Pathology informatics is a growing subspecialty that will become even more crucial in the future, according to experts.
“Pathology Informatics is a discipline where informaticians select and deploy technology, such as whole slide imaging, laboratory information systems, or business analytics solutions to name a few,” says Mark Tuthill, Division Head of Pathology Informatics at Henry Ford Health in Detroit, Michigan.
The impact on patient care
Pathology informatics can feel like an “invisible” specialty because it doesn’t involve as much direct interaction between providers and patients, even though it is crucial to patient care, according to Ulysses J. Balis, MD, FCAP, FASCP, Fellow AIMBE, Associate Chief Medical Information Officer, Professor of Pathology, and Director of the Division of Pathology Informatics at the University of Michigan.
However, it is crucial to “closing the loop” in patient care after tests have been ordered, Dr. Balis says. “It’s really important that the delivery of pathology care is concluded when you’ve completed the loop, and ascertained that the person who asked for the information not only received the report but then understood it and acted upon it appropriately.”
This relatively small but quickly growing subspecialty of pathology is continually changing, with new trends tending toward a greater adoption of such aspects as digital pathology and artificial intelligence (AI).
Perhaps the most promising trend in the specialty, says Dr. Tuthill, is an increased awareness of the role of pathology informaticians in general. “[Laboratories] are just recognizing that without this type of resource and talent pool, they really can’t move their labs to the next level.”
Another positive change in the field, is a greater increase in diversity, according to S. Joseph Sirintrapun, MD, FASCP, Director of Pathology Informatics and Associate Attending in Pathology at Memorial Sloan Kettering Cancer Center. Over the years, he says the field has been “largely white male,” but he has seen more trends for inclusivity, including more people of color, women, and younger people. “There’s been a lot more enthusiasm, a cultural shift, and an inclusive shift,” he says. “My role is to make sure this continues, that we always have a steady stream of a wide variety of thoughts, people with agile minds, and making sure it’s sustainable,” he says.
Changing government regulations
Recent government regulations are also driving healthcare in general toward great adoption of technology. 2008’s The HITECH ACT of 2008 brought the Meaningful Use rule, pushing clinicians to adopt electronic health records (EHRs) and the 2020 CURES Act urges interoperability of healthcare systems, driving a greater use of information technology, according to Dr. Tuthill.
“I see these laws as a continuous thread that drives what we do with information technology and what pathology informaticians need to be aware of,” Dr. Tuthill says.
Increased use of analytics
Laboratory scientists and directors are beginning to rely more on analytics, or the ability to pull data out of systems and use that data to drive business activities, be that laboratory-based data, or lab data combined with EHR data, Dr. Tuthill says.
“Obviously COVID-19 had a huge impact on this because labs provide the data that let the hospital know who they can work with, who was affected,” Dr. Tuthill says.
Dr. Tuthill envisions that with AI and machine learning capabilities becoming more sophisticated, the next phase of analytics will be predictive analysis that determines future trends and better predict outcomes.
The COVID-19 pandemic also forced a swift and radical pivot for laboratory professionals when it was not safe for them to come into hospitals to do their work. More pathologists were able to do remote sign-out of cases, which had a positive impact that Dr. Balis hopes will not be reversed.
“As a specialty we’ve demonstrated to ourselves that [remote sign-out] can be done safely and effectively. I think it cemented in the minds of many pathologists that it’s doable and convenient,” Dr. Balis says.
Dr. Sirintrapun agrees and suggests that remote sign-out will provide future opportunities and access. “We will be able to democratize digital pathology more, where you’re not stuck in one location. You’re able to sign out cases in different areas and you can create different business models, different efficiencies, and different optimizations, and work to serve underserved populations.”
Digital pathology is a trend in its infancy
Digital pathology is also proving to be more essential than ever, such as whole slide imaging and image analysis, which are driving what Dr. Tuthill calls “computational pathology”—“Basically the idea that pathology can no longer be purely subjective but can leverage rigorously analyzed data that can be operated on by a computer,” he explains.
He sees that molecular and digital pathology, business analytics, and computational pathology are all interrelated and will become more so. “You could not do modern genotyping and phenotyping molecular sequencing without the computer.”
“Fundamentally, pathology informatics improves quality,” Dr. Sirintrapun says.
Of course, every laboratory director will have to determine the value of increasing these technologies in their labs, Dr. Tuthill says. While lab directors may resist such things as digitizing their slides, due to the big output of time and money, without utilizing these forms of technology, Dr. Tuthill says a laboratory will have a tough time leveling up.
“Digital pathology is really the prerequisite to whole slide imaging, which is the prerequisite to using AI in surgical pathology,” Dr. Tuthill notes. “So, if labs want to get to that endpoint, they have to walk the entire walk.”
AI is becoming more prevalent
If laboratories are unsure about adopting AI, Dr. Tuthill explains that most labs are already using some form of it or won’t be able to stay away for long. “People don’t realize that inside your CBC analyzer there are algorithms and AI operating that help you quantify the lymphocytes and the amount of blastocytes and whether you need to do a manual differential, and so on. The same is true in molecular pathology.”
AI will become more crucial to imaging and pathology, particularly surgical pathology and histopathology, he says.
“AI will help to overread slides and make sure that pathologists don’t miss things. These tools are becoming primetime and will really assist pathologists,” Dr. Tuthill says.
He adds that AI can help “determine measurements and values that you couldn’t otherwise make with the human eye, so we’re using AI to predict a lab value that otherwise wasn’t measured.”
With greater use of AI and other technologies, comes a greater need for clinical informaticians to drive innovation, says Dr. Balis. “If you have a cohort of suitably trained informaticians within pathology and laboratory medicine practices, those individuals can serve as the change agent translators of new ideas into something that can be clinically actuated.”
Slow to grow
Of course, finding suitably trained pathology informaticians is difficult due to a lack of programs and fellowships in the specialty. Though the trends are promising and worth getting excited about, Dr. Tuthill warns that there is still a dearth of pathology informatics representation in medical school and training, with fewer than 20 informaticians graduating each year.
Dr. Balis also worries that without more pathology informaticians to handle the evolving needs of the specialty, the future of informatics technology will wind up in the hands of other data scientists outside the field and be “dumbed down to the common denominator.”
Without devoting the proper resources to expanding pathology informatics, he warns, “The victim here will be innovation and the pace of improvement.”
A need for pathology informaticians
Informaticians will be necessary to interpret the new kinds of molecular assays coming on board, Dr. Sirintrapun says. “Because pathology informatics is transforming so quickly with all these different technologies, you need informaticians who have the skills to make these things happen. Otherwise, we’re just not going to evolve.”
Dr. Balis agrees that there needs to be a greater effort made to spread the word about the necessity of pathology informatics in medical school and beyond. “I want to underscore how important [pathology informatics] is to everything we do in the laboratory, and it will be even more important for the laboratories of the future,” he says.