International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

Abstract

Background:Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service.Materials and Methods:This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014.Results:A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases.Conclusion:These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated pathologists who understood the language and culture on both sides. Lack of clinical information, missing gross pathology descriptions, and insufficient tissue sections submitted for evaluation were the main reasons for indefinite diagnoses. The overall experience encourages international telepathology practice for second opinions.

Future-proofing pathology: the case for clinical adoption of digital pathology

“…On an international scale, digital pathology may help to broaden access to quality diagnostics, while offering income generating opportunities, a strategy already being explored at a number of centres, including the University of Pittsburgh Medical Center 19. Similarly, time-sensitive diagnostic slides could be outsourced to trusted partners in alternative time zones to enable rapid diagnostic turnaround out of hours, without resorting to costly and inconvenient pathologist on-call rotas.…”

International telecytology: Current applications and future potential

“…Digital telecytology has several potential clinical applications, as listed in Table . Among these, the use of telepathology for consultation and expert opinion in difficult cases has been used most successfully with surgical pathology slides, and this has been well‐described in the literature . The adoption of telecytology consultation into clinical practice has been slower, however, due to the unique technical challenges inherent to cytopathology materials and the difficulties these materials impose on digital imaging, especially on digital whole slide scanning.…”

“…International telepathology consultation services with digital whole slide image capabilities have been established at several academic medical centers, including the University of Pittsburgh Medical Center (UPMC), the University of California at Los Angeles (UCLA), and the University of Utah through Associated Regional and University Pathologists (ARUP) Laboratories (Dr. Rosai Surgical Pathology Consultative Services) . Other platforms for international telepathology consultation include the iPath network, MECEMS (the Medical Electronic Consultation Expert system), and the Virtual International Pathology Institute (VIPI) .…”

International Telepathology: Promises and Pitfalls

“…Furthermore, poorly prepared tissues and slides (e.g. tissue present outside the coverslip or tissue folds) may affect optimal scanning and thereby hamper interpretation [3]. Another limiting factor is when experts do not have additional data about the case, such as pertinent clinical information, radiology images or measurements, and the results of ancillary studies (e.g.…”

“…Telemedicine in Africa has proven to be a very useful conduit of health care [2]. A review of telepathology consultation between the University of Pittsburgh Medicine (UPMC) in the USA and KingMed Laboratories in China revealed that in many cases patient management was significantly impacted as a result of expert diagnoses [3]. In recent years, international teleconsultation has grown and provided a novel source of revenue.…”