Introduction

We all know the switch from manual pathology methods to digitisation is underway. Digitisation is continually improving as slide imaging solutions progress in quality, scan times are reduced, and analysis via artificial intelligence (AI) improves. So far, the benefits of this move have been recognised. Reports of long-term savings in costs, as well as time-saving for pathologists, have been noted [1]. These savings are due to a reduction in the need for confirmatory testing, a faster turnaround time for results, and the savings made by having fewer off-site pathology asset costs [2]. But what are the long-term effects of the complete transition to digitisation?

The Evolution of the Role of the Pathologist

As the role of the pathologist evolves, what can we expect in the future? Pathology training may change completely, as it is already moving towards digital tasks such as training on computer software including AI. Trainees will have access to stored images relating to unusual or rare cases to support their learning. They will also have access to more learning material from home. Additionally, it may attract those from different educational fields, such as computing or engineering creating a more diverse team. Furthermore, the technology is modern and could be more engaging for students [3].

In the UK, The NHS has included in its long-term plan the notion that training must adapt as medicine merges with technology. It addresses the fact that careers are beginning to evolve into specialist roles which allow for the adoption of the new technology [4]. Health Education England (HEE) has produced the Topol review, led by Dr. Eric Topol. This document aims to guide NHS staff on how to include digital technology into its services to allow for technology progression and improvement [5].

The day-to-day requirements of the pathologist will also change. The role may become more demanding as basic laboratory tasks are performed by digital software and AI, freeing up the pathologist for more involved tasks. For example, analysing and researching difficult or unusual results, or looking at data from multiple sources, researching issues in slide analysis, and perhaps even finding ways to optimise the technology as they develop the specific expertise. Although this change could potentially be more demanding, one could argue that the work would also be more interesting.

Occupational Health Concerns

At present, little research has been conducted into the effects of health when progressing to digital pathology e.g. on back and neck strain (musculoskeletal complaints) or the occurrence of computer vision syndrome (CVS) also known as digital eye strain [6]. Spending more time sat at a desk rather than hunched over a microscope may be beneficial, particularly if the computer workstations have been adequately set up for optimal postural support. However, increased screen time can increase eye complaints such as dry eyes, headaches, blurry vision, and fatigue. This change in working conditions is perhaps something that should be considered by managers.

Lab workflow and scale of work

As the scale of work rises for pathologists due to increases in diseases such as cancer, digital pathology will become an increasingly key asset. Having data available online will allow pathology departments to respond to fluctuations in workload by having the option of transferring work to other pathology groups for support. Patients will get a faster service, perhaps better outcomes, and pathologists will have a more even workflow. However, for this to be successful, the digital infrastructure needs to be optimised so that images and reports can be accessed by multiple users at the same time, and there must be adequate bandwidth and data storage available to download and store the vast amounts of digital images and reports [7]. There is also the risk that if the workflows are not balanced correctly, it could result in some pathology laboratories being overwhelmed with work.

Increased Global Connectivity

The adoption of digital pathology will increasingly connect laboratories around the world, allowing quick and easy access for pathologists to gain second opinions or consultations with world experts when advice is needed regarding unusual samples and results. Digital pathology has also been beneficial during the current COVID-19 pandemic allowing more people to work safely in isolated rooms. However, remote working does reduce face to face communication which is important to many.

As digital pathology is accepted worldwide, the global market is set to rise for digital histopathology services. How will this affect pathologists? An increase in wage competition may occur if work can easily be diverted to lower-wage countries. There is then the potential for pathologists working in higher-wage countries to have their pay put under pressure due to this free market competition [6].

FDA Approval and In Vitro Diagnostic Regulation (IVDR)

Concerns over the accuracy of new digital systems have been an issue in many areas. By May 2022, the new European Union IVDR legislation requires that all in-vitro medical devices such as software and slide scanners need to apply for CE-marking. Manufacturers will also need to provide validity reports and carry out performance evaluations. Therefore, the regulations are becoming tougher for manufacturers as more digital platforms and software systems become available. The new European Union regulations will be nearer to those required by the American Food and Drug Administration (FDA). These new regulations will ensure that all digital devices entering the market are thoroughly validated [6].

Conclusion

The role of the pathologist is evolving as digital platforms and AI become incorporated into laboratories. It may lead to fresh opportunities like new career paths and more stimulating work environments. Instant connections can be made between specialist pathologists throughout the world allowing knowledge to be shared, thereby aiding diagnosis and training. Flexible work locations will allow for remote working. Finally, improvements to the validation and performance of new technology will aim to reassure pathologists that the technology is there as vital support. However, a smooth transition requires organisation and communication between healthcare workers, IT professionals, and healthcare managers.

References

• Baidoshvili, A., Bucur, A., van Leeuwen, J., van der Laak, J., Kluin, P., van Diest, P.J. (2018) Evaluating the benefits of digital pathology implementation: time savings in laboratory logistics. Histopathology. 73(5):784-794. https://doi.org/10.1111/his.13691
• Hanna, M.G., Reuter, V.E., Samboy, J., et al. (2019) Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings. Arch Pathol Lab Med. 143(12):1545-1555. https://doi.org/10.5858/arpa.2018-0514-OA
• Turnquist, C, Roberts-Gant, S., Hemsworth, H., et al. (2019) On the Edge of a Digital Pathology Transformation: Views from a Cellular Pathology Laboratory Focus Group. J Pathol Inform. 10:37. https://www.jpathinformatics.org/article.asp?issn=2153-3539;year=2019;volume=10;issue=1;spage=37;epage=37;aulast=Turnquist
• Douglas, A. (2020) Science in healthcare: Delivering the NHS Long Term Plan The Chief Scientific Officer’s strategy. science-in-healthcare-delivering-the-nhs-long-term-plan.pdf (england.nhs.uk)
• Health Education England (2019). The Topol Review. https://topol.hee.nhs.uk/wp-content/uploads/HEE-Topol-Review-2019.pdf
• Jahn, S.W., Plass, M., Moinfar, F. (2020) Digital Pathology: Advantages, Limitations and Emerging Perspectives. J Clin Med. 9(11):3697. https://doi.org/10.3390/jcm9113697
• Harris, G. (2020). Digitisation will transform the future of pathology. British Journal of Healthcare Management. 26 (4). https://doi.org/10.12968/bjhc.2020.0018