Pre-Analytic Best Practices for a Successful Digital Pathology Implementation

• 2023 ICBE-B: Pre-Analytic Best Practices for a Successful Digital Pathology Implementation
• Digital Pathology Implementation at Memorial Sloan Kettering Cancer Center Podcast Episode

Lisa Tomcko:

Welcome to the latest edition of the College of American Pathologists CAPcast I'm Lisa Tomko, content specialist with the CAP. The digital transformation of pathology is increasing the need for laboratories to have access to equipment and software that enables the use of innovative diagnostic tools such as machine learning and artificial intelligence to implement any of these diagnostic tools, the laboratory leadership must take several analytic considerations into account to ensure a successful digital pathology system implementation in this episode, I'm joined by Dr. Matthew Hanna, who authored a new case on this topic for the Informatics Essentials and Pathology Program.

Dr. Hanna is director of Digital Pathology Informatics at Memorial Sloan Kettering Cancer Center in New York City with clinical expertise in breast cancer and informatics. He also serves as the vice chair of the CAP's Artificial Intelligence Committee and is a member of the Informatics Committee. Dr. Hanna, so glad you're here to talk about this topic and give us a sneak peek into the case. But first, would you like to introduce yourself?

Dr. Matthew Hanna:

Thank you, Lisa. It's a pleasure to be here. Matthew Hanna I'm a pathologist at Memorial Sloan-Kettering, as you stated, and I was very fortunate enough to complete an Informatics fellowship at the University of Pittsburgh Medical Center under the directorship of Dr. Liron Pantanowitz, and ever since then have been really excited about the field of informatics and pathology.

Lisa Tomcko:

Great. Thanks so much for joining us today. And just to jump straight into things, this new case discusses some of the prerequisites for implementing digital pathology systems. What drove your interest in this topic?

Dr. Matthew Hanna:

Well, Lisa, I think especially recently, we've seen an increase in and definite uptick in institutions planning to move their analog workflows and really establish that digital transformation, including digital pathology. And so I thought it was a really great idea to put together a lot of what we've learned here at this organization on paper so that we could create a blueprint for laboratories who are just starting to jump on their digital pathology journeys.

Lisa Tomcko:

It certainly seems like a trend that's going to continue. And can you give us an idea of the points that this new case covers in terms of digital pathology implementation? What can learners expect?

Dr. Matthew Hanna:

So we'll put out a little teaser just for people to get excited about the case, but it's definitely a great opportunity to take a deep dive into some of the specifics and even technical needs for how to really implement a well-oiled machine from a digital pathology standpoint. So the case really takes everything from the beginning stages of how to actually set up a digital pathology laboratory.

And so the first thing hopefully people don't dive into is thinking of which scanners to buy or which software is the best. So the first step is to actually go through what are all of the pre analytic needs of a laboratory before they even start thinking about the hardware and software of the digital pathology systems. So it gives them an overview of what data is to be expected and needed to even embark on this digital journey, as well as taking a step back and reviewing their histology practices and making sure that those are streamlined.

Because at the end of the day, creating a perfect digital slide still stems from creating the perfect glass slide. And then after that, it does dive into some of the prerequisites, such as bar coding and tracking, as well as the laboratory information system integration. And it touches on how the interoperability between the pre-analytic and analytic hardware components play into each other.

So I think it's a great case and will be and there's a lot of learning packed in there for, for those who are interested to participate in it.

Lisa Tomcko:

Definitely. It sounds like laying a good foundation for what that process will look like. What are possible consequences for a poorly implemented digital pathology system?

Dr. Matthew Hanna:

Well, this I think it's like anything in life. It's, you know, garbage in and garbage out. And we want to provide the best patient care for those who are coming to organizations. And digital pathology really only increases the care that we can provide or enhances the care that we can provide for them. So with a poorly implemented solution will very likely leave pathologists frustrated with using their technology or maybe even the lack of using the technology in the way that they want to.

And at the end of the day, it won't satisfy the need that pathologists will have expected it to be used for, and those use cases will just fall to the wayside. So pathologists will expect that these systems help them in their day-to-day activities. Otherwise, the purpose for the digital transformation will ultimately be pointless.

Lisa Tomcko:

And can you tell us about your personal experience in digital pathology implementation?

Dr. Matthew Hanna:

And of course, so Memorial Sloan Kettering being an early adopter, we really saw the technology mature over the last 10-15 years, and I think our experience may be quite different from a laboratory who would be starting with a blank slate today as the technology matured, Memorial Sloan Kettering effectively had to have a phased approach in their implementation and slowly brought on use cases.

Year after year as new milestones were met within the departments. And again, seeing the technology mature where we had to develop a lot of systems in house, there may be off-the-shelf solutions that again, institutions that are starting this today may be able to purchase or at least customize to their own liking.

Lisa Tomcko:

Got it. Thanks for sharing your experience with us. It sounds like maybe it'll hopefully be even a smoother process potentially for institutions doing it now. But I know you delved into matters of implementation in a previous Capcast with one of your colleagues from Sloan Kettering, Dr. Sirintrapun, I believe, and we encourage listeners to check out that episode as well. It was a great discussion.

Dr. Matthew Hanna:

Thank you. And I'll just add that institutions that are looking to buy these off the shelf solutions have a lot of options these days and in encouraged those who attend the CAP annual conference to go to the exhibit halls and discuss with them and find out what those offerings are. But they do extend from hardware solutions which are going to be your scanners, monitors and maybe even input devices like whatever the new computer mouse will be for for navigating these digital images and also stem to the software, which are the image viewers as well as any decision support solutions such as these machine learning or A.I. sort of applications that will help pathologists on their day to day basis.

Lisa Tomcko:

And how well do you think most pathologists understand some of the needs that you just referenced or some of the things that go into that successful implementation?

Dr. Matthew Hanna:

I think over the last several years, the pathologists have actually become much more aware of at least the needs that these sort of solutions will hope to resolve or will help enhance the pathologist's day to day workflows. I do still think there and there are plenty of educational activities that the CAP also provides, both at an ongoing basis as well as these informatics, space education.

I think the education around these as well as institutions likely embarking on these journeys today have positioned pathologists in a way where they have learned at least what these technologies are enabling for pathologists and for patient care. But they're likely is still an ever-growing need for more pathologists to be involved in these activities and be educated on what these technologies are and how they can benefit them, as well as the patients who are going to their organizations.

So there's a balance that I think needs to be struck where you have champions at institutions that have already implemented these digital solutions. But then you do have a wide swath of laboratories who likely haven't embarked on these journeys yet and that need the level of education and community that can support them to also drive their digital workflows.

Lisa Tomcko:

That makes sense. And definitely then a good reason for hopefully some of these laboratories and pathologists to check out the new case. And before we go, any final thoughts you'd like to share with us, Dr. Hanna?

Dr. Matthew Hanna:

I would just like to say that we're all learning from each other in this phase, and I think that digital pathology relative to the practice of pathology is relative and it's relatively in its infancy. And so we should definitely strike a network between all of the organizations who have moved digital or have digitized their laboratories, as well as those who are learning, and they're eager to transform their analog workflows into it with this digital transformation and learn from each other where all of these lessons learned can help each new institution that that wants to move digital, as well as those who have already gone digital, help them perhaps learn something that maybe they didn’t know with their specific use cases. So we’re all learning from each other at this point and we should work together.

Lisa Tomcko:

Well, thank you so much, Dr. Hanna, for your insights on transitioning to a digital model. For all of us listening, you can access the Informatics Essentials in Pathology case on Digital Pathology Implementation in the link in the description. You can also find the link to Dr. Hanna's previous episode on this topic, Digital Pathology Implementation at Memorial Sloan-Kettering Cancer Center.

We encourage you to check it out. And of course, stay tuned for future episodes of CAPcast. For more information about the CAP, visit CAP.org.

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