Journal Article

Remote Pathology Practice: The Time for Remote Diagnostic Pathology in This Digital Era is Now

Schukow, Casey P., Allen, Timothy Craig

2024

Overview

[...]the remote review of these materials does not require equipment that is essential to being a separate laboratory, while maintaining the accuracy, reliability, and timeliness of laboratory results.3 As such, pathologists' freedom to practice remotely remains intact postpandemic. On May 16, 2023, the College of American Pathologists (CAP) released an advocacy update summarizing this new CLIA post-public health emergency guidance (see Table I),4 which supersedes prior CMS directions regarding digital pathology and remote practice.3,4 The COVID-19 pandemic spotlighted the importance of laboratory medicine in diagnostic testing for societies and health care systems, but the pandemic's demands simultaneously accelerated an already critical pathologist shortage.5,6 This pathologist shortage has actually been growing for decades, dating from before the 21st century.7-16 Pipeline efforts, including those by the CAP, have already been instituted to address the shortage by increasing medical student awareness of the field with postsophomore fellowships,17-21 student interest groups,22 virtual pathology electives,23 social media initiatives,24 and other curricular exposure programs.25-31 In fact, these efforts have yielded improvements nationally32 and internationally33 so far. Other studies43-45 have drawn similar conclusions to these, including remote diagnosis of intraoperative and intraprocedural consultations by frozen section and rapid on-site examination.46 Past obstacles have delayed the routine implementation of WSIs in pathology laboratories globally, including storage capacities, information technology (IT) resources, slide access requirements, plug-in software applications, system compatibilities, practice integration, regulatory agency ferences, aspects (ie, scanner qualities and times), and overall cost.47 Another significant obstacle has been pathologists' resistance to change and adaptation.48 Pathologists' emotions certainly impact their medical-related decisions.49 But although healthy skepticism is encouraged and essential in delivering efficient care and optimizing patient outcomes,50 pathologists' ever-increasing role in population health, precision medicine, and data aggregation calls for pathologists to embrace virtual diagnostic tools.51 These obstacles, however, are being increasingly overcome as more pathologists, especially new-in-practice pathologists, recognize and voice their preferences for the opportunities to practice in various hybrids of remote diagnostics. Numerous advantages counter these obstacles, including reliable data security (ie, glass slides can be lost or broken), easier slide access (ie, ability to sign out cases remotely), sharing of cases (eg, for second opinions, virtual teaching/education), research standardization, and implementing automated algorithms to improve diagnostic accuracy, time, and productivity.47 The US Food and Drug Administration approved the first WSI system in 2017 (Philips IntelliSite Pathology Solution) to allow pathologists to review and interpret digital slides \"prepared from biopsied tissue,\" and ensured that special controls (for WSI systems) \"must be met to assure..

• Publisher: College of American Pathologists
• Subject: Accuracy / Clinical medicine / Coronaviruses / COVID-19 / Epidemics / FDA approval / Forecasts and trends / Humans / Hybrids / Laboratories / Medicaid / Medical diagnosis / Pandemics / Pathology / Pathology, Clinical - methods / Pathology, Clinical - trends / Precision medicine / Public health / Shortages / Standardization / Technology application / Telemedicine / Telepathology - methods / Telepathology - trends / Trends / Virtual private networks