Things to consider for digital pathology

Digital pathology has been embraced by Anatomic Pathology; but labs need to think beyond a scanner and storage, explains Jake Morrow, Product Manager at Clinisys.  Laboratory Information Systems such as WinPath that include Specimen Processing and VUE are necessary to drive quality workflow and support clinical integrated reporting.

Digital pathology is the acquisition, management, sharing, and integration of pathology information in an electronic environment. Its advance is particularly evident in Anatomic Pathology, where the traditional glass slide is digitised.

Anatomic Pathology laboratories in UK have gone digital, are going digital, or are looking at a business case for change. There has been national support and funding for the switch, and labs have embraced the opportunity to improve reporting efficiency. This is great news as there is a national shortage of Pathologists to meet the current workload.  However, efficiency is only realised if there is a digital pathology adoption at the system level.

“A scanner and storage are not enough”

Many business cases for digital pathology have focused on image acquisition and management but labs also need to consider how to implement the new digital workflows and how to support the clinicians who will be reporting the cases.

As digital reaches more specialities and disciplines, Pathology departments could find themselves with many component systems but little information on what is happening across them.  There could also be challenges to integrate reporting across multiple disciplines and providing a digital route to order extra tests for precision medicine.

“Start with the LIS”

These challenges can be addressed through the WinPath system, that is equipped with modules like Specimen Processing and the new VUE diagnostic console.

The patient-centric WinPath LIS is designed to drive workflow across all disciplines within Pathology. It allows users to govern everything that happens across departments through one system with multiple workflows and an overarching patient layer to ensure specimen and patient records match.

As labs introduce digital pathology, the need to support different reporting workflows emerges. Digital pathology projects must consider how reporters transition to digital, as not all reporters are ready at the same time. An LIS driven workflow can accommodate both glass and digital workstreams to encourage adoption and a phased transition to digital operation.

Specimen Processing

Specimen Processing is already well-established in the UK, managing the routing, tracking and quality assurance of specimen procedures with numerous integrations to Anatomic Pathology workflow management and digital pathology systems. The next 2 releases of Specimen Processing provide in-module tracking without a workflow management system and light up the VUE diagnostic console, which Clinisys are excited to launch in the UK as a reporting hub for clinicians during the first half of 2023.

Lighting up VUE for digital pathology

VUE aggregates diagnostic information from multiple systems on to a single screen, including digital pathology, which increases reporting efficiency as there are less clinical systems to interact with.  This means that many more cases can be reported each day.  It also reduces friction to adopt digital technology as the reporter feels like they are reporting in one system.

Perhaps surprisingly, not all digital solutions guarantee a paperless workflow.  The WinPath solution, including Specimen Processing and VUE, facilitates paperless extra test requesting and processing as the reporter and laboratory maintain an intrinsic link with the LIS.  Additionally, from the pre- to the post- analytical phases, a match between sample and case is assured due to organic integration throughout the LIS with the patient record at the heart. 

Management reporting

Maintaining pathology information centrally is essential for management reporting and business intelligence.  One example of management reporting for Anatomic Pathology is the submission of data to the national cancer registry.  Both VUE and WinPath integrate with the new Clinisys partner application, mTuitive xPert.  xPert captures synoptic data for reporting and simultaneously manages COSD submission with no user intervention.  COSD collection and submission to the national cancer registry can be challenging without the WinPath system as it requires combining data in the LIS about the patient and reporter and information from the case report which includes macroscopy, SNOMED CT and digital pathology.

SNOMED CT is a key component of the Unified Test List that is strategically important for interoperability.  The UTL should be considered by the mature Pathology network at the same time as digital reporting; the ability to share digital images is only one element of interoperability.

Data Pathology future  

Digital Pathology is almost synonymous with Anatomic Pathology right now, but the reality is there are other disciplines that have been digital for years and there are other areas that would benefit equally too, it isn’t just about glass slides in Histopathology.

A pre-requisite to a patient centric process is a multi-disciplinary approach.  In time there will be information for the diagnostician available in digital format for all elements of clinical support. Maintaining all Pathology data in one place, the LIS, is a good starting point.

When we are digital, we can think about AI.  I think the UK is still figuring out where AI from digital images is most useful.  For example, is it best to prioritise the worklist, for reflex testing or to screen out cases.  Whatever the use, Clinisys will be innovating at the middle of the Digital Pathology ecosystem for years to come, recognising that what feels novel now in Pathology will be routine in coming years.