“Radiology is digital at the beginning; Pathology is digital at the end”
In a previous post last month entitled “Digital Pathology Debate Continues: Hope or Hype?” I made mention of a Dark Daily story talking about a talk that Dr. Paul Chang, Co-Founder of Stentor and Vice-Chair of Radiology and former Director of Pathology Informatics at the University of Chicago gave at Pathology Informatics 2012.
You can hear and watch Dr. Chang’s talk from the PI 2012 website
My post included some commentary on the story by Dr. Stacey Mills over at Pathology Network blog on the talk and the commentary from Dark Daily.
Bloggers have to take a stand on topics of the day among many things. You have to call out a candidate, support or admonish your favorite sports team, make reference to topic-specific issues such as self-referral as Dr. Mills recently did or review interesting news.
In the post prior to this one Dr. Mills talks about the iPhone5. One of his comments says “Switching from one sophisticated electronic device (home computer, laptop, smart phone), to another can be a traumatic experience with all sorts of concerns about data loss, lost and forgotten passwords, familiarization with a new device, etc. I’ve had a few nasty experiences in this regard over the years, and I’m sure you have as well.”
It should come as no surprise then that Dr. Mills completely missed the points Dr. Chang, a radiologist and innovator was making to pathologists.
Radiology is digital at the beginning; Pathology is digital at the end.
We get that. It costs time and money without a reimbursement code for slide scanning services and the FDA Class 3 mention many pathologists are using as a crutch for reason not to adopt digital pathology.
Radiologists make impressions. Pathologists make diagnoses. We get that too. Radiologists will be the first to tell you this.
Our files are bigger and the images are more complex. Our tea leaves require some color interpretation, depth, contrast and depth of focus beyond black and white two-dimensional shadows shown at 5 mm intervals from a digital acquisition at point of collection.
One of the points I think Dr. Chang was trying to make was emphasize on some more complicated workflows in pathology than radiology and ways in which digital pathology, including, but not limited to whole slide imaging alone after coverslipping. Multiple parts, containers, pieces on those containers, multiple blocks, slides, additonal slides, immunohistochemical stains, recuts, deepers, levels all contribute to a much more complicated workflow than radiology.
The radiology workflow goes something like this – MRI ordered, schedule MRI, show up at 2 AM, sit in MRI machine, leave, call doctor for results. He/she is told the radiologist suggested a CT because of some black on white or white where there should have been black and they could not make out and CT is better for that than MRI. So, schedule CT, show up at 4 AM, get CT, leave, call for doctor for results. He/she is told that the results are inconclusive and CT with contrast would be a better study to further assess “indeterminate imaging”.
Eventually you get your knee scoped for 30 minutes with an orthopedic resident providing necessary torque following 
,where r is not a normal r, F is excessive force and the angle is not designed to be used on the human body to go for six months of rehab and your knee hits worse than before you saw the doctor.
Anyways, the point is digitization in pathology is actually not the end. It could be the beginning, from the time of collection, after coverslipping, through case assembly and well beyond sign-out.
Given all the talk about cuts to 88305 and other billable codes for services provided the costs for digital pathology are nominal and scalable with value on positive patient ID, appropriate documentation, slide delivery, review, sign-out and archive.
Not too mention I think we are at the tip of the iceberg and failing to recognize, much like radiology did 15 years ago that digital will allow us to do much more than we can with analog slides. The ability to view tissues and cells three dimensionally, as nature intended, with improved contrast, depth of field and orientation beyond which we can do with a light microscope will be realized and improved quantification will be delivered.
Lastly, Dr. Chang emphasizes improvements to workflow and Dr. Mills dismisses this as digital review taking longer than glass slide review. Not sure I agree with this one either. Would launching a digital slide, with paired radiology, endoscopy or gross images along with electronic medical records including clinic visits, operative notes, requisitions prior history linked with those images, as well as prior cases if need be save time or take time? Anyone who has received a tray of slides with an incompletely filled out requisition form, prior slides not available in real-time, had to review notes and imaging in disparate systems, wait for prior slides, call the clinician and then order immunos might like to try a system that enhances this workflow before claiming that the case review takes longer.
