On March 27, 2026, the Panel of National Pathology Leaders convened its first Digital Pathology & AI Focus Group meeting of the year, featuring a presentation by Eder Lagemann, Vice President of Engagement at KLAS Research. Lagemann, a co-author of the newly released Digital Pathology 2026: Early Adoption and Technology Performance in an Emerging U.S. Market report, shared insights derived from direct interviews with healthcare providers, offering a practical, real-world view of vendor performance, adoption patterns, and the evolving business case for digital pathology.

A key takeaway from the session was the early stage of digital pathology adoption in the United States. While momentum is building, adoption remains limited, with estimates suggesting that only 10–15% of organizations have implemented digital pathology at any meaningful scale. Even within this group, only a small subset of organizations — primarily large academic centers and well-resourced integrated systems — have achieved near-complete digitization. The majority of institutions remain in pilot phases or partial adoption, underscoring both the opportunity and the complexity associated with scaling digital workflows.

KLAS’ research methodology was a central differentiator highlighted during the discussion. Rather than relying on internal evaluations or vendor-reported data, KLAS collects feedback directly from end users (pathologists, laboratory leaders, and operational stakeholders) who assess the solutions they use in practice. This customer-driven evaluation model provides a useful reference as to how technologies perform in real-world environments, including both strengths and limitations.

Across the vendor landscape, performance scores were generally strong, reflecting a maturing market with no clear “underperformers.” However, important distinctions emerged between pathology-specific vendors and enterprise imaging platforms. Pathology-focused companies, such as those dedicated exclusively to digital pathology workflows, were consistently viewed as more responsive to customer needs, particularly in areas such as feature development, workflow optimization, and customization. Their narrower focus enables faster iteration and closer alignment with pathology-specific use cases.

In contrast, enterprise imaging vendors — those offering integrated solutions across radiology, cardiology, and pathology — bring advantages in system-wide integration and scalability but often face longer development cycles due to the complexity of managing broader product portfolios. As a result, organizations must weigh the trade-offs between agility and integration when selecting a vendor, particularly within health systems pursuing enterprise imaging strategies.

Scanner selection emerged as another critical component of digital pathology adoption. Based on KLAS findings, image quality and scanning speed are the primary criteria driving purchasing decisions, with reliability and service responsiveness also playing important roles. Leica scanners demonstrated the highest level of adoption among surveyed organizations, with consistently strong feedback on performance and support. At the same time, cost considerations remain highly influential. For example, Roche scanners — while associated with more reported technical challenges — are often selected due to favorable pricing structures or bundled purchasing arrangements, highlighting the ongoing tension between performance and affordability in capital investment decisions.

The discussion also explored the current state of artificial intelligence in pathology, which remains in its early stages of adoption despite significant interest. Existing use cases are concentrated in relatively narrow domains, particularly breast and prostate pathology, where algorithm development has progressed further. However, widespread clinical deployment is still limited. A critical success factor identified by participants is workflow integration: AI tools must be seamlessly embedded within the diagnostic workflow to deliver meaningful efficiency gains. Solutions that require separate systems, additional steps, or manual data transfer introduce friction and limit real-world utility, regardless of their technical capabilities.

Beyond technology selection, Lagemann emphasized the importance of aligning digital pathology initiatives with broader enterprise imaging strategies, particularly within health systems. As organizations increasingly seek to consolidate imaging data across specialties, pathology is emerging as a key component of these strategies. In many cases, this creates both an opportunity and a constraint: pathology departments may benefit from leveraging existing enterprise imaging infrastructure, but may also face limitations in vendor choice or system flexibility. Early engagement with enterprise imaging leadership was recommended as a critical step in planning digital pathology adoption.

Despite growing interest and technological advancement, cost remains the primary barrier to adoption. The financial burden extends beyond initial capital expenditures for scanners and software to include ongoing costs associated with storage, infrastructure, and system integration. Storage, in particular, was highlighted as a frequently underestimated challenge. Digital pathology images are significantly larger than those generated in radiology or other imaging domains, requiring substantial capacity and thoughtful data management strategies. Organizations are adopting a range of approaches, from short-term storage with limited retention to long-term archiving for research and secondary use cases. Some institutions are even exploring opportunities to monetize their image archives through partnerships with research organizations and industry.

To overcome financial barriers, early adopters are building business cases around two primary value drivers. The first is workforce strategy, including improved recruitment and retention. Digital workflows are increasingly attractive to younger pathologists, and the ability to support remote work expands access to talent in a constrained labor market. The second is operational efficiency and revenue generation, including faster turnaround times, reduced reliance on physical slide transport, and new opportunities for remote consultations and second opinions—both domestically and internationally.

Implementation strategy was also identified as a critical determinant of success. Organizations typically pursue one of two approaches: a “big bang” model, involving rapid, enterprise-wide adoption, or a phased rollout, beginning with smaller groups or specific use cases. The big bang approach can accelerate realization of benefits but requires strong organizational alignment and change management. The phased approach, more common in larger institutions, allows for incremental learning and internal advocacy, with early adopters serving as champions to drive broader adoption over time.

Importantly, the discussion reinforced that not all technology deployments succeed. In some cases, pathologists have resisted adoption of certain image management systems due to poor usability or workflow inefficiencies—highlighting the importance of user experience in driving adoption. Even technically capable systems may fail if they do not align with how pathologists work in practice.

The session concluded with a broader reflection from participants on the transformational impact of digital pathology beyond traditional ROI metrics. In addition to operational and financial benefits, digital pathology is reshaping the perception of the specialty, increasing interest among medical students and enhancing the overall visibility of pathology within healthcare organizations. These intangible benefits — while difficult to quantify — were viewed as meaningful contributors to the long-term value of digital transformation.

Conclusion

Eder Lagemann’s presentation highlighted a digital pathology market at an inflection point. While adoption in the United States remains in its early stages, the foundational elements — technology maturity, emerging AI capabilities, and validated business cases — are increasingly in place. For pathology practices and health systems, the path forward will require thoughtful alignment of technology, workflow, and strategy, grounded in practical experience and informed by the lessons of early adopters.

Panel of National Pathology Leaders’ Member Practices have access to a wealth of information and tools to help navigate management challenges, including exclusive access to reports, data, and surveys. For information on how to join PNPL, see our website or email ak****@*********rs.org.