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Tele-Consultation Systems for Today’s Pathologists

Pathology is dealing with an area of diagnostics that is extremely variable. General pathologists are able to diagnose virtually any disease, but in rare or complex cases it is common practice to consult an expert. Many pathology labs have developed particular expertise in certain subspecialties and receive consult cases predominantly for these specific indications.

With this extensive network of pathology consultation and the advantages of working with virtual slides (improving speed and reducing risk of lost or damaged material), we would expect that most pathology labs use telepathology to ask for (remote) expert opinions. However, only few pathologists are performing telepathology.

Sharing Blocks or Slides?

Pathologists either share a glass slide or the tissue block when asking for remote consultation. Since glass slides are a fundamental source of evidence for the diagnosis, pathologists are quite reluctant to send it. Sending the block is the preferred way and has the advantage of the consulting pathology lab to apply its own stains. However, generating duplicate sections reduces the amount of valuable tissue and f the block rather than the slide is requested, telepathology solutions cannot be used.

A Word About Costs, Upload Times and Storage

To perform teleconsultation a lab must invest in a DP solution and costs can easily exceed 1 million USD, which takes years to amortize. While more labs are taking the step to go digital, especially the small and mid-sized labs, where the demand for (remote) expert opinion is largest, cannot afford this spending for a full-fledged DP solution. And there is more: The consulting end needs to run a DP system too, or at least a software for viewing, commenting and annotating virtual slides. Most DP scanner vendors provide such software for free, but are usually limited to one specific virtual slide format. Experts who consult for various labs running different DP solutions need to switch between various applications.

Transferring virtual slides via the web is not done easily, as uploading files or file sets is time-consuming. However, with expected speedier internet connections and decreasing storage costs, bandwidth and upload times will be less of a barrier.

Compliance and Security

Transferring pathology data via the web requires several safety criteria to be met. Even though many pathologists are using file sharing apps, email correspondence and social networks, a professional teleconsultation system should guarantee Protected Health Information (PHI) to be secured. Although histology images are not considered PHI, the metadata stored within a virtual slide or the pathologist’s descriptions that are necessary information for the consulting expert quickly make them PHI. Using non-HIPAA compliant sharing systems require the pathologist to decide what information is shared and what is kept private, which is why teleconsultation is often discarded.

User Experience

One of the most important limiting factors for a broad acceptance of telepathology is the ease to use these systems. Pathologists are restricted by time and cannot afford to invest hours in learning complicated user interfaces. If they cannot share a case with a colleague with only a few clicks from their work desk, teleconsultation will not happen. While screen-sharing tools are intuitive and easy to use, they lack asynchronous communication. Screen sharing requires both pathologists to be at their workstation at the same time, which is unrealistic for most remote consultation cases.

‘I have a Dream’

What would a teleconsultation system look like that has the potential for broad acceptance and usage?

  • Sharing of virtual slides and communication must be accompanied by an extremely easy set-up that only focuses on: upload, annotate, invite, and comment with a few clicks.Micordimensions pic 1
  • A system should be provided for free or for a minimum fee to account for the very limited reimbursement levels of pathologists’ work in many countries.
  • Transfer of virtual slides is taking time. If this time cannot be spent, there should be other options for online collaboration: Support the sharing of smaller fields of view, or live streams of camera microscopes to speed things up if need be.
  • Data safety, security, and secure communication channels should allow pathologists to share information. If a system is compliant to the HIPAA, US pathologists would be able to even share PHI. In other countries, where laws are less clear or requirements for data security are higher, these systems should adapt, or provide tools for a thorough anonymisation of patient data before sharing cases.
  • There must be support of all data formats. No assumption can be made on the underlying hardware or a possible standardisation of virtual slide formats in the future. Labs in non-industrial countries cannot afford a DP solution but create digital images with their camera microscopes. For them, teleconsultation should be made possible.
Have we Forgotten a Fundamental Requirement?

Many will argue that a system must be optimally integrated into the pathology workflow and software eco-system, which ultimately boils down to interfacing with existing laboratory/hospital information systems as well as image management systems. While challenging from a technical perspective, integration is complex, takes time and inevitably increases the costs while decreasing flexibility and versatility. It is important to balance the benefits of a full integration with the costs.

Is it necessary for teleconsultation to directly access all the information stored in the LIS? Is the effort it takes to copy the relevant information from the LIS into the telepathology system acceptable if this system can be available (almost) for free?

In either case, the patient benefits from a consultation solution based on telepathology. The quality of the diagnosis is likely to increase while turnaround times will decrease, and that’s the good news.

Microdimensions pic 2With MicroDimensions newly launched image sharing and collaboration platform Anyslide, the company helps to overcome some of the major hurdles on the way to digital pathology.

This article was originally published by Dr. Martin Groher, microDimensions, September 2017, and is published in a condensed version with permission.

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