The national view of digital diagnostic pathology
Posted 7th April 2017 by Jane Williams
A national view of digital diagnostic pathology could enhance patient management through improved communication within and between organisations. This is the belief of Tim Helliwell, Vice President of Learning at the Royal College of Pathologists.
The patient experience
In general, the population is much more comfortable with digital technology, and so the expectation is that it will be used in every part of life. There are advantages but also disadvantages to this and there needs to be explanations about why we don’t all adopt the latest technology immediately, if at all. It’s natural for patients to ask, “Well if businesses can do things promptly and deliver things the same day and I can track where they are, why can’t they do the same with laboratory tests?”
However, there is a disconnect between what the NHS can do and what people see happening in the commercial sector. Patient expectations need to be managed in the interest of their safety. We also need to be looking at the other ways in which we can make a difference to a patient’s journey through the service and work to implement them.
My experience working in histopathology
Doing things in traditional ways can be very inconvenient. For example, if you have two hospitals 20 miles apart, the traditional approach would be for the pathologist in Hospital A to phone the pathologist at Hospital B to say “Would you mind having a look at this case? I’m finding it difficult” and posting the case to them. It arrives several days later at Hospital B, the pathologist gets around to looking at it, and then posts the results back. We can do better than that in the 21st century.
We need to get the balance right between instantaneous results and choosing the right method: digitally isn’t necessarily the best or most appropriate means for every situation. But, if you can avoid patients having to come back to the clinic two or three times to get results because you’re able to do it the first time they come back, it’s better for them, it frees up outpatient slots and the system benefits.
The other thing to consider is equity of access to health services. Not all pathologists are equal. Some have expertise in different areas, or simply more of it. Due to the current system’s difficulty and time-consuming nature, pathologists don’t tend to seek advice or support as readily as they would do if it was quick and easy.
When it comes to receiving expert opinions, these would be far more readily available if it was easier to do. From the patient’s perspective, why shouldn’t advice from experts be available? In my experience if a local pathologist sends something to me, and says “I haven’t seen something like this in a while, but I think it’s probably that.” Usually they’re right. The ability to promptly reassure them they are right is very, very useful and everything else flows as a result.
Pathologists need as much relevant information as possible at the time they are looking at the images, including basic patient information, relevant imagery, radiology studies and blood tests. That is all very useful information that pathologists use to put the biopsy into context. It is about the joining of systems and being able to get the information that people need easily within reach, within one organisation or between organisations.
Patients move between hospitals and they don’t understand why the information from one hospital isn’t immediately available for people in another hospital and it can be frustrating for clinical teams. Although they’ve had the relevant tests at the first hospital, it’s quicker to do them again rather than to spend several days retrieving information from another hospital. If there was easy access to information, savings could be made in time and money for repeat testing.
Challenge to overcome
The next step needs to be getting people more involved in using digital pathology, and getting them to use it daily. Not necessarily to do everything with it, but to at least have it available for use every day.
The biggest challenge will be figuring out how to get commissions of services to invest in it, and that’s an investment in both time and people. This is particularly tricky when the NHS is currently trying to reduce how much it spends.
Part of my work with the Royal College of Pathologists is influencing the people who make decisions within the NHS to support going digital and at least build it into considerations of what should have priority.
Looking to the future
In the future, I hope that every laboratory will have access to digital pathology, and a fast high-speed scanner, primarily with a view to sharing locally generated images to seek advice wherever it’s required. In five years, I’d expect all pathologist to be doing some of their work digitally.
The way that the software is presented to the pathologist has moved on a lot in the last few years. That contributes to the idea that pathologists will find it more acceptable and increase the ease of use. You don’t want to be sitting there thinking you could have done a job in half the time if you had done it with a conventional microscope. That doesn’t encourage engagement and take up. It’s got to be easy and intuitive and actually help you do your job.
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