Digital Pathology is innovation. Digital Pathology make changes to something established (ie. pathology) by introducing new methods, ideas, and products.   At USCAP last week there were examples all over the exhibit hall of digital pathology being used with other types of innovation including mobile devices, cloud computing, Software As A Service (SAAS), and methods to improve the pathologists workstation experience.

iPads, iPads, and more iPads!

Nikon Live Remote Viewing

I recently blogged about the iPad trend in healthcare (see post iPad Deployment In Healthcare to Reach 70% In 2011). This trend was reinforced by the number of iPads in use at USCAP.  The Information Week article stated that 1/3rd of the 950 respondents listed lab order visualization and results, clinical decision support, and medical image viewing applications as “top priorities” for the use of the iPad in healthcare. All great reasons for digital pathology too!

New Olympus VS800 viewer on an iPad

At USCAP Nikon demonstrated live image sharing (aka telepathology) on an iPad with their digital site camera system, Aperio was showing the mobile site of the Juan Rosai Collection on one, Aurora’s mScope really was “anytime, anywhere” on an iPad, and Olympus was demonstrating the new VS800 software on an iPad too!

WSI’s & more in the Cloud

Aurora's mScope

Software (and/or Storage) As A Service (SAAS) are catching on to help overcome the IT barriers of digital pathology. I blogged on the storage element of this over a year ago (see post SAAS- Cloud 9 For Digital Pathology?) and firmly believe that SAAS has it’s place in healthcare and for digital pathology.   At USCAP, several digital pathology providers were showing examples of SAAS with support for cloud based storage and secure web-enabled software solutions to ease the strain on IT. Aurora is “building communication networks” and overcoming IT barriers through their SAAS model; Aperio’s SecondSlide & Ventana’sPathXchange are cloud based; Apollo launched a collaboration with Hitachi to offer their Enterprise Patient Media Manager in the cloud, and Mikroscan offers a cloud based solution through a collaboration with Simagis.  Why is this becoming more popular? SAAS solutions are accessible from anywhere with an internet connection, do not require installation on a local server or client, can be up and running quickly, and can be rapidly scaled as needed.   Another example of SAAS is as an adjunct to a client-based solution.  Omnyx developed a web-enabled version of their pathology workstation viewer to work with their client based Pathology workstation software.  This will give the pathologist access to cases remotely (home, vacation, etc) and allow for safe, secure sharing of slides outside the hospital network for consultations.

The Pathologist Workstation

The Pathologists workstation experience has become a hot spot of innovation.  Barco (see post Diagnostic Color Displays for Digital Pathology) was beta testing software that could improve the “viewing experience” and provide the speed, image quality, and intuitive interaction needed to diagnosis off of a WSI.  It was amazing, and they were only using simple input devices bought at Best Buy.   The Diagnostic Intelligence and Health Information Technology (DIHIT), a department of CAP STS, were again advocating for and demonstrating their prototype of a pathology diagnostic workstation.  Also a few digital pathology manufacturers, like Aperio and 3DHistech, were showing new and/or compatible input devices.

A beta tester at Barco trying out the speed and ease of viewing

Aperio's Innovation Station w/Compatible Input Devices

3DHistech "Microscope like" Input Device

Digital pathology continues to be at the forefront of innovation.  It was wonderful to see so many digital pathology solutions leveraging other key innovations!

Look for my final post on Monday, USCAP Part 3: Breaking Down The Barriers Of Digital Pathology.

I attended Pathology Visions last week (more on that later…) which is organized by the Digital Pathology Association (DPA).  The DPA released on Tuesday two white papers; 1) Interoperability between Anatomic Pathology Laboratory Information Systems (APLIS) and Digital Pathology Systems and 2) Archival and Retrieval in Digital Pathology Systems.

The white papers are good and provide vendor neutral information to help the digital pathology industry and consumers.  Here are the abstracts and a few of my favorite points from each:

Archival and Retrieval in Digital Pathology Systems

This white paper frames the issues related to Archival and Retrieval of images and associated data as Anatomic Pathology laboratories adopt a digital imaging workflow in a research or clinical setting. This overview also includes a brief discussion of some of the solutions being developed and offered in digital pathology systems (DPS’s).

DPS’s start with creation of a whole slide image and provide an imaging workflow for pathologists by associating the images with a patient and case and furnishing the tools to review the cases digitally. Whole slide images (WSI) are very large and will drive the need for extensive storage and information life cycle management. Customers seek options for fast access to high quality and highly available data, when they use the DPS in a business critical application. Most importantly, since DPS’s are deployed in regulated environments, data reliability, privacy, and security need to be built into the solution and its management process.

Solutions that are being developed and deployed in digital pathology systems are also presented.

Favorite points:

• WSI are about 10x that of Radiology images.  The white paper talks about an average, compressed image size and the storage and network requirements needed to support a DPS for different size programs.
• The importance of data integrity, reliability, and audit trails for HIPAA, CLIA, and FDA compliance.
• An overview of Image Life Cycle Management (ILM) and important decision criteria.

Interoperability between Anatomic Pathology Laboratory Information Systems and Digital Pathology Systems

This white paper offers an overview of the current state of interoperability between Anatomical Pathology Laboratory Information Systems (APLIS’s) and Digital Pathology Systems (DPS’s). This overview also includes a brief discussion of future work that will impact interoperability.

Both systems rely on data from the other to efficiently deliver full digital imaging functionality to the healthcare provider. Anatomic Pathology (AP) departments and patients will benefit most from imaging workflow when there is a high degree of integration of Digital Pathology information within AP workflow. Implementations of such data sharing already exist via interfaces and standard communication protocols between APLIS’s and DPS’s, and work continues on these interface standards to improve the degree to which these systems can be used together.

The current state of interoperability provides Pathologists with access to images and image analysis data from within the APLIS or the DPS. This information is then available to the Patient Report.

Favorite points:

• In depth analysis and information about digital pathology and the AP Lab workflow
• Examples of current interoperability implementations between the APLIS and DPS
• Dealing with network and security issues for outside consultations
• The importance of barcodes
• Understanding the difference between compatibility and Interoperability

Cloud storage, or storage as a service (SAAS), is definitely the new buzz word in the informatics world.   New cloud companies are being formed every day trying to capture their piece of blue sky; and similar to real clouds, each one seems to be unique.  But could the use of SAAS be an answer to the strain digital pathology puts on IT and their all ready overtaxed resources?

Zetta, a new Cloud company, just released the results of a survey they did on over 400 IT professionals, with healthcare/medical being in the top five of the industries that responded.  In the survey, the most often-cited issues with current storage methods included:

• Limited scalability (53%)
• Limited flexibility (50%)
• Data integrity (43%)
• Data protection (41%)

As a result, nearly half of the respondents (47%) either already were or are planning to use cloud storage.  The applications most often planned for include backup (38%), archive (37%), and primary storage (25%).  The expected benefits of cloud storage included:

• Lower storage costs (64%)
• Dynamic growth/contraction (61%)
• Ease of use (45%)
• Offsite data storage (43%)
• No more capacity planning (41%)

In a white paper issued by Iron Mountain, titled “Iron Mountain Reduces Medical Storage Costs.”  issues that healthcare providers face in today’s data explosion are outlined.  The paper states that assuming a provider needs to store approximately 22 TB of medical images over the course of five years, a cloud based solution would produce savings of over 60% compared to an onsite storage alternative.  The cost savings jumps to 240% if the provider chooses to replicate the onsite storage solution to  a secondary location for disaster recovery purposes as mandated in the HIPAA Security Rule (Contingency Plan Standard- section 164.308, and Device and Media Controls Standard- Section 164.310), which Iron Mountain includes at no additional cost as part of their solution.  See Fiqure 1 from the white paper.

In addition, the white paper outlines that customers will save with their cloud solution because:

1. They avoid all storage-related operations expenses, which make up 86% of total onsite storage costs
2. The first year cost is 2x’s less then that of the capital outlay for an onsite storage solution, and 4x’s if an additional solution is purchased to support replication

On a big picture scale, it does not seem that healthcare providers are planning for or considering the impact that digital pathology will have on medical image storage in the near future- much of the talk is still focused on radiology imaging studies.  However,  current users of digital pathology solutions know what I am talking about as they work to manage all the data that scanners produce.

i-Path Diagnostics offers PathXL™, a novel web-based virtual slide viewing technology and management software for digital pathology with a high performance hosting capacity to provide a cloud-based service to customers.  Dr. Peter Hamilton, describes PathXL™ as “…cloud computing for virtual microscopy at its best!  PathXL™ offers a unique solution across a range of applications including education, training, competency testing, biomarker research, biobanking, and digital archiving of clinical samples.” Some of iPath’s cloud benefits include:

• Removes the need to purchase dedicated server hardware and employ dedicated staff to manage systems, reducing the cost by as much as 50% per annum.
• Storage and server capacity is all managed off-site in one of i-Path’s dedicated high performance server farms which guarantee up-time, regular backup and disaster recovery plans.
• Extensive storage facilities are available for clients to upload and manage their digital slide archives on-line.  This is fully scalable allowing clients to grow their needs accordingly.
• i-Path’s cluster of high performance image servers allows for high volumes of internet traffic without impacting on the speed of delivery.  It is resilient where if one server goes down, traffic is routed to another server.  By using satellite clusters, dispersed across continents, i-Path have reduced latency of image transmission over distance supporting the sharing of slides and easy collaboration across laboratories, hospitals and or universities.
• It is a highly secure facility, already being used by major Pharmaceutical organizations and Hospitals.
• To read more on iPath’s PathXL cloud technology, click here.

Overall, I believe that SAAS may be “Cloud 9″ for Digital Pathology.  If you have an opinion or question about cloud storage, please feel free to comment, our take the Cloud poll. Feedback is always welcome.