In a recent note, I commented on the new strategic alliance between GE Medical and the University of Pittsburgh Medical Center (UPMC) in the pursuit of the digital pathology department and whole slide imaging (see: GE Medical Partners with UPMC in Pathology Imaging Venture). It is often stated that digital radiology took about a decade to mature and that digital pathology will take an equal amount of time to become the accepted standard of practice. However, major incentives were available in the conversion to digital radiology such as the ability to offer new imaging procedures with attractive profit margins plus a groundswell of enthusiasm on the part of hospital clinicians for these new offerings. These same incentives do not exist for digital pathology -- there are no additional profit margins to be gained for the hospital and the pathology reports to clinicians are largely the same except for the routine integration of digital images into surgical pathology reports.
However, it you are searching for a "killer app" associated with digital pathology, it is most certainly image search. By this I mean the ability to isolate "fields of interest" in a challenging surgical pathology case, an unusual malignant tumor for instance, and then match them against a large image database of diagnosed lesions for similar lesions. For challenging cases today, this same process often takes place laboriously by searching surgical pathology atlases on the shelf. Parallel to this process, many such cases are also referred to local colleagues for their opinions and also sent to "marquee" surgical pathologists who have established reputations as having superb diagnostic skills in various specialty areas. This is the basis for what has been called eminence-based surgical pathology.
And now comes the rub. These marquee pathologists have little to gain and much to loose by the introduction of digital pathology and image searches. Image searches and pattern matching is, in fact, what is taking place in the brains of these eminent pathologists. I suspect that they will have little enthusiasm for any technology that serves to lessen their influence, prestige, and livelihood. Many of these latter pathologists are also highly placed in the hierarchy of prestigious pathology departments. I suspect that they will be leaders of the chorus opposing the conversion to digital pathology and perhaps highlighting the failures and inadequacies of digital pathology departments.