Seeking Funding from Hospital Executives for Digital Pathology Platforms

In response to my note yesterday about pathology naysayers regarding the purchase and deployment of digital platforms (see: "Not Yet" a Common Response by Pathologists to Digital Pathology Adoption), Barry Portugal, a veteran and knowledgeable consultant in pathology and lab medicine, submitted the following comment: 

While I agree that age is certainly a factor to the "not yet" conundrum, it's been my experience that "technology phobia" and capital investment are both more prevalent reasons. It's my view that digital pathology companies need to step up their efforts to educate pathologists and hospital system executives on the clinical, operational, and financial benefits associated with digital pathology.

I agree with Barry that it may be very difficult for pathology departments to acquire funding from hospital executives for a digital pathology program. Hospital execs generally tend to favor projects with a rapid and generous return on investment and often disregard those with a quality orientation. It thus falls to the pathology department leadership to put forward the strongest possible case for digital pathology couched in a convincing set of ROI numbers. In my mind, the two strongest arguments to be made currently for digital pathology are the following:

• Given that whole slide images are highly portable, large health systems have the opportunity to modify their surgical pathology workflow. Glass slides no longer need to be transported to the relevant in-house speciality pathologist or outside consultant. Prior pathology images for current surgical patients can be quickly reviewed. Some multi-hospital systems may even choose to place many, or even most, of their surgical pathologists in one work space to take full advantage of a centralized model.
• For teaching hospitals, the quality of the surgical pathology program is a major factor for residency applicants. I believe that the best candidates will now favor teaching programs with a successful digital pathology program to launch their careers. In short, capital investment in this technology is necessary to retain and attract the best trainees. 

Further and with regard to the financial return for digital pathology projects, one caution I would put forward to departmental leaders is not to promise a rapid return on investment. This is because of the broad organizational changes that will be required to optimize surgical pathology workflow under digital. Also and like many other deployments of emerging technology, digital pathology projects are subject to the S-curve whereby productivity gains are initially slow for early adopters because users are initially unfamiliar with the technology (Innovation and the S-Curve). Efficiency gains then become easier and more rapid as an organization works toward the rapidly ascending portion of the S-curve.

Barry's second point is that "technology phobia" may be inhibiting the deployment of digital pathology. If you were to ask me which departments/units in a hospital are the main "repositories and adopters" of new technology and science, I would respond with the following five: pathology/lab medicine, radiology, cardiology, oncology, and the operating rooms. Thus, if the leaders of a pathology department tend to feel phobic and inhibited by digital pathology, I would suggest that perhaps they are misplaced in the organizational hierarchy and should step aside to allow others to lead the high-tech projects that require major capital investments. 

Comments

[Steve A McClain]

The first argument is NOT very strong at all in practice. Caution is appropriate. Original slide review is still needed is many critical or difficult cases, because slides are far better optically, more data, and with higher resolution. Some objects can only be seen when the microscope is defined- condenser adjusted or polarizer added.
For example, small objects like fungal hyphae and bacteria may be nearly invisible in scanned images. Distinguishing
Merkel cell carcinoma from Basal cell carcinoma may be difficult. For those reasons original slide review workflow is still needed.
Second, for practical purposes most labs will need N+1 scanners (1 extra backup when a scanner is down or being serviced). Third, we have determined results can be comparable, but we have NOT YET determined where the scanning technology fails or interpretations can be prone to error.

"Given that whole slide images are highly portable, large health systems have the opportunity to modify their surgical pathology workflow. Glass slides no longer need to be transported to the relevant in-house speciality pathologist or outside consultant."