Preparing your lab’s automation infrastructure for the inclusion of digital pathology and AI

Incorporating digital pathology and AI solutions and workflows into your organization is an exciting opportunity to enhance your operational efficiency, positively impact your diagnostic accuracy, and increase the overall automation of your laboratory practice. It is essential for maintaining your competitive position in the industry with adoption of leading technology occurring at an ever-increasing rate. It is also important to understand your current technology infrastructure and workflows and to work closely with your digital pathology solution provider to ensure that you are taking full advantage of the benefits of deploying these technologies —both today and setting the foundation for further adoption of new technologies into the future.

Things to consider

1. Understand your initial goals and your long-term goals. These two may be the same or very different, depending upon your adoption strategy and reasons. The most common goals for digital pathology solution adoption in the clinical setting today are:

• Reduce the need for transportation of glass between labs
• Access to geographically distributed facilities and pathologists
• The ability to recruit and retain pathologists
• Support the technical component (TC), professional component (PC), and global workflows for outreach clients
• Instant access to consultations for subspecialties and/or complex cases
• Tumor boards
• The ability to use artificial intelligence

When considering the above, you may have one or more initial reasons or objectives in adoption with the understanding that you would like to achieve more of these goals, or additional ones, moving forward. 

2. The implementation of digital pathology needs to be an organizational goal and not just one of the lab’s. The process starts with the technical side of the workflow — from the understanding of what the scanner(s) you choose to deploy require for ‘clean’ slides.  This is something that can have a significant impact on the usability, speed, and value of digital. You must start with proper identification of your lab process for creating slides and know that things like misaligned slipcovers, smudges, fingerprints, substances on the glass, folds in tissue, bubbles, and other artifacts are going to cause scanned images (WSI’s) to be unusable. This will create inefficiencies and increased time by having to redo and rescan slides in order to get usable images to the pathologists. This is the first step in quality in, quality out.

3. Understand that your vendors are also your coaches, guides, and mentors in this process.  If you have selected the right vendors — from scanner to digital solution (IMS) and AI — they are the experts on their products and services, not to mention this new fundamental workflow. Utilize them and take their input into the recommendations for how to deploy their solutions in the most effective way possible. Remember, you don’t simply want to automate a manual process. That negates the underlying value of deploying digital solutions. 

4. Not all vendors and solutions are created equal. There are several ways to say you are using or deploying digital pathology. From simply looking in a viewer (monitor) to view scanned images — literally just replacing the microscope — to fully interoperable solutions that include the image management system (IMS), viewer, automated workflows, pathologist cockpit or working environment, reporting, AI, collaboration, consults, TC, PC and global workflows, etc. in a single solution. You need to consider that if your long-term goal is to be fully digital and interoperable, having less technological solutions will not get you there. 

Involve stakeholders

This step is key to having a clear understanding of all facets of your current environment and infrastructure and the touchpoints for integration and workflow definition for your digital deployment. This not only includes your Medical Director, Lab Director and representative pathologist(s), but also your IT and functional areas of the laboratory (histology, cytology, molecular, etc.). But remember that too many people can simply cause analysis paralysis. And a strong project manager on your side will be required and responsible for ensuring that the project stays on track for your organization’s goals. 

Monitoring implementation

Most vendors will set a kick-off meeting to determine the steps, goals, timelines, etc. for your deployment. It is imperative that you have a good relationship with your vendors and that they work with you as partners in this initiative and don’t just see you as a customer. The difference is in taking a true interest in understanding your workflows, test types, and current configurations and ensuring that your implementation plan will meet your needs for your initial go-live or rollout but also be set up as a foundation that can pivot and scale to achieve your long-term goals. 

Vendors that see you as a partner will take the time to work with you and not just have a checklist to get you to point A — meaning they get paid and can say you are live. This is something that you can determine during your evaluation of vendors and be sure they have experience in laboratory healthcare and understand this industry and your daily working environment. Square pegs and round holes don’t make for successful adoption and use.

Each step or milestone of the implementation process should be clearly defined with roles and deliverables for each party laid out. Updates and status reports should be shared, and smaller groups may meet between the larger group meeting to ensure that the project stays on track.  Vendors should also work closely with each other and ‘play’ nicely with each other without you having to be in the middle. The overall goal for all involved is for you to be successful in using your solutions the way that you intend to. Any course corrections should be identified and acted upon immediately to prevent having to undo or reverse work later.

Ample testing

Testing is key to a successful go-live experience. This is very much like an LIS go-live. There are many moving parts that can be tested throughout the implementation process, allowing for  faster deployment. If you are doing testing in tandem with your configuration and integration builds, then you can do them in buckets or silos and each workflow or stage is fully vetted and verified for flow. 

Once you are fully configured and all applications are integrated, then full, round-trip testing of each workflow is imperative. I would recommend a testing scenario that also includes a representation of your organization. For example, if you have multiple locations, remote pathologists, multiple case types, a variety of scanner formats, and high volumes, make sure that you are testing a percentage of these simultaneously. This will ensure that your configurations, performance, and load balancing are optimized prior to roll out.   

Ensure proper training and rollout

Setting expectations is a core requirement for successful adoption and use within your organization. You can determine if you are doing a phased roll-out, i.e., a certain case type across your entire organization, or a representative group of pathologists for all case types, or a single location, etc. Or, depending upon your size, it might be an all-at-once scenario. 

Whatever you determine, you need to work with your vendor to determine the best time for training — you want it to be close enough to go-live that people are comfortable and remember how to use the solution(s) but out far enough to allow for any questions or support that may be necessary. 

It also needs to be clearly explained that while digital pathology is a natural extension of what pathologists are doing manually and historically, there is still a slight ramp time.  When a pathologist first started diagnosing cases on glass, they were not as fast as they are today. It took some time (usually only a few months) for them to be able to fly through their glass cases. The same is to be expected when adopting a new workflow — it may start slower, but once they are up to speed, digital shows exponentially faster workflows, overall efficiency gains, and improved pathologist experience.