Today, the anatomic pathology laboratory is faced with a multitude of challenges affecting workflow and patient care. These include reductions in pathology staffing, shortages of specialty pathologists, shrinking biopsies, the growth of diagnostic tests related to personalized medicine, and the adoption of a wide range of new electronic technologies to more efficiently handle the sharing of various medical records. Pathologists are also under more pressure to increase efficiency, collaboration, and responsiveness while positively affecting treatment decision outcomes. The labor and time-intensive processes traditionally used in the AP laboratory may not be congenial with the demands of the new healthcare paradigm.
The average pathologist in a commercial lab currently views approximately 20,000 slides per year.1 The rate of retiring pathologists is climbing; it has been estimated that the number of actively practicing pathologists in the United States will drop from 18,000 in 2010 to 14,000 in 2030. At the same time, it has been estimated that some 20,000 pathologists will be needed by 2030 to meet medical needs of a growing (and aging) population—so there will be a serious supply and demand gap.2
All these challenges are requiring implementation of new and different solutions outside the normal operations that have been in place in the AP laboratory for decades. Digital systems are increasingly being seen as one response to the challenges of the present—and the future.
ePathology solutions
Many laboratories and life science institutions are turning to digitally driven ePathology solutions that provide a variety of sophisticated tools to help address these issues. Digitized microscope slides, along with sophisticated software and connectivity programs, allow pathologists and laboratory staff to overcome the limitations of conventional glass slides and meet growing demands by providing a new environment for managing and interpreting pathology information. This solution provides increased ease of internal and external collaborations, easy access to quantitative image analysis tools, and improvements in educational formats. In addition, workflow and reporting turnaround times also benefit from easy-to-use accessioning software, digital archiving, and instantaneous retrieval of electronic records.
ePathology procedures
ePathology provides smooth and efficient conferencing and sharing capabilities that can be used in a wide variety of contexts. These capabilities are especially beneficial when addressing issues related to shortages of pathologists or when the need arises to confer with internal or external specialists on complex cases.
An example is the ability to use this electronic-driven solution for intraoperative consultations of frozen sections. Accessibility through ePathology can benefit short-staffed pathology groups providing these services to multisite facilities, small hospitals (such as in rural locations) with limited access to such services, and ambulatory surgical facilities that infrequently require pathology reviews. Instead of a pathologist having to spend time traveling to a location, the pathologist can view live-stream video of the grossing procedure from his or her main facility, followed by digital images of the frozen section slides. This provides for streamlined communication about a preliminary interpretation and critical feedback to the surgeon, thus helping to expedite important care decisions.
Laboratories implementing this solution find excellent concordance, minimal time delays for reporting to the surgeon, and time/cost savings to the laboratory. “The ePathology solution was simple to use and reliable, and the quality was wonderful,” says Brian Michelson, MD, previously with the Royal Brompton and Harefield Hospitals in London. “Diagnosis was found to be no more problematic than using a conventional microscope.”
Another benefit to utilizing this solution is the ability to review and conference, anytime, anywhere on cases that require additional reviews or the input from a specialized pathologist. Reviews can be performed in minutes or hours rather than the days or weeks that are required with the transfer of glass slides. Live interactive conferences, with multiple participants, can enhance collaborations and increase confidence in pathology findings. Cost savings can also be realized in the shipping of slides and the reduction of paperwork as well as in the decreased potential for misplaced items and related errors.
Delivering personalized medicine
As the emphasis on personalized medicine has grown among clinicians, the need has increased for more precise analysis of specimens in order to enhance the use of targeted therapies. Advances in the application of genetic and molecular companion diagnostics, in addition to a growing number of stains, are requiring maximization of a tissue sample—even as sample size has been shrinking due to improvements in collection techniques. A tissue sample is no longer subjected to just hematoxylin and eosin (H&E) and a couple of immunohistochemistry (IHC) stains. Multiple stains are now applied across a number of slides, and all must be reviewed and compared, and intensities must be quantified with consistency and accuracy.
ePathology provides image analysis tools that empower pathologists with automated, easy-to-use quantitative capabilities for precise evaluations on digitized images of glass slides. Labor-intensive searching, counting, and subjective analysis of stain intensities have been replaced with the ability to view multiple slides at once and apply algorithms that efficiently provide consistent, quantitative results. Use of this solution can exponentially help AP laboratories meet the priorities of personalized medicine.
It is a challenging time—but pathology labs are meeting the challenges with digital solutions. Labs are being asked to keep pace with technological advancements related to personalized medicine and sharing of medical records, while at the same time addressing the demands to increase efficiency, collaboration, and responsiveness with fewer pathologists. ePathology is defining the new paradigm of anatomic pathology. It is enabling pathologists to engage, evaluate, and excel in a whole new dimension of transparency, consistency, and collaboration. As a result, AP laboratories can realize exponential gains in both efficiency and productivity while meeting the goal of better patient care.
References
- McEvoy & Farmer, U.S. Pathology 2011 Report. http://www.mcevoyandfarmer-pathology.com/wp-content/uploads/2012/12/USPathReportContents.pdf.
- Robboy SJ, Weintraub S, Horvath AE, et al. Pathologist workforce in the United States. Arch Pathol Lab Med. 2013. Epub ahead of print
http://dx.doi.org/10.5858/arpa.2013-0200-OA. Accessed September 30, 2013.
