Digital pathology is transforming the pathology business. Clinical laboratories of any size can expand their professional services beyond geographic boundaries by using digital technologies which bring unique advantages to the specialty of pathology.
Pathologists do not have to see their patients in person. Patients are represented by a set of microscopy slides, and if these slides are digital, pathologists can serve patients anywhere in the world. This opens up enormous opportunities to American pathologists to provide services to countries with shortages of pathologists. (In some emerging countries, there is only one pathologist for 200,000 people!) The ability to provide remote services and diagnostics globally is becoming essential for clinicians and pathologists.
Digital pathology makes the pathology business global, but it also changes the traditional workflow of a pathology lab. Unlike physical samples, incoming digital cases are not accessioned into a traditional Laboratory Information System (LIS); instead, they come to a digital workspace via the Internet from a variety of sources and locations. That means that pathologists are losing access to the reporting function in LIS. They have to create reports manually, which can lead to inefficiencies and inferior reports. However, in the digital world pathologists can complete case information and create professional reports from their workspace, a secure and easily accessible place such as a computer or a server that stores medical digital images.
The key is collaboration: the sharing of medical images and data among businesses around the world. Globalization and global changes in the pathology world can be beneficial for both healthcare professionals and their patients. One recent example of international collaboration involved a cancer case at the Ural Oncology Center in Yekaterinburg, Russia. In a seven-day period, five doctors from five cities in the United States and Canada worked on the case, which included the analysis of 11 histological slides and contained 12 gigabytes of medical images. The specialists used a digital pathology-cloud technology system over the Internet, shared the information within the system, and never left their offices. The final report was generated with four possible diagnoses.
At the same time, the patient went to the Moscow Oncology Center, where he received a similar diagnosis; however, it took more time for him to get the diagnostics done at the Moscow facility, and the process was more expensive for the patient. The North American pathologists analyzed the case in the most time-efficient and productive manner via digital technology.
That is one anecdote, but it is a significant one that points to emerging paradigms. Important opportunities for clinical laboratories and healthcare providers can be opened via the digital world. Cloud services are an increasingly attractive option for laboratories and hospitals as they seek to improve patient care, become more cost-efficient, and increase organizational efficiency and productivity. Cloud computing helps healthcare providers to achieve economies of scale by paying for the hosted services and the amount of capacity they actually use, and paying for storage as an expense without making additional capital investments. It helps them to manage their medical imaging data and get access to images from the Internet using a computer, laptop, smart phone, or tablet. Medical organizations do not have to purchase and maintain expensive servers. Storing, archiving, sharing, and accessing images in the cloud allows the industry to manage data more efficiently while overcoming many technical and regulatory challenges and providing better patient care.
Federal law requires healthcare organizations to ensure the security of their data from all “reasonably anticipated threats.”1 According to the Health Insurance Portability and Accountability Act (HIPAA) Security Rule (Security Standards for the Protection of Electronic Protected Health Information), healthcare organizations must put in place administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of electronic protected health information (ePHI). Technical safeguards include access, audit, and integrity controls, as well as transmission security. In case of disaster, the Security Rule requires various contingency plans to be put in place and tested regularly, including data backup, recovery, and access plans. In addition, new HIPAA privacy and security rules that are part of the Health Information Technology for Economic and Clinical Health Act (HITECH) require them to provide patients with the separate right to an “accounting of disclosures” that “would provide additional information about the disclosure of designated record set information, whether hard-copy or electronic, to persons outside the covered entity and its business associates for certain purposes (e.g., law enforcement, judicial hearings, public health investigations).”2
The HITECH Act is the portion of the 2009 American Recovery and Reinvestment Act (ARRA) that establishes requirements for healthcare organizations to achieve “meaningful use” of healthcare data through the use of electronic health records and other technology.3 HIPAA requires healthcare providers to keep medical records archived for six years after discharge. Most hospitals try to keep records on hand indefinitely for various reasons, contributing to the rising demand for data storage. These requirements can put pressure on hospital and clinical laboratory IT departments. Thus it can be an essential part of good business practice for IT departments to utilize the technological advances available in the marketplace.
In the intersection of two curves of supply and demand, it is important to make sure that solution providers come up with systems that meet the needs of pathology diagnostics—that the innovative engine of technology can help healthcare providers of any size to reduce the cost and time of operations and increase productivity and efficiency. Many hospitals and clinical laboratories are better utilizing their equipment, expanding their businesses globally, and gaining a competitive edge through the use of cloud computing and digital pathology.
References
- AT & T. Medical imaging in the cloud. https://www.corp.att.com/healthcare/docs/medical_imaging_cloud.pdf. Accessed September 26, 2013.
- Healthcare Info Security. HITECH disclosures rule proposed: guidelines for revealing who accesses patient data. http://www.healthcareinfosecurity.com/articles.php?art_id=3682. Accessed September 26, 2013.
- HealthIT.gov. Certification and EHR incentives: HITECH Act. http://www.healthit.gov/policy-researchers-implementers/hitech-act-0. Accessed September 24, 2013.
