A Survival Guide for the Rapid Transition to a Fully Digital Workflow: The “Caltagirone Example”

Abstract

Digital pathology for the routine assessment of cases for primary diagnosis has been implemented by few laboratories worldwide. The Gravina Hospital in Caltagirone (Sicily, Italy), which collects cases from 7 different hospitals distributed in the Catania area, converted the entire workflow to digital starting from 2019. Before the transition, the Caltagirone pathology laboratory was characterized by a non-tracked workflow, based on paper requests, hand-written blocks and slides, as well as manual assembling and delivering of the cases and glass slides to the pathologists. Moreover, the arrangement of the spaces and offices in the department was illogical and under-productive for the linearity of the workflow. For these reasons, an adequate 2D barcode system for tracking purposes, the redistribution of the spaces inside the laboratory and the implementation of the whole-slide imaging (WSI) technology based on a laboratory information system (LIS)-centric approach were adopted as a needed prerequisite to switch to a digital workflow. The adoption of a dedicated connection for transfer of clinical and administrative data between different software and interfaces using an internationally recognised standard (Health Level 7, HL7) in the pathology department further facilitated the transition, helping in the integration of the LIS with WSI scanners. As per previous reports, the components and devices chosen for the pathologists’ workstations did not significantly impact on the WSI-based reporting phase in primary histological diagnosis. An analysis of all the steps of this transition has been made retrospectively to provide a useful “handy” guide to lead the digital transition of “analog”, non-tracked pathology laboratories following the experience of the Caltagirone pathology department. Following the step-by-step instructions, the implementation of a paperless routine with more standardized and safe processes, the possibility to manage the priority of the cases and to implement artificial intelligence (AI) tools are no more an utopia for every “analog” pathology department.

Digital Pathology Implementation in Private Practice: Specific Challenges and Opportunities

“…Most articles addressing digital QC report a low scanning error rate, usually around 1–1.5%%, and, at most, less than 5% [ 1 , 7 , 9 , 22 ]. However, most studies only report the errors detected by the scanner and not by visual assessment of WSI image quality.…”

“…However, most studies only report the errors detected by the scanner and not by visual assessment of WSI image quality. Different labs report different ways to perform pathology QC: from checking all WSIs [ 5 ], to a percentage of cases, or even not performing a WSI QC, since it takes a significant amount of time for technicians to execute and can be considered unnecessary if the error rate is negligible [ 1 ]. In our experience, significant focus errors were encountered in 3.5% WSIs during the manual pathology QC in the test phase.…”

“…Digital pathology (DP) is gaining momentum worldwide as an innovative technology associated with improved laboratory efficiency and productivity. A progressive growth in DP deployment in many laboratories across the globe is taking place, but, in spite of this, real world data indicate that a fully digital transition has been accomplished in only a minority of pathology departments [ 1 , 2 , 3 ]. Moreover, most of the successful implementations reported in the literature concern public health laboratories and hospitals [ 1 , 4 , 5 , 6 , 7 , 8 ].…”

“…A progressive growth in DP deployment in many laboratories across the globe is taking place, but, in spite of this, real world data indicate that a fully digital transition has been accomplished in only a minority of pathology departments [ 1 , 2 , 3 ]. Moreover, most of the successful implementations reported in the literature concern public health laboratories and hospitals [ 1 , 4 , 5 , 6 , 7 , 8 ]. The reasons for low DP adoption in private practice laboratories are mostly related to the initial high costs of implementation, necessary workflow adjustments and pathologists’ receptivity.…”

Best Practice Recommendations for the Implementation of a Digital Pathology Workflow in the Anatomic Pathology Laboratory by the European Society of Digital and Integrative Pathology (ESDIP)

“…Since several recommendations and guidelines have already been proposed, primarily focusing on the validation of WSI for clinical purposes or on the technical environment, this paper mainly covers DP implementation and all the prerequisites for a pathology laboratory to change from an analogue to a digital workflow [8]. Considering all that has been reported about DP workflow implementation and its associated benefits, it is anticipated that this new methodology has many advantages that should be attractive and convenient for all pathology laboratories worldwide, independently of their dimension, workload, number of pathologists or type of activity (academic/nonacademic, private/public) [6,7, [9][10][11].…”