With little more than a vision to go on, he convinced the C-suite to begin investing in the new technology. Now, 7 years later, the Cleveland Clinic is on the cutting-edge of digital pathology and has set the bar high for institutions that follow.
Let’s take a look at how he did it.
The Cleveland Clinic is a large hospital system comprising a main campus and numerous satellite facilities. With a team of people spread not only across the country, but around the world, the institution was looking for ways to improve the workflow of their decentralized staff.
Digital pathology looked to be the solution they needed to expand the work of centralized technical teams to the rest of the institution. But one problem stood in the way: digital pathology was not approved for primary diagnosis by the FDA.
Recognizing this barrier, Dr. Bauer sold the practice on the platform of research and education. But, his ultimate goal was to build evidence supporting its use in patient care.
With the go-ahead from the C-suite, Dr. Bauer and his team started the E-pathology department. To do this, they:
Bought a slide scanner
Hired an administrative assistant and an IT image analyst
Assigned one full-time scanning tech—which eventually became 2
Appointed Bauer E-pathology medical director
With a solid foundation, the next major step was getting his team of pathologists on board.
His department consisted of 60+ anatomic pathologists of varying levels. Some were straight out of residency while others were nearing retirement. This meant Dr. Bauer had drastically different experience levels and habits to manage.
Working in his favor though, was the fact that no one on his team had experience with digital pathology. This allowed him to level the playing field and begin with basic education.
Following essential instrument instruction, it was time for the team to dig in.
To get his team of pathologists working hands-on with the equipment, each staff member was given an external hard drive. They were encouraged to have their slides scanned and load their drive with other cases in their specialty.
Eventually, the team had compiled a digital education library of over 10,000 slides. This type of access proved to be invaluable in helping the team become experts in their field.
This digital library also enabled staff members who spoke at conferences to use whole slide images in their presentations. They had the ability to make slides available online to upcoming conference participants. And audience members could refer to them for up to a week following the lecture.
My motive really wasn’t education primarily. My motive was for pathologists to gain competence in their ability to interpret these cases. And that again was quite successful.
Pathologist and Medical Director ePathology
To prove the success of digital pathology, Bauer and his team embarked on a series of validation studies. These studies demonstrated competence in interpreting scanned biopsies.
You can argue about that number, whether 4% is the right number or not, but for what it’s worth, the FDA has maintained that. So, now in the ongoing studies that manufacturers are doing and submitting to FDA, the FDA chose that same threshold.
As Dr. Bauer’s team became more comfortable with digital pathology, they looked for ways to utilize the technology beyond internal education. The most obvious opportunity was to provide consultation diagnoses.
They recognized that parts of China don’t have the same pathology capabilities as the United States. So, they developed relationships with two Chinese institutions and began performing consults utilizing scanned slides.
Case is scanned in Guangzhou
Technician in Guangzhou will add clinical information in English
Original pathologist adds cover letter with any other pertinent patient data
The consult is initiated
Dispatcher at the Cleveland Clinic reviews the case and, based on sub-specialty, assigns it to a pathologist at the Cleveland Clinic
Pathologist is notified via email that they have a case to review
If needed, the pathologist can request more information
Once a conclusion is made, a pathology report is filed and sent back as a PDF
Beyond international consults, the Cleveland Clinic is also gradually rolling out scanners to each of its 15+ facilities to implement a similar practice internally.
Dr. Bauer saw the potential in digital pathology and knew he needed to get his C-suite on board. By focusing on the educational benefits of the platform, he could sell the technology despite the FDA regulations.
While digital pathology is not yet a mainstay for diagnosis in the United States, the technology is gaining traction. This means widespread adoption most likely won’t be far off. So how do you make the case for implementing the practice sooner than later?
Even when not used for patient diagnosis, digital pathology can open many doors for internal collaboration and research. Get your C-suite to see the advantages of the technology as a training tool by emphasizing the invaluable learning opportunities it provides.
Implementing digital pathology can bring a multitude of benefits to your institution, but realizing these benefits will take time. Just as Dr. Bauer exemplified, staff needs time to learn and adapt to new technology and management needs to determine how to optimize workflows accordingly. By bringing the technology in sooner, your team can get comfortable with the new system and be ready to hit the ground running.
By taking geography and shipping costs out of the equation, your institution will be able to take on more consult cases. This opens the door for an even greater revenue stream and the ability to broaden your reach throughout the medical community. Look for areas such as China where there is a known shortage of pathologists and begin fostering relationships for mutual success.
Just like digital pathology can remove barriers for international consults, it can have the same effect on decentralized care teams. The Cleveland Clinic is poised to take advantage of these benefits and your organization can be, too. The ability to access slides through a cloud-based server makes geography a non-issue. Make a case for how this technology can enable better workflows and help your team do more.
Technology is changing almost as fast as the health care landscape.
By making an evidence-based business case to implement new technology such as digital pathology, you can stay ahead of the curve and continue to redefine the value of your lab.
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