Clinical Implementation Challenges and Potential Solutions

Addressing challenges regarding the integration of digital solutions into clinical practice. This is part three of our report on the Digital Pathology & AI Congress: USA. For other parts, please see links toward the bottom of the article.

 

As digital pathology and AI technologies make their way into clinical practice, several presenters addressed challenges and considerations regarding the integration of digital solutions into clinical practice for patient care. Key challenges discussed include validation concerns, regulatory considerations, and workflow optimization.

Phased Adoption of Digital Pathology: Lessons From Early Adopters

In her presentation, Orly Ardon of the Memorial Sloan Kettering Cancer Center explored the benefits and potential considerations of a phased implementation approach for digital pathology. She addressed challenges such as resource allocation, infrastructure building, staff training, and ongoing operations, providing valuable insights for organizations at various stages of digital pathology adoption.

The Memorial Sloan Kettering Cancer Center started its digital pathology adoption journey in 2008 when the institute purchased its first slide scanner and began digitizing.[1] They implemented barcoding in 2012 but only transitioned to clinical workflows in 2020, when New York State conditionally approved a remote review of digital pathology images because of the pandemic. This allowed the institute to implement a phased implementation approach with gradual investment in technologies and infrastructure.

During her presentation, Dr. Ardon discussed lessons from their experience with phased digital pathology adoption, providing practical insights and best practices for organizations embarking on their digital transformation journey. She emphasized the importance of understanding institutional-specific needs and goals when setting up digital pathology operations. She noted that following a phased implementation strategy allows organizations to gradually introduce digital pathology capabilities while managing resources and mitigating risks. Additional benefits of this approach include the ability to assess and address workflow issues, identify suitable scanners and digital tools before scaling up adoption, optimize integration with laboratory information management systems, train existing staff, and maximize digital efficiency within the laboratory.

Moreover, Dr. Ardon discussed the financial considerations associated with digital pathology adoption, as the costs of additional resources, such as infrastructure and personnel, can be a barrier for many organizations. By adopting a phased approach, organizations can better allocate resources and build a compelling business case for digital pathology implementation. Dr. Ardon recommended the use of the Return on Investment (ROI) calculator developed by the Digital Pathology Association (DPA) to help institutions assess the financial implications of transitioning to a digital pathology system.

Dr. Ardon also discussed strategies for change management, stakeholder engagement, and continuous improvement based on real-world experiences. She recommended using available resources, engaging vendors early in the development of the digital pathology plan, and preparing for additional middleware and software solutions for scaling to clinical operations. She also noted that the integration of Al tools for pathologist sign-out workflows should follow the integration of digital pathology into existing workflows.

By allowing for gradual investment and sufficient time for training and cultural and organizational changes, phased adoption of digital pathology minimizes financial risks and increases the chances of transition success. However, Dr. Ardon cautioned that new disruptive technologies evolve and cost savings are slow to realize, which may act as barriers to full adoption.

[1] Orly Ardon. Phased adoption of digital pathology: Lessons from early adopters. Presented at the 10th Digital Pathology & AI Congress: USA; May 7-8, 2024; San Diego, CA.

Dr. Ardon, Director of the Department of Digital Pathology Operations at the Memorial Sloan Kettering Cancer Center.

Digital Pathology: The Next Chapter, Post-Adoption

Zoltan Laszik, director of the Department of Digital Pathology at the University of California, San Francisco (UCSF), discussed lessons learned from adopting digital and computational pathology tools for patient care, focusing on challenges post-adoption.[2]

Despite recent technological advances in digital tools, the adoption of digital pathology has been slow, and pathologists still rely on brightfield microscopy to determine the diagnosis, make treatment decisions, and assess prognosis. The implementation of computational pathology requires collaboration among different disciplines, including pathology domain experts, imaging experts, image analysis experts, and data scientists.

Additional requirements for the successful implementation of digital pathology for patient care include having a vision, institutional support, appropriate infrastructure (e.g., scanners with dedicated space, monitors, high-speed Internet, and storage), image management software, and learning information services.

Scanning standardization, costs, digital platform validation, scanner interoperability, reimbursement, legislative uncertainties, and training and proficiency testing for faculty, trainees, and staff are important considerations and potential barriers to the clinical implementation of digital pathology for patient care.

Despite these challenges, the three hospitals at UCSF fully implemented digital pathology tools without significant issues in March 2020, when HIPAA-compliant solutions became available. Dr. Laszik ended his talk on a positive note, saying, “The future is bright, and momentum is building.”

[2] Zoltan Laszik. Digital pathology: the next chapter, post-adoption. Presented at the 10th Digital Pathology & AI Congress: USA; May 7-8, 2024; San Diego, CA.

Dr. Laszik, Director of the Department of Digital Pathology, UCSF.

Beyond Technology: The Impact of Digital Pathology and AI on Culture, Teamwork, and Communication

Suzanne M Dintzis, professor at the University of Washington School of Medicine, discussed the often-overlooked aspects of digital transformation, such as its impact on work culture, teamwork, and communication within pathology laboratories.

Although the technological aspects of digital pathology and AI are often the primary focus of efforts to facilitate the clinical implementation of digital pathology, Dr. Dintzis stressed the importance of understanding and addressing the cultural and organizational shifts that accompany digital transformation in pathology to ensure successful digital implementation and effective collaboration between pathologists and laboratory staff.[3]

Despite technological advances, 70% of digital initiatives do not reach their goals, and the lack of transformation of mindset and organizational culture is a key barrier to the successful clinical adoption of digital pathology. Although most laboratory personnel and pathologists are positive about new technologies and digital pathology, they share challenges and concerns. Dr. Dintzis discussed the need for clear communication and alignment among team members regarding the expectations and requirements for remote work and the potential changes in workflow and processes. A worker-focused digital implementation focusing on employee attitudes and behavioral change would allow stakeholders to identify shared values, increase employee commitment, and improve transformation acceptance.

As digital tools and AI-powered solutions become more prevalent, it is crucial to ensure that all team members are adequately trained and comfortable with the new technologies and that their concerns and feedback are actively addressed. However, recent data suggests that training on digital pathology for existing staff (mostly through industry seminars, conferences, and industry representatives) is insufficient. The hiring of new employees during digital pathology adoption also presents challenges. Dr. Dintzis recommended recognizing the fear of irrelevance and replacement in employees and providing opportunities for skill upgrades to address employees’ reluctance to change. Establishing post-training competency can help ensure that existing employees are sufficiently trained on new technologies, and updating job descriptions to include new technologies can facilitate hiring new employees during or after digital pathology adoption.

Dr. Dintzis also discussed communication challenges, as digital work can lead to communication breakdowns, misunderstandings, or delays in responses, and transactional relationships often replace deeper relationships in remote work environments. In turn, communication breakdown among members of the care team can compromise patient care. Dr. Dintzis highlighted the importance of fostering a collaborative environment that encourages open dialogue and knowledge sharing between pathologists and laboratory staff. Laying out the ground rules for remote work and involving employees throughout the transformation process can also help enhance collaboration and communication among different stakeholders during the implementation of digital pathology.

Dr. Dintzis concluded that by proactively addressing these human factors, pathology laboratories can better navigate the challenges associated with the transition to digital workflows and maximize the benefits of AI integration while maintaining a strong sense of teamwork and effective communication.

[3] Suzanne M Dintzis. Beyond technology: The impact of digital pathology and AI on culture, teamwork, and communication. Presented at the 10th Digital Pathology & AI Congress: USA; May 7-8, 2024; San Diego, CA.

Dr. Dintzis, Professor at the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine.

Links To Other Parts Of The Series

Part 1: Highlights from the 10th Digital Pathology & AI Congress: USA

Part 2: Digital Pathology Implementation: Insights From Experts At DP&AI: USA

References

[1] Orly Ardon. Phased adoption of digital pathology: Lessons from early adopters. Presented at the 10th Digital Pathology & AI Congress: USA; May 7-8, 2024; San Diego, CA.

[2] Zoltan Laszik. Digital pathology: the next chapter, post-adoption. Presented at the 10th Digital Pathology & AI Congress: USA; May 7-8, 2024; San Diego, CA.

[3] Suzanne M Dintzis. Beyond technology: The impact of digital pathology and AI on culture, teamwork, and communication. Presented at the 10th Digital Pathology & AI Congress: USA; May 7-8, 2024; San Diego, CA.

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