Digital Pathology Operations at an NYC Tertiary Cancer Center During the First 4 Months of COVID-19 Pandemic Response

Abstract

Implementation of an infrastructure to support digital pathology began in 2006 at Memorial Sloan Kettering Cancer Center. The public health emergency and COVID-19 pandemic regulations in New York City required a novel workflow to sustain existing operations. While regulatory enforcement discretions offered faculty workspace flexibility, a substantial portion of laboratory and digital pathology workflows require on-site presence of staff. Maintaining social distancing and offering staggered work schedules. Due to a decrease in patients seeking health care at the onset of the pandemic, a temporary decrease in patient specimens was observed. Hospital and travel regulations impacted onsite vendor technical support. Digital glass slide scanning activities onsite proceeded without interruption throughout the pandemic, with challenges including staff who required quarantine due to virus exposure, unrelated illness, family support, or lack of public transportation. During the public health emergency, we validated digital pathology systems for a remote pathology operation. Since March 2020, the departmental digital pathology staff were able to maintain scanning volumes of over 100 000 slides per month. The digital scanning team reprioritized archival slide scanning and participated in a remote sign-out validation and successful submission of New York State approval for a laboratory developed test. Digital pathology offers a health care delivery model where pathologists can perform their sign out duties at remote location and prevent disruptions to critical pathology services for patients seeking care at our institution during emergencies. Development of standard operating procedures to support digital workflows will maintain turnaround times and enable clinical operations during emergency or otherwise unanticipated events.

Keywords: COVID-19; clinical; digital pathology; implementation; operations; remote signout; telepathology.

Figure 1.

Schematic workflow of pathology glass slides at MSKCC from specimen receiving to pathologist signout. In blue—steps that require on-site support staff whereas only 2 steps shown in orange can be achieved remotely.

Figure 2.

Weekly glass slide scans at MSKCC’s department of pathology. Current scanning volumes (blue) indicate prospective digital slide scanning, where archival scanning (orange) refers to digitization of off-site glass slides from prior accessioned years. In gray, combined archival and current slide scans. All whole slide images are interfaced with the anatomic pathology laboratory information system and may be accessed for clinical use.

Figure 3.

Median relative turnaround time assessments before and after prospective biopsy scanning of glass slides as percent of 2019 data which was used as baseline (in blue). June 2020 median turnaround time directly preceding prospective scanning began (in orange); August 2020, median turnaround time following prospective scanning implementation (in gray).

Figure 4.

Workday distribution among staff during the study period as % of total work days in period (n = 1761).

Figure 5.

Distance from work of digital scan team members based on reported residence zip codes (A) and mode of transportation to Work (B).