The nuances of digital pathology integration and interoperability

Interoperability benefits

Adopting high level interoperability is a complex process. However, the many benefits of full integration make it a worthwhile investment. These include:

• Easy access to patient data enables clinicians to more easily understand a patient’s complete case history. This both increases productivity and decreases duplicate testing
• The ability to access data from multiple systems allows expertise to be pooled for better patient care. For example, multidisciplinary tumor boards (MDTBs) benefit when all board members have access to the same information and can share results and discuss treatment in real time
• Sharing data across networks – or even outside of networks – facilitates second opinions and consulting
• Large-scale analytics, can support patient care by enabling assessment of clinical and logistical data, including patient outcomes.
• A harmonized common interface and auto-population of reports reduces manual tasks, enhances workflow and improves patient care as physicians spend less time looking for information and more time focused on patients.*

Digital pathology challenges

Digital pathology workflow presents some unique challenges, including:

• Lack of existing infrastructure to support image acquisition, processing, review, storage and analysis
• Large file sizes
• Small budgets
• Multiple proprietary image standards: Pathology has a plethora of proprietary image standards in use which make image exchange much more difficult, although the industry is now moving towards open exchange
• Digital pathology requires the deep integration of LIS and imaging workflows to prevent duplication of labor, including order entry, result reporting, image storing, image manipulation and image management

Advancing DICOM for digital pathology

Digital Imaging and Communications in Medicine® (DICOM) is an established imaging standard that permits the sharing and storage of medical imaging and related data. Use of the DICOM standard for digital pathology enables easier incorporation into radiology PACS and VNAs, supporting cross-modality collaboration. Because it allows an organization to leverage existing investments in radiology archive solution by sharing with pathology, it also saves on investment in IT infrastructure. In addition, it has the potential to facilitate image analysis for research.

Preparing for a digital future

Efforts are underway to adapt DICOM for pathology applications. Rather than waiting for full development, pathology departments can invest in vendor-neutral practices to integrate across departments. An essential step is ensuring that non-imaging data can be exchanged bi-directionally between the LIS and the digital pathology image management system (IMS). The benefits of bi-directional integration are:

• LIS software can register expected stains to occur, meaning that additional actions, such as extra cuts for molecular biology and immunofluorescent stains can be excluded
• LIS software’s communication alerts the IMS when a case is complete and can be dispatched
• Users can choose to report from either the LIS or the IMS
• Access control allows the pathologist to have direct insight into what colleagues must report

Is now the right time?

Focusing on interoperability from the beginning allows start-ups to focus more on technological development in fields like machine learning and less on ensuring their technology is accessible to a wide enough audience. Beyond AI tools, throughout the healthcare ecosystem technologies such as digital companion diagnostics and federated learning are expected to impact clinical care in the near-term, becoming a necessity for most care providers. 

There are pros and cons to enacting a digital pathology strategy today. To mitigate risk, organizations should determine long-term strategy up front, seek clarity about integration from partners and investigate operational expenditure models, SaaS-based models or leasing contracts.

Conclusion