The microscope, considered the gold standard for rendering diagnosis for the past 100 years, met its match, as many things did, when coronavirus hit. Social distancing and stay at home orders prevented pathologists from signing out cases at the office. After a powerful win by the College of American Pathologists (CAP) (@Pathologists, @CAPFndn) grassroots advocacy efforts, the Centers for Medicare & Medicaid Services (CMS) granted a temporary waiver during this public health emergency to ensure pathologists may review pathology slides remotely. Most pathologists we interviewed did not implement protocols involving 100% remote sign out of cases. We did, however, interview pathologists with the full range of experience and access to digital pathology protocols and products at their respective institutions. We discuss their thoughts on the benefits and challenges of implementing digital pathology in the world affected by the pandemic.
Dr. Julie Feldstein (@feldstej), a hematopathologist at Mount Sinai, is experienced in using a slide scanner at her institution. Dr. Feldstein explained, “COVID-19 accelerated the need for remote access. It’s so much easier and accessible. Colleagues can jump on quickly and have remote consensus. Plus I don’t have to hunt for slides in my office.” She believes online memory is a big bottleneck when it comes to digital pathology. Dr. Genevieve Crane (@evemariecrane), a hematopathologist at Cleveland Clinic, told us she sees digital pathology gaining traction in the future. “I am excited that we already see digital consults here at Cleveland Clinic. The slide review itself is not yet as facile as looking at glass, but it is amazing to be able to see challenging cases from across the world that might not otherwise be accessible,” she told us. And the challenges? “Institutions would need the infrastructure to store and display images. Depending on the magnification you scan them at, the files can be huge. I imagine the price of a high quality scanner could also be a challenge," she said. Dr. Raj Singh (@mydermpath), Director of Dermatopathology and Associate Chair of Digital Pathology at Northwell Health, also has experience with digital pathology at his institution. What spurred the decision to go digital? “The initial motivation was the size of Northwell -- 23 hospitals scattered throughout the city. If we need to consult each other, it becomes difficult to share glass slides. It makes it a very simplistic process if you can consolidate into a digital workflow,” Dr. Singh told us. He agrees that COVID-19 has shed some light on the need for digital pathology. “With COVID-19, we now can really see the benefits of going digital. This is the only way work can be done efficiently. And with board exams going digital, it’s almost a requirement for departments to have digital.” The challenge he sees is getting used to reading slides on a computer screen.
Dr. Singh makes a good point about board exams going digital. Students will need to be comfortable interpreting pathology images on a computer screen. This is a skill that needs to be taught to the up and coming pathologists of tomorrow. Dr. Ritcha Saxena (@RitchaSaxena), Professor of Pathology and Course Director at the Medical University of the Americas, teaches exclusively with digital images on the computer. “We haven’t been using a microscope for years,” she said. “We have a lot of stuff to teach in a limited time.” Instead of crowding around a multi-headed microscope, every student sees the same thing on their own computer screen. This allows for more interactive learning as a group, more material can be covered and now, in the age of coronavirus, students can study any and all images off campus. Dr. Liza Quintana (@LizaMQuintana), a cytopathologist and breast pathologist at Beth Israel Deaconess Medical Center, told us, “I would love to scan all of my teaching slides. It would be nice to curate an online collection for the residents. Slides break and fade; it would be nice to have a curated collection where nothing is faded and everyone could have access to it.” While Dr. Quintana does not currently use a digital slide scanner, she definitely can see the benefits of doing so. It’s important to remember that the future of pathology will be in the hands of residents, med students, even high school students sitting in class right now (probably on their phones). This new generation of pathologists will shape the future gold standard. Right now this new generation expects information at a second’s notice via the help of a computer screen. Digital pathology fits hand in hand with how the upcoming generation of physicians optimally processes information.
Now more than ever, we are living in a digital world. With classes, conferences and sign outs taking place over video conferencing platforms, all of which require a screen of some sort, we are taking a step in the direction of digital pathology. It’s obvious a challenge hindering digital pathology adoption has been that pathologists are accustomed to looking at slides under a microscope rather than on a computer screen. When the pandemic forced many pathologists to adapt to viewing more slides on a screen, we learned that the learning curve for interpreting slides on a screen may not be as steep as some think. Every pathologist we interviewed (and we imagine most pathologists) had to evaluate slides on a screen during the pandemic, and every pathologist considered it a success. Not only were pathologists able to accurately diagnose cases on a screen, but further experienced the benefits of remote workflow - notably increased consultation and education efficiency. Perhaps one silver lining of new workflows arising from the pandemic is the momentum that now exists to bring digital pathology to the front so the entire industry can experience these benefits as a new gold standard in pathology.
We hope you enjoyed our series Scoping COVID-19. Links to all posts in the series can be found below. Again, thank you to all of the pathologists and interventional radiologists who we interviewed. This series wouldn’t be possible without you.
Built on the vision of better patient outcomes, Instapath was founded in 2017 by engineers and scientists to enable patients to immediately know their cancer diagnosis. Our team made it our mission to develop fast and easy digital pathology technology so diagnosis can be made in minutes instead of days. To learn more about Instapath and our technology, visit https://instapathbio.com or contact us at firstname.lastname@example.org.