Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings

Abstract

Context.—: Digital pathology (DP) implementations vary in scale, based on aims of intended operation. Few laboratories have completed a full-scale DP implementation, which may be due to high overhead costs that disrupt the traditional pathology workflow. Neither standardized criteria nor benchmark data have yet been published showing practical return on investment after implementing a DP platform.

Objective.—: To provide benchmark data and practical metrics to support operational efficiency and cost savings in a large academic center.

Design.—: Metrics reviewed include archived pathology asset retrieval; ancillary test request for recurrent/metastatic disease; cost analysis and turnaround time (TAT); and DP experience survey.

Results.—: Glass slide requests from the department slide archive and an off-site surgery center showed a 93% and 97% decrease, respectively. Ancillary immunohistochemical orders, compared in 2014 (52%)-before whole slide images (WSIs) were available in the laboratory information system-and 2017 (21%) showed $114 000/y in anticipated savings. Comprehensive comparative cost analysis showed a 5-year $1.3 million savings. Surgical resection cases with prior WSIs showed a 1-day decrease in TAT. A DP experience survey showed 80% of respondents agreed WSIs improved their clinical sign-out experience.

Conclusions.—: Implementing a DP operation showed a noteworthy increase in efficiency and operational utility. Digital pathology deployments and operations may be gauged by the following metrics: number of glass slide requests as WSIs become available, decrease in confirmatory testing for patients with metastatic/recurrent disease, long-term decrease in off-site pathology asset costs, and faster TAT. Other departments may use our benchmark data and metrics to enhance patient care and demonstrate return on investment to justify adoption of DP.

Figure 1.

Digital pathology suite. Whole slide scanners and computers are arranged ergonomically for digital pathology supervisors and technicians to manage scanning workflow.

Figure 2.

Increase in monthly scanning volumes. Clinical whole slide scanning initiated in August 2015; each month shows (nonadditive) individual monthly scan volumes as each phase of the digital pathology implementation commenced. As scaling increased, in April 2017, networking issues were encountered, which were subsequently resolved.

Figure 3.

Subspecialty distribution and increase in scale by subspecialty between 2015 and 2017 (n = 424 901 whole slide images [WSIs]): Peds (pediatrics; n = 39); Neuro (neuropathology; n = 8212); Cytology (n = 15 272); BST (Bone and soft tissue; n = 20 794); Head and Neck (n = 21 825); Heme (hematopathology; n = 25 728); GYN (gynecology, n = 28 954); Thoracic (n = 38 878); Derm (dermatopathology; n = 50 155); Breast (n = 72 103); GI (gastrointestinal; n = 69 920); GU (genitourinary, n = 73 021). a, At our institution, the 3 largest subspecialties with WSIs include the breast, gastrointestinal, and genitourinary pathology services. b, Increasing scale of clinical scanning across the department shows additive scanning volumes between 2015 and 2017.

Figure 4.

Glass slide scanning indicator: composite red dot stickers with chalk ink. a, Color-coding label stickers; inset: sticker shown covering outside hospital barcode. b, Liquid chalk ink markers; inset: chalk ink dot shown in upper right hand corner of slide label as slide scanning indicator.

Figure 5.

Decrease in glass slide requests with increasing availability of whole slide images (WSIs). a, With the increasing availability of WSIs, glass slide requests from the departmental slide library decreased by 93%. b, Off-site intraoperative consultation of glass slide requests decreased by 97% over time as the whole slide scanning operation scaled.

Figure 6.

Clinical cases with immunohistochemistry (IHC) test ordered. In 2014, the clinical whole slide image (WSI) database was not interfaced with the laboratory information system (LIS), which had 52% of cases with IHC orders. After WSIs were available in the LIS, IHC orders decreased by 30% in cases with documented review of prior patient WSIs.

Figure 7.

Operational cost analysis. a, A projected savings of more than $267 000/y secondary to personnel restructuring; decreased vendor services (ie, pathology asset retrieval, labor, and other vendor services), due to the decreased need for transport and ready availability of whole slide images; and physical storage of glass slides. b, These calculations show a $1.3 million savings for a projected 5-year period (2019–2023). “Without digital pathology” includes the off-site storage vendor services (based on our volume tracking from pre and post digital pathology implementation) and also includes Personnel:FTE for slide file clerks. “With digital pathology” includes a decrease in off-site storage vendor services (based on our volume tracking from pre and post digital pathology implementation) and Personnel:FTE for slide scanning, digital storage, and hardware/software costs specific to the scanning operation. The increase in scaling of digital storage costs is contrasted to the decrease in hardware/software costs over time and overall decrease in personnel costs. Abbreviations: FTE, full-time employee; IT, information technology.

Figure 8.

Digital pathology experience survey questions and responses. A digital pathology experience survey was distributed with Likert-scale responses.