day gathering of key clinical laboratory stakeholders who share a common interest in developing initiatives that would directly increase the number of individuals choosing to pursue a career in laboratory medicine.
This is not a new problem, as the lack of trained laboratory scientists across all scientific disciplines has been acute for many years.
In a communication sent to invited participants, COLA’s CEO, Nancy Stratton, and COO, Kathy Nucifora, described the objective of the summit, writing:
“Clearly a call to collective action is required if we are to address the impending clinical laboratory workforce shortage. The past three years have demonstrated the significance of a resilient laboratory infrastructure, not only for the daily care of millions of Americans, but also during the global pandemic. The numerous efforts currently underway to resolve the shortage are unquestionably a component of the solution. Many, however, believe that these efforts are insufficient to close the gap between the projected number of new entrants into the profession, the rate at which those currently in the profession are departing, and the future demand for laboratory testing.”
Robert L. Michel, Editor-in-Chief of Dark Daily’s sister publication The Dark Report was a participant at COLA’S workforce summit. The Dark Report regularly profiles clinical laboratory organizations that have developed innovative and productive initiatives designed to increase the number of students choosing to train as medical technologists (MTs), clinical laboratory scientists (CLSs), medical laboratory technologists (MLTs) and other skilled lab positions.
In materials distributed at the summit, the ongoing gap between demand for skilled lab professionals and the supply was illustrated thusly:
“The US Department of Labor estimates 320,000 bachelors and associates degreed laboratory professionals are working in the United States. If each of those professionals worked a standard 40-year career, the natural annual attrition of 2.5% would require 8,000 new professionals to maintain their current numbers. This exceeds the current output of accredited educational programs by more than 1,000 annually.”
Case Studies of Success
Over the course of the day, participants at the summit heard about the successes of certain laboratory organizations designed to get more students into training programs, supported by the educational courses required for them to become certified in their chosen area of laboratory medicine. These case studies centered around several themes:
Obtaining funding specifically to establish an MT/CLS training program to increase the number of candidates in a region. One example involved ARUP Laboratories and its success at working with a local Congressional representative to get a $3 million federal grant funded as part of a larger legislative package.
The medical laboratory scientist (MLS) program at Saint Louis University (SLU) worked with Quest Diagnostics to launch an accelerated bachelor’s degree program. The 16-month program combines online academic courses with intensive hands-on learning and clinical experiences in Quest’s Lenexa, Kansas, laboratory. The first students in this accelerated degree program began their studies in the spring semester of 2023.
By rethinking the structure of its existing didactic and experiential learning structure, NorthShore University HealthSystem’s MLS program, located at Evanston Hospital north of Chicago, doubled its enrollment capacity.
During the afternoon, working groups addressed ways that lab organizations can collaborate to increase recruitment and retention of laboratory scientists across all disciplines of lab medicine. This input was synthesized into action planning for the three priorities that can lead to expanding the lab workforce.
By day’s end, several working groups were organized with specific next steps. COLA is taking the lead in managing this initiative and giving it momentum. All clinical laboratory professionals and pathologists are welcome to participate in the Workforce Action Alliance (WAA). Anyone wishing to learn more can contact COLA by clicking here, calling 800-981-9883, or by visiting https://education.cola.org/contact-us-page.
Family medicine academic departments in Canada are dealing with a shortage of applicants qualified for their residency programs, mirroring the shortage of pathologists
For the past decade, the number of medical residencies in Alberta Canada that went unfilled have increased each year. Now, just like in many parts of America, the province is experiencing severe medical staffing shortages that includes clinical laboratories and pathology groups.
According to data compiled by the Canadian Resident Matching Service (CaRMS), after the first round of matching for post-graduate training spots as many as 12% of all spots went unfilled, especially in family medicine, the Canadian Broadcasting Corporation (CBC) reported.
Though the trend seems to be worse in Alberta, the resident shortage is affecting the entire Canadian healthcare system. According to the Angus Reid Institute, approximately half of all Canadians cannot find a doctor or get a timely appointment with their current doctor.
That is fueling predictions of an increased physician shortage in coming years, particularly in Alberta.
The graphic above taken from the CBC report shows how the number of residencies in family medicine that go unfilled has been increasing for the past 10 years. This trend mirrors similar trends affecting clinical laboratories and pathology groups around the world. (Graphic copyright: Canadian Broadcasting Corporation.)
Internationally Trained versus Home-grown Doctors
Canada’s current doctor shortage appears to be rooted in red tape that determines which MDs qualify for residency matching. According to John Paul Tasker, a senior journalist at the CBC, “there’s no shortage of doctors in Canada. What we have is a shortage of licensed doctors.” In his article, “Canada Is Short of Doctors—and It’s Turning Away Hundreds of Its Own Physicians Each Year,” Tasker notes that there may be as many as 13,000 medical doctors in Canada who are not currently practicing.
What’s standing in the way of Canadian doctors becoming licensed to practice? Some claim the system of residency matching is discriminatory towards Canadian doctors who received their training outside of Canada. Rosemary Pawliuk, President of the Society for Canadians Studying Medicine Abroad, is one of those who believe the system of matching is broken.
“They have cute slogans like, ‘You’re wanted and welcome in Canada,’ but when you look at the barriers, it’s very clear that you should not come home. Their message is essentially, ‘Go away’ and so [doctors] do,” Pawliuk told the CBC.
According the Pawliuk, “the current residency selection system puts internationally trained Canadian doctors at a serious disadvantage,” the CBC reported. “The Canadian public should be entitled to the best qualified Canadian applicant. Whether they’ve graduated from a Canadian school or an international school, whether they’re a Canadian by birth or if they’re an immigrant, they should be competing on individual merit,” she added.
Canada’s Medical School Matching Bias
In Canada’s current matching system, medical schools decide who gets a residency. Critics say the schools are biased towards Canadian-educated doctors and overlook foreign-trained doctors. About 90% of all residencies in Canada are set aside for Canadian-trained doctors and the remaining spots are left for the physicians trained abroad, CBC noted.
It is important to note that these doctors who are trained abroad are either Canadian citizens or permanent residents. Thus, it’s not a question of citizens from other countries competing with Canadian citizens.
So, if a surplus of doctors are being shut out of residency training opportunities, why are there open slots in Alberta? Some believe this indicates individuals are not interested in practicing medicine in Alberta.
But, Nathan Rider, MD, President of the Professional Association of the Resident Physicians of Alberta (PARA), claims he has not heard of residents turning down Alberta. He notes that the factors of where a resident may want to go geographically often depend on factors such as proximity to loved ones, cost of living, and program culture.
But Rinaldi still has concerns, “We may fill them with 42 disinterested people who have no interest in family medicine,” she says.
Anderson admits that “Across the country, over the last five or more years, family medicine has become less popular with medical students graduating from medical schools than it was in the years before.”
Therefore, both Anderson’s and Hemmelgarn’s schools have changed curriculum to put more of an emphasis on family medicine. Perhaps with these changes, and possibly an opening for internationally-trained Canadian doctors to achieve residency positions, Alberta’s—indeed all of Canada’s—residency match days will be better attended.
In the United States, there is little news coverage about serious problems with the health systems in other nations. The experience of residency programs in Canada, as explained above, demonstrates how a different national health system has unique issues that are not identical to issues in the US healthcare system. What is true is that Canada is dealing with a similar shortage of skilled medical technologists (MTs) and clinical laboratory scientists (CLSs), just like here in the United States.
It was a special and unusual moment for this mother and son duo as they applied for acceptance into residency programs and were both matched on the same day
Pathologists and other clinical laboratory scientists who underwent the matching process will be interested to learn how a mother and son were matched on the same day as part of the National Resident Matching Program (NRMP) 2023 Match Day.
Match Day is the next step for medical and medical technology students to be placed into desired training programs in chosen specialties. According to the NRMP website, pairings are determined by a mathematical algorithm to match applicants with residency positions.
Wenjing Cao, MD, PhD, and her son Hefei Liu, MD, didn’t plan to apply for residency together, but when Cao wanted to return to medicine, the pair realized they could be matched to programs at the same time, Good Morning America reported.
Cao, 54, is currently a research scientist/professor at the University of Kansas. She graduated from medical school in China and spent 10 years practicing internal medicine there before immigrating with her family to the US in 2006. Liu, 26, is finishing his oncology studies at the Medical College of Wisconsin where he expects to graduate in May.
Hefei Liu, MD (left), a radiation oncology student at Medical College of Wisconsin, and his mom hematologist Wenjing Cao, MD, PhD (right), a research scientist and professor at the University of Kansas, matched residencies on the same day during the annual National Resident Matching Program 2023 Match Day. Pathologists and clinical laboratory scientists know how exciting this day can be for residency applicants. (Photo copyright: Good Morning America.)
Pair Express Their Excitement, Awe
The matching program will take the pair to different locations for their training. Cao will be headed to the clinical pathology residency program at the University of Wisconsin-Madison and Liu to the University of Pennsylvania for the radiation oncology residency program, Good Morning America noted.
“When she told me she was going to reapply this year and it was the same year I was applying, I thought, this could actually happen. Somehow it did and it’s still incredible to me,” Liu said.
Cao is also thrilled. “This is incredible and amazing, something I feel very excited about. I never thought I would go through this process with my son together,” she told Good Morning America.
National Resident Matching Program
Though this is a special and rare moment, it’s not the first time the NRMP matched a parent/child in the Main Residency Match. However, Stephanie Bartek, Senior Communications Analyst for the NRMP, told Dark Daily that the NRMP does not track whether applicants are related, so there is no way to provide odds of it occurring.
The NRMP has matched physicians to residency training programs since 1952, but in 1984 it formalized the Medical Specialties Matching Program (MSMP) which matches physicians into fellowships and subspecialty training programs.
The first fellowship match was for Colon and Rectal Surgery. Since then, the NRMP has grown the MSMP to 73 subspecialties in 20 separate fellowship Matches, according to an NRMP press release.
The report shows 13,919 active applicants competed for 13,365 fellowship positions offered by 5,734 programs, according to the press release.
“For the past 70 years, the NRMP has been proud to play a part in helping physicians transition into residency training and begin careers serving their patients and community,” she added.
Age is Only a Number
Cao hopes her match will impact individuals who are holding back from following their desires.
“I hope my story can inspire so many others like me, at my age, [in their] 50s, and as a mother, as a woman, as an immigrant, [anyone] can pursue their dream, as long as you want it,” she said. “It’s your dream, put hard work on it. Keep positive. Stay motivated. You can get it.”
Her son Liu mirrored her sentiment. “If you see your parents or any of your family members who are interested in pursuing medicine and they have an interest, but they clearly have some sort of obstacles in their life, you should … be supportive of them and encourage them to pursue that dream because I think with dedication, hard work, and sometimes just even luck, that you can truly achieve your success.”
With the demand for pathologists in the United States outstripping the supply, Wenjing Cao, MD, PhD, may have her pick of positions when she finishes her pathology residency program and any pathology fellowship programs she may undertake.
As with clinical laboratories, worker shortage is affecting large retail pharmacy chains and independent pharmacies alike
Staffing shortages in clinical laboratories and anatomic pathology groups caused by the Great Resignation is having a similar impact on retail pharmacy chains. Consequently, pharmacy chains are reducing store hours and even closing sites, according to USA Today.
As Dark Daily covered in “Clinical Laboratories Suffer During the ‘Great Resignation,” the US Bureau of Labor Statistics reported that from August 2021 through December 2021, the healthcare and social assistance workforce saw nearly 2.8 million workers quit—an average of 551,000 people during each of those months. By comparison, in December 2020, 419,000 healthcare workers left their jobs.
Pharmacies now report similar shortages in qualified workers, partly due to the sharp decrease in revenue from COVID-19 vaccinations, but also due to worker burnout. Both developments have counterparts in clinical laboratories as well.
“I’m concerned that without the help from the COVID-19 vaccinations that everyone needed, these pharmacies that were able to tough it out for another year or two might not be able to continue,” B. Douglas Hoey, PharmD, CEO of the National Community Pharmacists Association (NCPA), told USA Today. Clinical laboratories that processed large numbers of SARS-CoV-2 diagnostics have experienced the same sudden drop in revenue causing similar difficulties maintaining staffing levels. (Photo copyright: Cardinal Health.)
Staffing Shortages Leading to Safety Concerns
According to the Washington Post’s coverage of a study conducted in 2021 of 6,400 pharmacists in various retail and hospital environments, a majority did not feel they could conduct their jobs efficiently or safely.
“75% of the pharmacists in [the] survey disagreed with the statement ‘Sufficient time is allocated for me to safely perform patient care/clinical duties.’”
“71% said there were not enough pharmacists working to ‘meet patient care/clinical duties.’”
“65% said ‘payment for pharmacy services’ did not support their ‘ability to meet clinical and non-clinical duties.’”
“Workplace conditions have pushed many pharmacists and pharmacy teams to the brink of despair,” said the board of trustees of the American Pharmacists Association (APhA) in a press release, the Washington Post reported. “Pharmacy burnout is a significant patient safety issue. It is impacting patients today with delayed prescription fulfillment, unacceptable waits for vaccines and testing, and potential errors due to high volume, long hours, and pressure to meet performance metrics.”
This is a sentiment that has been repeated across every facet of healthcare—including in clinical laboratories—where staff shortages are being felt.
Shortage of Pharmacists or Lack of Morale?
In “Drugstores Make Slow Headway on Staffing Problems,” the Associated Press outlined from where it believes the staffing problems originate. “There isn’t a shortage of pharmacists. There’s just a shortage of pharmacists who want to work in those high-stress environments that aren’t adequately resourced,” Richard Dang, PharmD, Assistant Professor of Clinical Pharmacy at the University of Southern California (USC), told the Associated Press.
“The pressure never let up. No matter how mind-numbing and repetitive the work could get, we had to work with constant vigilance, as there was absolutely no room for error,” Bator wrote.
“We techs were left unsupported and unmentored throughout the pandemic,” she continued. “No one cared if we were learning or growing in our job, and there was little encouragement for us to enter training or residency programs. We were just expendable foot soldiers: this is not a policy that leads to long-term job retention.”
Healthcare workers feeling burnt out and under-appreciated during the pandemic led to mass resignations that produced staffing shortages throughout the industry. It appears this trend has caught up to pharmacies as well.
Workforce Wasn’t Ready
Local and chain pharmacies played an important role in the COVID-19 pandemic. Pharmacists distributed COVID-19 tests and treatment to their communities. But for many it was a struggle to keep up.
Stefanie Ferreri, PharmD, Distinguished Professor in Pharmacy Practice and Chair of the Division of Practice Advancement and Clinical Education at University of North Carolina’s Eshelman School of Pharmacy, told the Associated Press that she felt the expanding role of pharmacies in public health was “awesome” but stated that “the workforce wasn’t quite ready” for what took place during the pandemic.
Much like Bator recounted in her essay, pharmacy workers suddenly had new responsibilities, longer working hours, and little room for error.
“There are multiple stories about pharmacists just getting overwhelmed. The stress level and burnout is high,” Dima M. Qato, PharmD, PhD, told USA Today. Qato is Hygeia Centennial Chair and Associate Professor (with tenure) in the Titus Family Department of Clinical Pharmacy at the University of Southern California. “So, pharmacists leave, and stores have to shorten” their hours, she added.
Scheduling and Patience Can Help
What can be done to soften some of the issues staff shortages are causing? Ferreri suggests that pharmacies set appointment times for regular customers so that a pharmacist’s workload can be more predictable. An appointment system can ease stress for both the pharmacist and patient. Ferreri advises customers to be patient when it comes to their prescriptions. She suggests patients give pharmacies more than a day’s notice for refills.
“I think on both sides of the counter, we need to all have grace and realize this is a very challenging and stressful time for everyone,” said Brigid Groves, PharmD, Vice President, Pharmacy Practice at the American Pharmacists Association.
With burnout, staff shortages, and stress affecting nearly every aspect of the healthcare industry, having patience with each other will go a long way to helping clinical laboratories, pharmacies, and patients navigate the road ahead.
