Preparing for & Deploying All-Digital Workflow at Significant Scale: University of Michigan Experience

Author: Christos Evangelou.

Ulysses G. J. Balis and Mustafa Yousif of the University of Michigan shared their experience in preparing for and deploying an all-digital workflow at a large scale. They emphasized the importance of thorough planning and organizational changes when transitioning to an all-digital workflow for primary diagnosis in large-scale pathology practice. Their presentation highlighted the key aspects of image management system selection and deployment, as well as the integration of AI-based solutions.

Dr. Balis presented key statistics for Michigan Medicine Pathology, which currently hosts 165,000 surgical specimens and over 100,000 transfer and consult cases and has 10%-12% annual year-over-year volume growth. With seven remote locations needing frozen sections and consultative support, the department is actively integrating recently acquired health systems.1 Benefits of digital pathology implementation at the University of Michigan include faster turnaround times, increased diagnostic accuracy, the possibility of multidisciplinary tumor board meetings, and enhanced communication between pathologists and other members of the care team.

Dr. Balis also discussed the 5-year digital transformation goals of the department, which include plans to integrate digital pathology with molecular omics (e.g., spatial transcriptomics) to allow for the development of predictive models. He also discussed the department’s post-modern view of the full portfolio of possible platform services enabled by cross-enterprise integration. These services include remote consultations and support, real-time consultation, image-based practice tools, image-based query and analysis tools, educational tools for the general public and pathology departments, integrated diagnostic reporting, multi-axial drug discovery tools, reference image libraries, and ‘patients like me’ tools. The department also plans to integrate AI into the digital pathology workflow to screen for diagnostic patterns, predict treatment responses, risk-stratify patients, assess billing completeness, and determine thresholds for seeking consultation. During the process, user satisfaction will be continuously monitored, and the tools and their implementation will be adjusted according to the feedback.

“Over time, the nice to have becomes a must-have,” noted Dr. Balis when discussing their plans of using Innovation Ambition Matrix to integrate pathology with next-generation sequencing and other omics technologies.

Commenting on challenges faced when deploying digital pathology for primary diagnosis at the University of Michigan, Dr. Balis said, “Overcoming natural skepticism of rank-and-file pathologists that digital sign-out could be as effective as that provided by microscopy is a key cultural challenge.”

Cost is another critical barrier to the large-scale implementation of digital pathology. “We ultimately decided to utilize departmental reserves, as this project was felt to be existentially important for us,” noted Dr. Balis. He explained that the initial investment is less than 10 million, but costs quickly increase to 25-30 million with long-term storage.

Dr. Balis, Associate Chief Medical Information Officer and A. James French Professor of Pathology Informatics, University of Michigan.

Dr. Yousif shared strategies for effective management changes, site preparation, and cockpit design to ensure a smooth transition to digital workflows. The department leveraged the existing infrastructure of Michigan Medicine and enterprise resources, highlighting that the digital pathology infrastructure can be siloed and fragmented.

A key challenge when a pathology lab is going digital is the number of slide scanners required. Dr. Yousif explained that they analyzed the scanning throughput for internal slide scanners, slide distribution, and the number of slides tested. Following this assessment, they determined that seven scanners would be ideal for the department.

Another important question is where the scanners should be placed in the lab. Based on their experience, they determined that the ideal scenario for their lab was to have scanners in the center of the room. This placement allows scan technologists to pick slides directly from the stainer or coverslip, reduces the overall walk for multiple workflows, improves immunohistochemistry cutting, and involves less handling of the slides.

They also assessed different scan workflows and found that having one reading and sign-out room in the center of the lab worked well. Factors for ergonomic workflow to consider when establishing a reading and sign-out room include lighting, furniture selection, temperature control, noise reduction, technology integration, organization, and accessibility.

Dr. Yousif also discussed the crucial role of case management workflow and phased service rollout in facilitating the smooth integration of digital workflows. He also touched on the importance of effective communication with stakeholders before project commencement and throughout the project, comprehensive training for faculty and staff transitioning to digital pathology, and robust quality assurance measures to ensure the accuracy and reliability of digital pathology processes.

Dr. Yousif, Assistant Professor and Director of Digital Pathology, University of Michigan.

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Christos Evangelou is a Medical Writer at Pathology News. This Report from the 1oth Digital Pathology & AI Congress: USA is reproduced with permission and thanks.