Making Progress Toward Digital Pathology One Funeral at a Time

I have posted previous notes about digital pathology (see: Digital Pathology vs. Digital Radiology: A Broad Divide, "Eminence-Based" Surgical Pathology and the Digital Pathology Department). I have come to the conclusion that a near-total conversion to digital pathology is absolutely critical for progress in the field. As only one facet of this discussion, digital pathology is an absolute requirement for the evolution of integrated diagnostics, the merger of pathology, lab medicine, and radiology. I have posted a number of previous notes about this topic. Efficient image search, which will revolutionize the practice of surgical pathology, is also in its early development stage and will arrive main-stream in a few years.

A major barrier to the conversion to digital pathology, in contrast to digital radiology, is that there are few major economic drivers to encourage pathologists to adopt this new technology. Pathology reports, by and large, look the same to clinicians under this new technology, with the possible exception that images can easily be integrated into reports. In radiology by way of contrast, all new imaging modalities are digital. All of these new modalities have been actively supported and ordered by clinicians and have attractive profit margins.

Pathologists will probably not be getting calls from their hospital executives urging them to pursue digital pathology, particularly in these difficult economic times. Hence we have a large cohort of hospital-based pathologists who have few incentives to approach hospital leadership for the capital to convert to digital pathology. This also relieves them of the burden of mastering the new skill of image interpretation on a screen. The political hierarchy in pathology departments will also altered under digital pathology with more influence exerted by younger members of the department who have been trained in the new techniques.

I am reminded of a discussion I had some years ago with some young pathologists about generating surgical pathology reports using voice recognition and then requiring them to make minor edits to the report copy on-line. I asked them if this minor editing chore was a source of concern for them, all of whom had good keyboard skills. They said to me: "How else would you do it?" A very reasonable question from individuals who had not spent decades handing audio tapes to surgical pathology transcriptionists who then produced the reports. This leads me to the prediction that we will make progress toward digital pathology "one funeral at a time."

Comments

[EM]

You write "Pathologists will probably not be getting calls from their hospital executives urging them to pursue digital pathology".

One context where bureaucrats would push for digital path is small peripheral hospital where a lone pathologist could be replaced, for the purpose of frozen sections, with a good PA and a slide scanner. Here in Canada with our low population density, this issue occasionally comes up but I have yet to see a scanner in action.