Digital Pathology: Enabling Remote Operations During COVID-19 and Beyond

Mike Bonham, MD, PhD

We are all severely impacted by the rapidly evolving coronavirus disease 2019 (COVID-19) pandemic. Terms such as “social distancing,” “self-quarantine,” and “flattening the curve,” have become the most meaningful descriptors of how we live our lives. This pandemic will, hopefully soon, resolve; however, its lasting effects will lead to permanent changes in how we live and work. We are growing used to remote technologies and the conveniences they offer. Although we will eventually go back to our regular activities, we will want to rely on these solutions in many workplace environments as we settle into the reality of a post-COVID-19 world.

In pathology, we are already starting to see the beginning of these permanent changes, as the need for social distancing and quarantine has forced the entirety of how pathology operates to be transformed almost overnight. Laboratory staff typically works on-site, reading patient biopsies affixed to glass slides under a microscope using validated methods as they have for the past 150 years. This routine clinical work, along with consultation and tumor boards, has been completely disrupted, meaning that patients may now need to wait longer to receive a diagnosis and begin treatment for diseases like cancer. Research and education have been similarly impacted as teams and students can no longer gather in 1 central location.

Digital pathology, which captures high-resolution images of tissue specimen, has been pivotal in enabling pathologists to maintain operations during the pandemic. These digital images can be viewed anywhere and easily shared for second opinions and consults, or in digital teaching sets, overcoming the limitations of working with physical glass slides and microscopes.

As a result, demand for digital pathology from both commercial laboratories and academic institutions has skyrocketed. Medical centers have introduced the technology to enable collaborative review sessions on challenging cases and expand access to sub-specialist expertise. Many medical schools have already shifted their classes online and are now providing an experience similar to, if not the same as, what students would receive in the classroom.

This demand for digital pathology is clearly being driven by the current need for remote operations. Importantly, it’s also being accelerated by a key regulatory development.

In late March, the Centers for Medicare & Medicaid Services (CMS) temporarily waived the requirement for pathologists to perform the complex and time-consuming validation requirements established by the Clinical Laboratory Improvement Amendment to read cases from home. This fundamental change makes it significantly more practical for pathologists to work virtually. It also raises an important question: is remote work for pathology here to stay?

Until now, we have never had a real opportunity to determine the impact of remote work on pathologists. Regulatory requirements, along with the reliance of physical glass slides, has made working remotely all too difficult. The COVID-19 crisis has given pathologists no choice but to work from home and has broken down the regulatory barriers for them to do so. It’s evident that digital pathology and the new standard operating procedures will address pathologists’ urgent needs, but are these responses here to stay for the long term?

As pathology organizations realize the advantages of remote operations as a first choice—from saving time on commutes to accessing cases on-demand and tapping into a much broader network of expertise—or in the event of a future crisis, it is hard to imagine that virtual work in the field will cease once this public health crisis is over.

Mike Bonham, MD, PhD, is the chief medical officer of Proscia. The presented analysis reflects his views, not necessarily those of the publication. 

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