Digital imaging technology and artificial intelligence are combining to remake the field of pathology by improving patient care while helping to address staffing challenges that face every healthcare institution. That was the message from Dr Darren Wheeler, vice president for Pathology and Medical Services at Quest Diagnostics, who spoke in a recent webinar sponsored by the American College of Healthcare Executives.
A simple but powerful concept
On its face, “digital pathology” is a simple concept—tissue slides are prepared in the classic manner, the slide is scanned at extremely high resolution, and the image is stored as a digital file. But creation of that digital file opens the door to an enormous change in how pathology is practiced. Instead of directly viewing the slide under the microscope, the image file is viewed on a computer screen. Instead of solely relying on the visual perception of the pathologist, the image can be processed with filters, analyzed with quantitative software, and otherwise evaluated to bring out subtle features that might otherwise remain obscure. And instead of sending that slide out for a second opinion, with inherent delays and risk of loss, that high-resolution digital file can be transmitted electronically to multiple pathologists across different practice locations, promoting collaboration, speeding diagnosis, and improving patient care.
And improving patient care “is where digital pathology shines,” Dr Wheeler says. The ability to do analysis of subtle patterns quickly and at a high level of confidence “creates improved accuracy and concordance from one pathologist to another, and that's definitely a good thing.”
There are also significant cost savings that can be achieved through digital pathology. “Although we think of pathology in the lab as a cost center, the reality is that our best chance to save healthcare dollars is to assure that accurate diagnosis upfront,” he says. Better analytic tools, and faster and more seamless collaboration with experts around the country, can go a long way to facilitate that accurate diagnosis.
The exponential benefits of AI
Digital pathology also “opens access to the use of artificial intelligence,” or AI, he adds. In the pathology space, the most advanced AI systems use “deep learning” to improve diagnostic accuracy. Trained on thousands of samples, such systems recognize and highlight regions of interest on a slide, quickly bringing them to the attention of the pathologist, saving time and focusing the pathologist’s expertise on the most important parts of the tissue sample.
AI is poised to exponentially increase in the pathology setting, Dr Wheeler says. As AI systems learn more thorough analysis of ever-larger data sets and feedback from pathologists, the field will see increasing accuracy, better recommendations for confirmatory tests, and more highly customized treatment plans. In oncology, this is beginning to bring about treatments tailored to the patient’s individual tumor mutations, genetic background, and health status. This kind of precision care “can continuously improve savings” and reduce unnecessary or harmful treatment approaches.
Coping with a tight labor market
The combination of digital pathology and AI could not be arriving at a more crucial time for the field,
Dr Wheeler points out. “The pathology market has been challenged with increased wages, decreasing reimbursement, and shortages at the technical- and professional-staff level,” that is, histotechnologists and pathologists. “We are looking at over 700 open pathologist positions across the country,” and perhaps as high as 1,000 positions. Population growth and increases in disease incidence will lead to a deficit of more than 5,700 pathologists by 2030, according to recent studies. Digital pathology can mitigate some of these shortages through reducing the need for human eyes on routine specimens, allowing the specialist to spend more time on the harder cases. Another significant advantage of the digital revolution is to free the pathologist to review tissues from anywhere the image file can be sent, which these days is almost anywhere at all.
“I believe digital, especially with AI, is going to enhance our efficiency,” Dr Wheeler says. “We're going to accelerate turnaround time, reduce backlogs, and collaborate and consult more. Pathologists are going to be able to read cases with more flexibility, and that's going to help us recruit more experts who can live and work where they want to.” All of that, he says, “is going to have benefit for downstream patient care.”
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