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YNHHS moves beyond the microscope with digital pathology

When patients come to Yale New Haven Hospital for treatment of diseases that were diagnosed elsewhere, our pathologists need to confirm that outside diagnoses. 

They also perform consults for pathologists at other hospitals who want a second opinion on a specimen, require a test their facility doesn’t perform or need help with a complex case.

In these situations, the microscope slides containing these specimens must be physically sent to YNHH, then returned to the hospital or treatment site that took the specimens. This happens thousands of times each year.

“We don’t have a record of these slides because they don’t belong to the hospital,” said John Sinard, MD, PhD, director of Anatomic Pathology and medical director of Pathology Informatics at Yale School of Medicine. “It can be an issue if the patient is eventually referred to YNHH for treatment.”

This is about to change. Yale New Haven Health has begun implementing digital pathology, in which microscope slides containing specimens are scanned to produce digital images that can be accessed and shared electronically. The technology will be piloted at YNHH in the coming weeks before being expanded to other health system delivery networks.

“This is a significant investment that will enhance the quality and efficiency of patient care,” said pathologist Sudhir Perincheri, PhD, MBBS, who is leading the effort. “Digital pathology can allow for faster diagnoses, which means patients’ treatment plans can be implemented sooner.” 

Digital pathology includes whole slide imaging (WSI), in which special scanners capture a detailed image of an entire glass microscope slide at magnifications comparable to those from a microscope. So far, YNHHS has purchased two high-volume scanners and software to view and/or analyze the digital files. In addition, Yale New Haven’s Clinical Imaging team and Information Technolog Services department have gone “above and beyond” to develop systems for storing, labeling and accessing the digital files, Dr. Perincheri said. Storage is a particular challenge. Each slide yields a digital file that’s 300 to 400 megabytes; YNHH’s Pathology department produces 1,000 slides per day on average.

Storage needs, development of the scanning and reading technology and equipment cost are among the reasons it has taken Pathology a while to go digital. But the “significant investment” of funds, time and resources will pay off, said Chen Liu, MD, PhD, YNHH chief of Pathology. YNHH will be able to scan the slides it receives from other hospitals for pathology consults and have an easily accessible record if the patients end up here. That will be particularly beneficial during Tumor Boards, when physicians from different specialties meet to review patients’ cases and develop treatment plans. 

In addition, pathologists will be able to review slides remotely – allowing timely patient care to continue while enabling safe working conditions and reducing their risk of exposure during situations such as the COVID-19 pandemic.

Once other YNHHS delivery networks convert to digital pathology, clinicians will be able to quickly and easily share specimens electronically. This will enhance YNHHS’ Care Signature, which ensures, in part, that patients receive the same quality of care regardless of where they are in the health system, Dr. Liu said.

Other future benefits of digital pathology include bolstering research and opening the door for future advancements, such as the use of artificial intelligence to improve the accuracy of diagnoses.
“This is the first step,” Dr. Liu said. “We’re looking forward to scaling this technology up.”