Journal Article
. 2019 Jun; 143(12):1545-1555.
doi: 10.5858/arpa.2018-0514-OA.

Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings

Matthew G Hanna 1 Victor E Reuter 1 Jennifer Samboy 1 Christine England 1 Lorraine Corsale 1 Samson W Fine 1 Narasimhan P Agaram 1 Evangelos Stamelos 1 Yukako Yagi 1 Meera Hameed 1 David S Klimstra 1 S Joseph Sirintrapun 1 
Affiliations
  • PMID: 31173528
  •     20 References
  •     15 citations

Abstract

Context.—: Digital pathology (DP) implementations vary in scale, based on aims of intended operation. Few laboratories have completed a full-scale DP implementation, which may be due to high overhead costs that disrupt the traditional pathology workflow. Neither standardized criteria nor benchmark data have yet been published showing practical return on investment after implementing a DP platform.

Objective.—: To provide benchmark data and practical metrics to support operational efficiency and cost savings in a large academic center.

Design.—: Metrics reviewed include archived pathology asset retrieval; ancillary test request for recurrent/metastatic disease; cost analysis and turnaround time (TAT); and DP experience survey.

Results.—: Glass slide requests from the department slide archive and an off-site surgery center showed a 93% and 97% decrease, respectively. Ancillary immunohistochemical orders, compared in 2014 (52%)-before whole slide images (WSIs) were available in the laboratory information system-and 2017 (21%) showed $114 000/y in anticipated savings. Comprehensive comparative cost analysis showed a 5-year $1.3 million savings. Surgical resection cases with prior WSIs showed a 1-day decrease in TAT. A DP experience survey showed 80% of respondents agreed WSIs improved their clinical sign-out experience.

Conclusions.—: Implementing a DP operation showed a noteworthy increase in efficiency and operational utility. Digital pathology deployments and operations may be gauged by the following metrics: number of glass slide requests as WSIs become available, decrease in confirmatory testing for patients with metastatic/recurrent disease, long-term decrease in off-site pathology asset costs, and faster TAT. Other departments may use our benchmark data and metrics to enhance patient care and demonstrate return on investment to justify adoption of DP.

The cost-effectiveness of immunohistochemistry.
S S Raab.
Arch Pathol Lab Med, 2000 Aug 03; 124(8). PMID: 10923081
Routine Digital Pathology Workflow: The Catania Experience.
Filippo Fraggetta, Salvatore Garozzo, +2 authors, Esther Diana Rossi.
J Pathol Inform, 2018 Feb 09; 8. PMID: 29416914    Free PMC article.
Implementation of large-scale routine diagnostics using whole slide imaging in Sweden: Digital pathology experiences 2006-2013.
Sten Thorstenson, Jesper Molin, Claes Lundström.
J Pathol Inform, 2014 May 21; 5(1). PMID: 24843825    Free PMC article.
Whole-slide imaging: routine pathologic diagnosis.
Toby C Cornish, Ryan E Swapp, Keith J Kaplan.
Adv Anat Pathol, 2012 Apr 14; 19(3). PMID: 22498580
Review.
Future-proofing pathology: the case for clinical adoption of digital pathology.
Bethany Jill Williams, David Bottoms, Darren Treanor.
J Clin Pathol, 2017 Aug 07; 70(12). PMID: 28780514
Review.
Digital pathology and anatomic pathology laboratory information system integration to support digital pathology sign-out.
Huazhang Guo, Joe Birsa, +9 authors, Liron Pantanowitz.
J Pathol Inform, 2016 May 25; 7. PMID: 27217973    Free PMC article.
Enabling digital pathology in the diagnostic setting: navigating through the implementation journey in an academic medical centre.
Chee Leong Cheng, Rafay Azhar, +7 authors, Puay Hoon Tan.
J Clin Pathol, 2016 Feb 14; 69(9). PMID: 26873939
Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization.
Jonhan Ho, Stefan M Ahlers, +6 authors, Anil V Parwani.
J Pathol Inform, 2014 Sep 25; 5(1). PMID: 25250191    Free PMC article.
Distance reporting in digital pathology: A study on 950 cases.
Aleksandar Vodovnik.
J Pathol Inform, 2015 May 15; 6. PMID: 25969793    Free PMC article.
Integrated Pathology Informatics Enables High-Quality Personalized and Precision Medicine: Digital Pathology and Beyond.
Zoya Volynskaya, Hung Chow, +3 authors, Sylvia L Asa.
Arch Pathol Lab Med, 2017 Aug 30; 142(3). PMID: 28849944
Implementation of whole slide imaging in surgical pathology: A value added approach.
Mike Isaacs, Jochen K Lennerz, +3 authors, John D Pfeifer.
J Pathol Inform, 2011 Oct 05; 2. PMID: 21969920    Free PMC article.
Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities.
D J Hartman, L Pantanowitz, +3 authors, G R Lauro.
J Digit Imaging, 2017 Jan 25; 30(5). PMID: 28116576    Free PMC article.
Digital pathology in clinical use: where are we now and what is holding us back?
Jon Griffin, Darren Treanor.
Histopathology, 2016 Dec 14; 70(1). PMID: 27960232
Review.
Future-proofing pathology part 2: building a business case for digital pathology.
Bethany Jill Williams, David Bottoms, David Clark, Darren Treanor.
J Clin Pathol, 2018 Mar 20; 72(3). PMID: 29549217
Implementation of Whole Slide Imaging for Clinical Purposes: Issues to Consider From the Perspective of Early Adopters.
Andrew J Evans, Mohamed E Salama, Walter H Henricks, Liron Pantanowitz.
Arch Pathol Lab Med, 2017 Apr 26; 141(7). PMID: 28440660
Review.
International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China.
Chengquan Zhao, Tao Wu, +13 authors, Liron Pantanowitz.
J Pathol Inform, 2016 Jan 06; 6. PMID: 26730353    Free PMC article.
Going fully digital: Perspective of a Dutch academic pathology lab.
Nikolas Stathonikos, Mitko Veta, André Huisman, Paul J van Diest.
J Pathol Inform, 2013 Jul 17; 4. PMID: 23858390    Free PMC article.
Claims, errors, and compensation payments in medical malpractice litigation.
David M Studdert, Michelle M Mello, +5 authors, Troyen A Brennan.
N Engl J Med, 2006 May 12; 354(19). PMID: 16687715
Highly Cited.
Review of the current state of whole slide imaging in pathology.
Liron Pantanowitz, Paul N Valenstein, +5 authors, Terence J Colgan.
J Pathol Inform, 2011 Sep 03; 2. PMID: 21886892    Free PMC article.
Highly Cited.
Clinical Applications of Whole-slide Imaging in Anatomic Pathology.
Zoya Volynskaya, Andrew J Evans, Sylvia L Asa.
Adv Anat Pathol, 2017 Jun 08; 24(4). PMID: 28590953
Review.
Introduction to digital pathology and computer-aided pathology.
Soojeong Nam, Yosep Chong, +5 authors, Heounjeong Go.
J Pathol Transl Med, 2020 Feb 13; 54(2). PMID: 32045965    Free PMC article.
Review.
Digital pathology and computational image analysis in nephropathology.
Laura Barisoni, Kyle J Lafata, +2 authors, Ulysses G J Balis.
Nat Rev Nephrol, 2020 Aug 28; 16(11). PMID: 32848206    Free PMC article.
Review.
Banff Digital Pathology Working Group: Going digital in transplant pathology.
Alton B Farris, Ishita Moghe, +10 authors, Kim Solez.
Am J Transplant, 2020 Mar 19; 20(9). PMID: 32185875    Free PMC article.
A Regulatory Science Initiative to Harmonize and Standardize Digital Pathology and Machine Learning Processes to Speed up Clinical Innovation to Patients.
Hetal Desai Marble, Richard Huang, +14 authors, Jochen K Lennerz.
J Pathol Inform, 2020 Oct 13; 11. PMID: 33042601    Free PMC article.
Whole Slide Imaging (WSI) in Pathology: Current Perspectives and Future Directions.
Neeta Kumar, Ruchika Gupta, Sanjay Gupta.
J Digit Imaging, 2020 May 30; 33(4). PMID: 32468487    Free PMC article.
Review.
Digital Pathology: Advantages, Limitations and Emerging Perspectives.
Stephan W Jahn, Markus Plass, Farid Moinfar.
J Clin Med, 2020 Nov 22; 9(11). PMID: 33217963    Free PMC article.
Review.
Deep neural network models for computational histopathology: A survey.
Chetan L Srinidhi, Ozan Ciga, Anne L Martel.
Med Image Anal, 2020 Oct 14; 67. PMID: 33049577    Free PMC article.
Review.
Deep learning for computer-assisted diagnosis of hereditary diffuse gastric cancer.
Sean A Rasmussen, Thomas Arnason, Weei-Yuarn Huang.
J Pathol Transl Med, 2021 Jan 22; 55(2). PMID: 33472333    Free PMC article.
Multispecialty Enterprise Imaging Workgroup Consensus on Interactive Multimedia Reporting Current State and Road to the Future: HIMSS-SIIM Collaborative White Paper.
Christopher J Roth, David A Clunie, +22 authors, Les R Folio.
J Digit Imaging, 2021 Jun 17; 34(3). PMID: 34131793    Free PMC article.
Review.
Digital Slide Assessment for Programmed Death-Ligand 1 Combined Positive Score in Head and Neck Squamous Carcinoma: Focus on Validation and Vision.
Albino Eccher, Ilaria Girolami, Giancarlo Troncone, Liron Pantanowitz.
Front Artif Intell, 2021 Jun 22; 4. PMID: 34151256    Free PMC article.
Artificial Intelligence Can Cut Costs While Maintaining Accuracy in Colorectal Cancer Genotyping.
Alec J Kacew, Garth W Strohbehn, +4 authors, Alexander T Pearson.
Front Oncol, 2021 Jun 26; 11. PMID: 34168975    Free PMC article.
Diagnostic digital pathology implementation: Learning from the digital health experience.
Samar Betmouni.
Digit Health, 2021 Jul 03; 7. PMID: 34211723    Free PMC article.
Digital pathology and artificial intelligence will be key to supporting clinical and academic cellular pathology through COVID-19 and future crises: the PathLAKE consortium perspective.
Lisa Browning, Richard Colling, +6 authors, Clare Verrill.
J Clin Pathol, 2020 Jul 06; 74(7). PMID: 32620678    Free PMC article.
Review.
Integrated digital pathology at scale: A solution for clinical diagnostics and cancer research at a large academic medical center.
Peter J Schüffler, Luke Geneslaw, +29 authors, Thomas J Fuchs.
J Am Med Inform Assoc, 2021 Jul 15; 28(9). PMID: 34260720    Free PMC article.
Integrating digital pathology into clinical practice running title: clinical implementation of digital pathology.
Matthew G Hanna, Orly Ardon, +3 authors, Meera R Hameed.
Mod Pathol, 2021 Oct 03;. PMID: 34599281
Review.