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Telepathology in the acute care setting

Speaking at the 2020 Digital Pathology Congress Liron Pantanowiz reviewed why he thought telepathology is still one of the key applications for digital imaging. In this blog, we report what he had to say about telepathology in an acute care setting and the importance of validation.

Watch Liron Pantanowiz’s full presentation here

The term telepathology was first coined by Dr Ron Weinstein 52 years ago. Since then, there have been major strides in developing the technology enabling the pathologist to become much more accurate in a clinical setting. With the introduction of whole side imaging systems and recently the introduced hybrid systems, the concordance between a “digital to glass read” matches almost perfectly.

These improvements are such that it now allows the pathologist to do a better job and improve the accuracy of making remote reads.

Keeping up with technology

In recent years we have seen improved devices, with better optics, hardware and even better software to support telepathology. Also, these newer instruments offer hybrid robotic microscopy and whole-slide imaging capability with much faster scanning. Importantly the software is much more user-friendly.

From an informatics perspective, it is important to consider the following two main things.

1 Hardware & Software

When doing telepathology on frozen sections, ideally the pathologist will get access to the entire slide, as it increases his/her accuracy. As much as possible, it is important to try and simulate microscopy so that the pathologist can navigate around the image, change magnifications and focus.

2 Operations & Workflow

To be efficient it is necessary to know whether there will be a pathologist on-site or not. If not, a skilled person is needed on-site to prepare the specimen, prepare the slide. This can be a physician’s assistant or a trainee. Bi-directional communication is essential either with the person on-site and the pathologist, or, the pathologist and the surgeon. Finally, system integration is essential. An image by itself is of no value unless you can connect to the rest of the lab information system or the clinical information in the electronic medical record.

The interests of efficiency also best served with good (IT and personal) connections, regardless of whether the personnel involved are in the same building, or 400 miles apart. And this can become complicated. For example, a VPN may be needed to maintain security. On the other-hand firewalls will need to permit the manipulation of microscope devices remotely. Nevertheless, this is achievable with the right IT support.

With today’s software, it is amazing how much can be accomplished.

Validation

All these systems have to be validated for clinical use. The critical question is what to validate? It is not an easy question to answer.

  • Do all the hospitals involved have to do the full validation?
  • Does every machine used need to be validated?
  • Every app, every IP address?
  • What about every update, not to mention mobile devices?

In Liron’s opinion, “everything needs to be validated”, including personnel. So, everybody should be trained with an onboarding process for new hires and continuing training to maintain and check competency.

This blog is a precis of a presentation given by Liron Pantanowitz, Professor of Pathology & Director of Anatomical Pathology, the University of Michigan at the 2020 Digital Pathology Congress.



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