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Keith Kaplan and the future of digital pathology

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Keith Kaplan is well known in the digital pathology circuit. A practising pathologist and author of the Digital Pathology Blog, he describes himself as an evangelist for the technology. We sat down with him at the Digital Pathology Congress, where he chaired a panel discussion, to get his thoughts.

What the challenge used to be

Ten years ago, the challenge was changing hearts and minds about using and adopting the technology. The problem and the opportunity now has become funding, so groups, universities, departments and laboratories can make the necessary investments with the technology.

It took some time for pathologists to feel comfortable using the technology and now they are comfortable, the questions are; how do we pay for it? how will we get paid for doing it? and how much money will we save or make using the technology. It has become more of a technical problem/opportunity instead of a practice problem/opportunity.

Five years ago, I predicted we would have full adoption by now but adoption has been much slower than many people would have predicted, but it’s certainly moving. The slope has changed, but it’s still moving on that trajectory towards near full adoption or full adoption particularly for select cases.

What needs to happen?

  1. The vendors in this space must make the solutions much more scalable, and that comes down to cost. Oftentimes we operate on very narrow margins in anatomic pathology, and you can’t add a whole lot to the cost of producing a slide before that slide is read.
  2. The price point must make good business sense so that you’re not adding unnecessary costs or adding significant additional costs to produce a digital image to be read. Cost remains the biggest barrier, but if we can get that down to a model that incentivizes use rather than de-incentivizes it, we’d be in a much better position. The good news is I think people have accepted the technology.

Thinking about the future

We’re not necessarily going to eliminate the microscope, like was once considered, but we will have tools and technologies to further what pathologists can do. Digital pathology will always remain an enabling technology, rather than a replacement technology.

In the United States, we’ve certainly struggled with ensuring that we’re providing patients safe, effective care using the technology compared to the gold standard. I think that has probably impeded the adoption a little bit, but that’s not to suggest that if we were to have regulatory approvals tomorrow that necessarily it will open up the floodgates on its use either.

We’ve always struggled with how do you validate this technology against the technology but that’s never been validated. In other words, our microscopes have never been inspected. Microscopes have never been regulated. Your colour vision has never been checked. Now we’re able to measure all those things in a digital environment without knowing what to actually measure or what may be clinically significant. I think that’s the bigger challenge.

2017 and beyond

We’re getting to a point now where we can reject the null hypothesis that digital pathology is not inferior to a light microscope and in some ways, it may be better faster, cheaper, and just as accurate or more accurate. There’s really a need to collect the body of data that’s been accumulated now in terms of peer-reviewed research and validation studies by a number of groups showing that it is not inferior to light microscope and in some ways actually may be better and faster. You can start to make some very convincing business cases.

This is an exciting time. Last year I made a prediction that 2016 would be a significant year for digital pathology and now we’ve seen vendors in the US make submissions to the FDA for clinical validation approval. We are closer to the end than we are at the beginning and that’s a welcome for everybody in this space that has been pulling the wagon this far.

Keith Kaplan, Digital Pathology

 

Keith Kaplan is Chief Medical Officer at Corista, a practising pathologist and author of the Digital Pathology Blog.

 


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