Author: Sidney Ocanagil-Tunstall

On 18 September 2024, NYU Langone began routine scanning across six tissue types. By September the following year, its surgical pathology department had moved to a fully digital sign-out model. For an operation spanning multiple specialties and hospital sites, the team managed to deliver on a seriously ambitious timetable.

Key to their success was a sequence of separate go-lives. Pathologists did not all begin diagnosing digitally on the same day, and the hospitals did not join the programme together. Dr Syed T. Hoda, NYU Langone’s Director of Digital Pathology, noted the team deliberately left room in their deployment timetable to support each group as it made the switch.

“We didn’t want to do them [transition pathologists to digital sign out] all at the same time because then you flood the system.”

So, how did NYU Langone plan and roll out digital pathology at breakneck speed without flooding the system and overwhelming their pathologists?

Putting a team around the plan

The first conversations involved a small number of people in pathology and IT. As the proposal took shape and senior administration approved the project and its budget, NYU Langone’s information technology group provided a dedicated project management team.

“I really think that the project management team here is key”

That gave the rollout a way to coordinate work that could not be completed by pathology alone. Clinical teams were planning how cases would move through the new workflow. IT was working on software, compatibility and image data movement. Administrative teams were handling approvals, hiring, equipment and physical spaces. The groups came together in central meetings, then continued work on their respective tasks.

Hoda says, “project management kept us on a timeline, and it kept it going, and the momentum continuously evolved”.

He estimates that at least eight to nine months of dedicated project management preceded the first go-live, with frequent meetings during that period.

The team also looked beyond NYU Langone for lessons. Its members spoke with other laboratories, visited sites and reviewed published work to understand what had worked elsewhere and where labs hoping to make the leap to digital had found pitfalls. Despite the additional research, Hoda and his team found no complete template or blueprint to bring home and paste into their lab space. Staffing, case handling and institutional culture differed, so the team had to build a plan around NYU Langone’s own circumstances.

A firm timetable, subject to a readiness check

Hoda wanted the department to have a defined destination. He had seen how a drawn out, partial transition could leave one group of pathologists working digitally while colleagues remained in a traditional workflow, with no clear sense of when they would move. At NYU Langone, he says, “we wanted all the doctors to feel that they were moving together in a unified effort to change the workflow”.

A shared timetable did not mean going live simply because a date had arrived. Before the first clinical use, NYU Langone’s IT team tested whether its system for moving image data was stable and reliable. Hoda also wanted the experience of using the technology to be consistent and fast enough for pathologists to depend on it.

As he puts it, “we never went live until we were sure that it hit those benchmarks”. On a rapid programme, waiting for a system to be ready required restraint. The plan needed both a reason to keep moving and a reason to hold a go-live if the workflow was not yet dependable.

Beginning with smaller specialties

The order of the specialty go-lives was another deliberate choice. Hoda is a soft tissue pathologist and wanted to be among the first to work with the new system himself. Bone and soft tissue were also a small service, with two pathologists; head and neck were another relatively small group. A good place to start small before working you way up to bigger specialities.

Starting there let the team introduce the workflow at a manageable volume and speak directly with the people using it. Some of NYU Langone’s larger specialties had close to 20 pathologists. Bringing one of those groups online first would have placed a much greater demand on the staff available to respond to problems.

Capacity was still increasing as the rollout began. “We were still hiring people in real time as we ramped up through this process,” Hoda recalls. The specialty sequence allowed the digital workflow and the team supporting it to grow together.

Using the time between go-lives

A phased rollout offered additional perks. The team could us the time between go-lives. Hoda describes checking in with pathologists after they began working digitally, sometimes over the following week or two and sometimes longer. He focused on their experience of the changed working day, while his IT colleagues dealt with technical issues. Philips also had a representative on site to assist.

“I would go to their offices, I would sit with them and check on them,” he says.

Those conversations were a way to find out what needed attention before the programme moved forward. Hoda and an NYU Langone IT colleagues also held small-group “Lunch and Learn” sessions where pathologists could discuss what was working and what was getting in the way. When the team identified barriers, it could make adjustments.

This is the practical significance of the staggered dates. Each go-live was followed by a period of observation and support. What the team learned from one group could inform its work with the next, even while the overall timetable continued to advance.

From Manhattan to Long Island

There were two levels to NYU Langone’s phased approach. Within Manhattan, smaller specialties went first. Across the hospital system, Manhattan itself was the largest site and went first. It had the most pathologists and the greatest volume, allowing the team to test the workflow incrementally in its largest laboratory to identify any pitfalls before moving on.

“We vetted out a lot of things from Manhattan before we get to the second one,” Hoda says of the subsequent move to Long Island.

The sites could not all be brought online together with the same level of support. Equipment, computers and monitors had to be ordered and distributed. Hoda also wanted to spend time with pathologists at Long Island, holding discussions and checking in with them as he had done in Manhattan. The team’s people and time were finite.

Nor could it assume that a plan refined at one hospital would fit the next without adjustment. Hoda points to differences in staffing shifts, case types and culture even within NYU Langone. The team aimed to align the underlying technology and its overall approach, while responding to the way each site worked.

NYU Langone’s rapid rollout therefore rested on a series of controlled decisions: organise the work across departments, test before clinical use, begin with manageable groups, stay close to them after go-live and apply what was learned as the programme expanded. The ambitious timetable set the direction. The space between go-lives gave the team a way to make progress through it.

For each specialty, going live digitally was one milestone rather than the end of the transition. Pathologists initially continued to receive glass slides alongside their digital cases. Deciding when that parallel workflow could stop was a further step and another decision the team made with the pathologists using it.