AI’s GROWING ROLE IN THE FUTURE OF PATHOLOGY W/ Adam Cole and Jason Camilletti

In this episode, I interview Adam Cole, MD and Jason Camilletti, two innovators who are pioneering the future of digital pathology. Adam, an anatomic pathologist and CEO of TruCore Pathology, and Jason, CEO of PathNet Labs, bring unique perspectives from their military backgrounds to their leadership in transforming pathology using digital tools and artificial intelligence (AI).

We delve into how AI is reshaping the way pathologists work, making diagnostics faster, more efficient, and more accurate. Adam shares his journey from being a traveling “mobile” pathologist, driving an RV across multiple states to deliver pathology services, to transitioning his entire practice to digital pathology. His personal experience highlights the challenges of traditional methods and why going digital was not just a choice but a necessity for improving patient care. Jason complements the discussion by explaining the operational and logistical hurdles labs face when adopting digital tools and how PathNet Labs is helping pathologists overcome these obstacles.

• Overcoming the fear of digital transformation: How resistance to change is one of the biggest barriers, and why it’s crucial to embrace new technologies.
• Adam’s “mobile” pathology journey: From traveling across the US to read glass slides to fully digitizing his practice, Adam’s story showcases how digital tools can enhance both work-life balance and diagnostic efficiency.
• AI’s role in diagnostics: How AI is improving diagnostic accuracy by helping pathologists quantify tumor volume, predict patient outcomes, and assist with real-time collaborations between experts.
• Improving patient care through digital pathology: We explore how digital pathology enables faster turnaround times and better collaboration, ultimately leading to more accurate diagnoses and better outcomes for patients.

In the final part of the episode, we discuss how AI is not just about automation but also about enhancing the pathologist’s role by providing new insights that were previously impossible with traditional methods. We reflect on how digital pathology is transforming patient care by enabling real-time collaboration and faster, more personalized diagnoses. Adam and Jason’s stories underscore the importance of embracing change and how TrueCore Pathology and PathNet Labs are leading the way in bringing digital solutions to the forefront of pathology.

This is a powerful conversation for anyone interested in the intersection of technology and healthcare. Whether you’re a pathologist considering the switch to digital, or just curious about the future of AI in diagnostics, this episode offers practical insights and real-world examples of how digital tools are already improving patient care.

• Contact PathNet
• Contact TruCore

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Jason: [00:00:00] There is one impediment to going digital, and that is fear of change. The cost to go digital is not insignificant. In fact, it’s actually more burdensome on our great lab employees. Anyone that says it’s more efficient in the lab space, they haven’t done it, or at least I haven’t seen it. Well, we have to find a way to cost share that burden because again, most of the upside is with the pathologists.

In terms of increased efficiency. So to me, fear of change is that, is that number one. And so you don’t get over that fear and say, Hey, this is what I’ve always been paid. And this is how it should work. Then I don’t think. You’ll get there intellectually because the cost is there.

Aleks: Welcome, my digital pathology trailblazers.

Today I have a special episode because I very rarely have two guests at a time, a true digital pathology implementers,  working digitally and the advanced [00:01:00] that digital pathology as a discipline, actually across the U. S.  I have Dr. Adam Cole, the,he’s from TruCore Pathology Group, powered by PathNet, and I have Jason Camilletti, the CEO of PathNet Lab.

Welcome gentlemen, I’m so happy to have you here. How are you today? 

Adam: Great, thanks for having me. 

Jason: Yeah, it’s great to be here. 

Aleks: I’m gonna be, I am, I need to like manage this conversation and ask exactly to which person I’m, I’m asking my question. So,  we always start with our guest.  Adam, let’s start with you.

What’s your background?  what is your current role? Tell the listeners a little bit about yourself. Don’t reveal the full story. Yet, because it’s going to be our next question. There’s an interesting story to this particular guest. 

Adam: Yes, ma’am.

My name is Adam Cole. I am an endodermic clinical pathologist.

I am the founder of TruCore [00:02:00]  Pathology.  Like you mentioned, fully digital. We’ll get into that in a second. I’m also a colonel in the, United States Air Force Reserve and the commander of the Full Force AMDF up at,  joint Base Lewis-McChord. 

Aleks: Okay. So,  Jason, what about you?

Jason: Hi, Jason Camilletti, A lot of people call me Vasco.

That is my call sign from when I was in the military. I’ve been the CEO of PathNet since,  summer of,  2022. Now August 1st to be particular. Or to be specific. And prior to that, I was a active duty Air Force for 23 years, career fighter pilot, moved all over. In fact, my last four years in the Air Force was,  serving in the United Kingdom, where I was the, base commander of the largest U.S. fighter jet mission,  in all of Europe and Africa. So,  the natural progression from being a fighter jet pilot [00:03:00] and military base commander is to jump into digital pathology. 

Adam: I got my plug in first before he got to say his. Mine doesn’t sound the earliest impression. 

Aleks: Oh my goodness, this is,  a very non-standard background.

Adam: Me and Vasco have known each other though for 15 years. We were both captains together back in tropical Holloman Air Force Base in New Mexico. 

Jason: Sunny, Alamogordo, New Mexico. That’s right. We were betting down,  a fifth generation fighter called the F-22 Raptor. And,  I was the only Captain Flyer, and Epic was the only Captain Doctor, and there weren’t, and there weren’t, there weren’t many of us,  there, but,  we hit it off there, despite, despite each other, and…  

Aleks: I feel like I’m in a movie, I feel like I’m watching Top Gun or something. 

Jason: Well, my wife always tells me the movie’s better than reality. 

Aleks: Oh my goodness, [00:04:00] 

Jason: But yeah, we’ve, we’ve been good buds ever since, and,  I never thought I would get out of the military, but when the decision to leave the military was there for my family,  Adam was one of the first people I reached out to, and before you know it, a couple of things,  bounced right away, and here we are.

Adam: Before, before you press on that, I mean, the fact that his beautiful bride…

Aleks: Keep, keep talking about it, because I’m not gonna have this on the podcast ever again. 

Adam: The fact that his wife, Meredith Cammelletti, says the movie is better than real life and see I’m a back theater guy and in the movie Goose died And that’s better than real life.

So I don’t know how to take that actually. Mary and I are going to have to have a conversation. This is terrible. This is all relevant to digital pathology as well. We should probably dive more into that. 

Aleks: It’s fun. I have a bunch of questions for you. So let me just tell you one thing. I once had Dr. David Clooney, he’s the DICOM person.[00:05:00]

In the medical society, he’s a radiologist and he has a helicopter. And I thought that was super cool.  But you guys topped his helicopter right now. 

Adam: Crashed a helicopter. I crashed it out at Alamogordo. Like we took an Army Air Huey down, but that’s a crash with me in it. 

Aleks: Oh my goodness. 

Jason: Aleks, I’m here to tell you a helicopter is an unnatural occurrence.

You know, that thing doesn’t fly. 

Aleks: I’m going to share this podcast with,  David Clooney. So then you guys can continue this conversation offline, especially when you want to like integrate DICOM in your,  you know, image sharing or everything. And you’re going to come across him if you haven’t already.

Adam: Perfect. 

Aleks: It’s gonna be a good conversation starter. So,  okay, now focusing on Adam.  When, so when I was interviewing Dr. Matt Levitt, I learned about your early days. And I also learned that, like, all the digital pathology people are interconnected.

So, he told [00:06:00] me that you were providing pathology diagnostic services, you were traveling non-stop around Arkansas to read Glasslight and sell that cases, and your main, like, place where you were staying or traveling in was a van.

Could you share that story with us and how was it like to be such a mobile pathologist? Like, I don’t know. Tell me about the mobile home. Did you sleep in there? Was it just your vehicle? How far did you have to travel? And,  yeah, how did this then maybe later motivate you to read a digital flight rather than glass?

If you want to serve more people than just one location? 

Adam: You bet. You bet, Aleksandra. It sounds better when you say recreational vehicle, RV, than van. Okay. When I hear van, all I can think of is Chris Farley down by a river, but I was one step north of that, but it was, it wasn’t bad.  so the deal was, [00:07:00] I started TruCore in 2015 and,  had one client at Arkansas Urology and one thing they asked me to help with was the, you know, this is almost 10 years ago.

And so the predictive and prognostic biomarker space was just kind of all over the board, just kind of getting its feet within prostate cancer and trying to identify these tests as far as who was going to be, you know, who’s appropriate for active surveillance or not. And so there was, I mean, there’s still the same three big players that there were at the time in the positive space.

So Oncotype or GPS, Prolaris and Decipher. And so they asked me just to kind of come up with a, like, pathologist input and help on deciding on when these tests might be appropriate so we weren’t over utilizing the test. So I did that, and then word kind of spread down to Dallas that,  hey, this sort of one was available.

And so this is, like you mentioned, this is pre-digital, so yeah, twice a week. I was reading maybe one month, Monday, Wednesday, Friday of Little Rock, Tuesday, Thursday in Dallas, and then the next week  [00:08:00] I would do Monday, Wednesday, Friday in Dallas, Tuesday, Thursday in Little Rock, and just driving back and forth.

Aleks: So how far away were these places? Like how much…

Adam: As a five, I can tell you exactly. It’s a five hour, it’s a five-hour drive down there. So it, and you know, it was, I was sometimes down there. 

Aleks: So like, every other days, other day your commute was five hours? 

Adam: Well, it would depend. Like, sometimes I would fly in the middle of there, and so I would go down, like, if I was spending at Dallas, I would just drive the van, the RV down there, and then I would spend kind of the week there, but I would fly in to Little Rock in the morning, drive over, you know, read the cases on glass, and then get back on a flight, fly back to Dallas, then drive around Dallas, because there was five clinics in Dallas, you know, all over Dallas, and so I would have to just kind of make that loop.

Driving to all the different clinics. There was a Tech 26 thing, so it was a TPC-PC-PC split kind of deal. And, you know, but I was trying to help the guys as well. [00:09:00] Like, it was beneficial for me. And we had maybe an idea where pathologists could help on the molecular side. And the urologists really liked it.

Like, they, and still do. Like, they still like having pathologist input as far as, so we’re not over utilizing those tests. But it didn’t take long doing that, maybe a year, 18 months of doing that where man, I, I cannot keep doing this. This is, this is a terrible lifestyle. So, that’s when the digital thing really kind of hit.

And so we went fully digital in the, in 2016, just really as a way I, like I say, I always tell, I wish I had the vision of foresight to say that I can see, you know, where digital pathology is gonna take us from an AI standpoint and all of that. But at the time I was just tired of traveling. I was, I was lazy, so, the guys you know…

Aleks: This is a motivation good enough, and I mean, digitization is the first step. And if you have a strong driver going digital, then you can like, I’ll do that downstream things and without even knowing that they exist. So did you like this RV? Was it something like the American camper vans that you can sleep in and you are using it as your like place of staying and then driving to the clinic and then reading there?

Jason: Aleks. It was not that nice. You know what he said? What he said? 

Aleks: Oh, not the camper van, not the American camper van. 

Jason: Wait, when he says a step up. By, I’m by the river. I mean, we’re talking a small step. 

Aleks: Do you have pictures?  

Jason: We, we could, we could show you some pictures. 

Aleks: If you have pictures of them, I’m gonna include them in the video if I can. That would be so cool.

Jason: When this was going on, you know, we’re on a text thread with a bunch of our fighter pilot buddies from,  from Alamogordo, New Mexico. And it was one part sheer hilarity. Just pure comedy. Here it is RV travel. And then the other part was like, man, he has some amazing pathways and exploring digital, you know, [00:11:00]  breaking barriers and digital pathology.

So, you know, that’s the one thing, the enigma that is Adam Cole, like both hilarity and just pure brilliance. 

Aleks: I know. Like, can you imagine, oh, my pathologist is the one, he sleeps in that,  RV. 

Adam: My cousin Eddie, just one step above my cousin Eddie in National Lampoon. 

Aleks: But see,  18 months of,  driving an RV and digital,  transformation happens. It was totally worth it. 

Adam: It’s fine. 

Aleks: So, thank you for doing that. 

Adam: My pleasure. I don’t want to go back. 

Aleks: No, just for recreation, not for work. 

Adam: That’s right.

Aleks: About TruCore and PathNet, your vision and mission for those two organizations. Let’s talk about it right now. So, what drove you to start this company and how are they changing the game in digital pathology?

And I would start with like, how are they different and similar and interconnected because we have. And Adam, you’re PathCore and Jason is PathNet Labs. How do you work together?  You can pick who speaks first. Let, let, maybe Jason, because Adam was… 

Jason: Adam, do you want to go with how we got here? I can say how we are? Existing today? 

Adam: Sure, yeah. When it’s one person and you’re just trying to kind of figure this out, which it was… 

Aleks: You guys are the best. You like to self-organize yourself. 

Adam: It was great. It was, it was not very organized. It was,  it was pretty rough there at the beginning.  you know, because it really was just me and like you mentioned, I was driving around doing all these different things and then we’d go fully digital and so I was actually using a lab out in Lehi, Utah.

It was kind of our sister lab,  that was helping furnish me the digital technology piece. I didn’t have a lab, I didn’t have the scanners, and I didn’t have any of that stuff at the time. And so, like [00:13:00]  you mentioned, Matt Leavitt, I met Matt Leavitt and his team at a conference up in Chicago, saw what they were doing, and one, it was readily apparent that this was a better mousetrap for prostate cancer and preserving tissue and all the things.

But it also got around a big issue with digital pathology, which is storage. And so if they were able to get six cores per slide, and you only had two slides with three levels each, That’s a very different than having, you know, 12 slides or… 

Aleks: Yeah, even if you have even without digital. So I’m going to just interrupt what we’re talking here about is,  a little device, like a little cassette that,  that Lumea’s product where instead of putting one, prostate biopsy core per slide and per block, you put six of them, right?

So instead of having six slides to look at, you just have one slide with six pieces of tissue. So,  even, in an RV, it’s a lot less, baggage to, to travel with if you took prostate. [00:14:00]  Yeah, no, it was game changing from the digital at the time. Remember these scanners were not GT 450s. They’re like, these were slow scanners.

They were not high throughput. So we, we’ve advanced a lot, you know,  on the scanner side as well, but it was taking quite a, so if you had to, if you were doing four minutes per slide and you had 12 slides per case, I mean, that’s almost crippling to the point where you can’t use digital. And so being able to condense the number of slides you were scanning as well as the storage fees and everything like that was, was pretty monumental.

So. You know, I’m in Arkansas, and so at the time,  I just started TruCore, which was a PLLC, remains a PLLC, so it’s entirely 100 percent doctor owned, but then as you’re… 

Aleks: Meaning it’s owned by you, right? 

Adam: It is, but it’s comprised of, like, from the, from the only people who are in TruCore are doctors, are pathologists. And so, but you know, it’s not long as you’re growing and you realize, while you may be good [00:15:00]  at diagnosing cancer, you actually don’t know the square root of zero when it comes to running a business, and how to bill and collect and, h.r…

Aleks: That’s another, another learning curve. 

Adam: Yes. You don’t know any of that stuff, right?  And so we really needed a management services organization, and that’s what PathNet kind of provides, and the laboratory and all that stuff. And so with that, I will kind of pass it over to one each of Vasco. 

Jason: Yeah. So on the MSO side, Matt Levitt’s vision for PathNet is exactly what it says in the title, network of pathologists.  You know, the reality is, is while we believe TruCore is the best on planet Earth, we are willing to partner with others. And, we, we have been talking to others and we service some, you know, in a limited capacity, but, but we look, continue to look for further partnerships. But the idea with PatNet is, you know, we can, whether you’re a single pathologist [00:16:00]  or a group of pathologists, we’re We can help you go digital, you know, because the cost to go digital is not insignificant.

Not everyone can afford one of those big scanners, etc, etc. Not everyone knows how to bill, like go down the list. We provide, PathNeth can provide the full array of those services. 

Aleks: Amazing. Okay. So are you like, because from my previous episodes and from talking to Matt and I’m going to link to that episode as well for everybody who didn’t listen to it.

So, would it be safe to say that PathNet is like the kind of business support and digitization support for pathologists who work with you? 

Jason: Not only would it be correct, you get the gold star. 

Adam: Fair enough. 

Jason: In fact, if you go to our website, you know, we have, PathNet has a website. TruCore [00:17:00] has a website on the PatNet website, it’s going to say something along the lines of moving pathology forward with turnkey digital and business solutions.

So, so you, you nailed that. And then on the TruCore side, we get, we get much more specific Army physicians with precision medicine to personalize each patient journey. And that’s what, that’s what Adam and his doctors are focused on. And at PatNet, we certainly care about the patient. Leaving the military, I felt like I was doing something meaningful, and there were lots of job opportunities, and when the idea to come in here, partner with my buddy, to take the fight to cancer, man, that is, that was an easy hook for me, you know, so,  we, in both companies, both organizations, we, we, we care very much about,  delivering the best possible patient care,  to the patient and their families.

But,  yeah, you see that distinction there, [00:18:00] as you just said, Aleks. 

Aleks: I very much believe that digital pathology is not just, you know, a fancy way of doing pathology, but it increases access to care. So that kind of brings me to my next question. Next question.

How a TruCore and PathNet using digital pathology to change patient care. And if you have any specific stories or outcomes that really highlight the difference you guys are making, because you are making a difference. And let me know about these as well. I want to know how it affects patients and especially like already starting with you, Adam, like driving all around to places that didn’t have pathology services and now taking it into the digital world.  Yeah, tell me about what it is, how you do it, and what’s the scale. 

Adam: That is a good point. Digital pathology is already saving lives. Because if I was still doing that, the world would be minus one each in epic coal. Like, there’s no way I could have kept doing this. [00:19:00] But, I will say, I’ve been saying, like, to your point, as the population continues to age, and we’re doing more and more biopsies, the number of pathologists continues to dwindle.  We’re going to have to find ways to utilize it. 

Aleks: Oh, wait, It’s like the coolest, coolest specialty. 

Adam: You’re preaching to the choir. 

Aleks: Right. And I only talk to pathologists were we are pathologist.  But like it’s cool. 

Adam: But I’ll tell you a quick story. My, you know, so I was the first physician in the family. And so my grandmother, bless her heart, Catherine Cole up in Chillicothe, Missouri, when she found out her grandson was a doctor, you’ve never seen anybody more proud.

She was bragging to everyone. She is. She told all of her friends at Bingo, at Church Bingo, and like the whole thing, like everybody was excited that her grandson’s gonna be a doctor. And then, the opposite of that, when I, when I showed up and said, yeah grandma, and I think I’m gonna be a pathologist.

You’ve never seen anybody so crestfallen [00:20:00]  in your life. She was heartbroken. He was like, I, what am I gonna tell everybody? Like, what do you mean, what are you gonna tell everybody? Just tell them I’m a doctor. Yeah. But right. You, you don’t wanna be a real doctor, 

Aleks: But I’m gonna ask what kind of doctor. 

Adam: That’s right. I can ask her a doctor with, I was like, no, it’s a real doctor, grandma, you know? But she was crestfallen. She’s like, well wait. Then, then there was like a spark of hope. She was like, well, are you gonna be like Quincy MD? And it’s like, no, I’m not gonna be, I don’t know who Quincy MD is, but it was her TV show on in the 70s where this old pathologist lived on a boat, same as ago, but he would, solve murders.

Aleks: Oh, okay. 

Adam: That was gonna be okay, but me just being a regular pathologist, that was so, that was so far from my grandma, but to your point, like, I think it’s a great specialty, and I think it’s becoming more and more exciting, especially with the quality of life, that’s a big, that’s a big initiative for the younger generation, so.

Aleks: You know what, I, I didn’t see it yet, but it, like, kind of, what I did,  I’m a veterinary pathologist, [00:21:00]  and I, went to vet school and decided, okay, let me work at the like clinician as a vet for a couple of years before I do, further education to my PhD and decide on specialization. And yeah, three years in practice, was enough to send me on the pathology course.

I briefly entertained doing horse medicine, but then I started my, internship at the pathology department and I called the horse clinic and I said, you know what? No, I’m not coming. I’m just staying in the department. 

Adam: Those slides never complain. They’re just sitting there ready to be looked at, right?  Nobody’s, nobody’s getting a biopsy because they want a work note or anything. Like, they’re actually worried about something if they’re getting a biopsy, but. You know, to the point being.  I lost my father to bladder cancer a little over 10 years ago. And so, we’ve all, like Vasco’s big on, you know, pointing this out.  If you haven’t, you know, you personally have not been touched by cancer, [00:22:00] you can just guarantee you’ve known someone who has been touched by cancer. So, it’s one of those deals where it’s easy when we’re in our little bubble, you know, and we’re seeing the same thing every day, where it becomes a little bit routine.

But to each one of those patients, right, it’s not just you’re affecting that patient but it has a ripple effect to their family, their friends, like, so you are affecting family when you’re rendering one of these diagnoses and so the days from when they get that biopsy to when they get the report, those are long days.

One of the benefits, I think, of digital pathology that we’re able to harness is we can decrease turnaround times. Obviously, we can look at several cores at a time. We have artificial intelligence, which we can talk about later. But then you can also, a big piece, you know, when we’re digital, we’re not necessarily always going into an office where there’s a congregation of, there’s nine pathologists with power.

We’re not all sitting together in nine, but we have access to all nine all the time. [00:23:00]  So when I need another set of eyes, All I have to do is send out a text message to say, Hey, can you guys look into this? You know, like, I’d like to get your opinion on this,  this case, and then everybody can kind of login.

We can look at it all in real time and then we can come up with a consensus diagnosis to include,  even outside that. We have organizations that are able to log in at the academic centers to take a look. I’ll give you a quick example of where the,  the paid dividends.  one of my client, we have clients kind of all over the country, but.

Neurologist called me and he goes,  Hey man, I’d like to get a second opinion, on this case. Patient would like a second opinion. I said, okay, no problem. Where do you want him set? He said, you know, whether it’s Hopkins or Cleveland, wherever they want it, MD Anderson, doesn’t matter to me. I said, okay, but before you do this, man, just so you know, we’re able to look at these things real, real time.

And the guy goes, oh, that’s good news because the patient is a pathologist. And I’m like,  [00:24:00]

Aleks: Oh. He wanted his own second opinion. 

Adam: Yeah, so I go, okay. He goes, oh, not only that, his son is a pathologist. Okay? And so I was like, all right, here’s what we do.  Send those, the patient, send them my contact info, we’ll get together.  I’ll get a Zoom going. And so I was able to Zoom, real time, with him and his son, both pathologists, and go over his wife. And starting at that call, They were determined. He did not want treated. He just wanted to be on active surveillance, by the end of that call, and we were going through all the different features, man.  He was ready to get the kitchen sink. He was like, and I was like, do you guys still want a second? He’s like, absolutely not. And the thumb like that, you know, you’re getting treated. He’s like, I know, I know, you know, they’re kind of going back and forth, but they were like, it was. I had not actually seen that, like, digital pathology transform, like, somebody, because it would have taken us weeks, you know, to, to get a second opinion to come back and then they’ve got to talk to the urologist and where to go [00:25:00]  and all the different brains.

We had it done that afternoon. 

Aleks: That was amazing!

Adam: So, I mean, that’s an in-on, but it happens. I talk to patients quite a bit about going over their slides when they just feel more comfortable talking to the actual pathologist. 

Aleks: Yeah. And I’ve heard,  this, being done on a routine basis in DermPath. I interviewed,  the CEO of pathology watch and this is how they operate. They like the dermatopathologist, the the pathologist,  dermatopathologist, evaluates the slides and the dermatologist get them, can show it to the patient on the tablet. So that’s like another level of,  like everybody gets their X-rays, right? You, you go walk around with your cd, you’re bringing it to the next,  radiologist or whoever is evaluating you.

Nobody does that with pathology slides. Why not? I mean… 

Adam: That’s a great point there is, I don’t… 

Aleks: We have the, the means right now, especially if you then, like in the US the population is a pretty [00:26:00]  mobile population, so you’re like, health record, don’t stay in one place. Even so me, I’m just now going to a different radiologist for,  my knee. I just take my cd, right? Because this one is like 20 minutes closer. I don’t wanna wait, I don’t wanna,  drive 40 minutes.  So this like giving different levels of empowerment and obviously your,  story is an extreme case because you were talking to pathologists who, totally understand the tissue, but, this, like empowerment to get a second opinion is something that they think a lot of patients are super intimidated and the process of getting all the materials, even if they are like brave enough and determined to get a second opinion is even more intimidating. So with digital, yeah, go and have a second opinion. Why not? It’s over hell. And keeps, I think it just elevates the standard for everyone. [00:27:00]  So digital,  makes that possible. 

Adam: Well, I think, you know, what’s important to remember, I think exactly what you’re talking about, but to get it, I’m all in favor of more eyes looking at it.

So second opinions, and it used to kind of wrap me around the axle. You know, if we would disagree. Because the natural tendency is to think well, you got a second opinion, so the second opinion guy is right. And that, actually, there’s no studies to back that up. It’s just the most recent opinion. And so everybody’s like, well, it’s the second opinion.

Actually, it’s just another subjective opinion that is being rendered on a very small amount of tissue that’s been sampled. And so to your point, like finding a way to remove what we’re really trying to do is just get to the meat of the question, right? So is it, is it good or is it bad as from a cancer standpoint, where, where are we in between?

So finding ways to insert like purely objective data into that space, I think that’s really where digital pathology is going to outshine what has been the established standard coil. Like it, it honestly doesn’t care, right? [00:28:00] Like it’s operating under the same criteria each time in order to upgrade or downgrade cancer.

Or so I think. I think, honestly, I think that’s going to disrupt the space when it comes to second opinions. At least I’m kind of hopeful. Not that I have anything against second opinions. But I think we can do better. Maybe we get a second opinion that also includes artificial intelligence to interpret and interpretate.

Aleks: Yes, and I can,  so I’m going to link to another episode I was talking to Raj Singh from Path Presenter and he, he, he like is super prolific with the Path Presenter software and like every single like area that digital pathology can improve pathology and care. He has an app for this, like, I don’t know how he does that, but he does have an app for second opinion and, and there is a specific episode on that and it’s going to be disrupted.

I, I totally second your,  your thought on that. So I assume PathNet helps,  do that at scale. Jason, what’s your take on that? 

Jason: Absolutely. Yeah. 

Aleks: So where do you,  geographically, where are your pathologists, serving patients? How widespread are you in the U.S.? Are you also or thinking or outside of the U.S. or?

Jason: Aleks, we’re in about 30 states right now,  serving clients in 30 states and,  again, to Adam’s point earlier, our clients, or, or, or pathologists can be anywhere. And, you know, assuming,  you know, the time zone is not the,  you know, is not a hindrance. Other than that, it is real time second opinion collaboration like that, which,  is one of the reasons,  you know, we have such a,  high cancer detect rate, you know, much higher than,  than, than the national average.  So, yeah, so clients in 30 states. 

Aleks: Amazing. So you can, like, set up the, time zones [00:30:00] of your pathologists and strategically send them cases so that you actually, like, can be in operation for, rendering diagnosis 24 hours a day. 

Jason: That’s true. 

Aleks: And now you’re talking. 

Adam: That is the problem with, you know, like, with the digital is that you’ve got a CEO who’s just cracking the whip saying you got to get more of these in and out.

But, I mean, it’s not, If you have, you know, like if you have Wi Fi and you’re in your clear certified space, I mean, there’s really those lines are loaded nonstop all throughout the day and night. So, you know, it’s, it’s nice when you have some down time and you’re like, Hey, I can check in and I can just keep whittling those down, keep knocking those down.

I can get the stains ordered when the stains need to get ordered. So those can get cooking. So, we’re constantly trying to drive that turnaround time down. In particular, we’re ordering molecular as well on behalf of the urologist, because the goal is, you know, like we mentioned before, those are long days. [00:31:00]

If we can get that pathology report back to the clinician so they can talk to the patient, and then ideally, if we’ve started that molecular train as well so that they can get the molecular results back before that patient comes back for their initial post biopsy consultation, that I mean, for a much more robust conversation, you know, it’s one thing to say, bad news, you got cancer.

And let’s be honest, right? That’s the last thing majority of patients are going to hear. And so if, but if you can caveat that with bad news, we’ve got cancer, that being said, we work with our pathologist, they order these molecular tests, and it looks like this is going to be the end of the type of prostate cancer, one that we can just watch.

I’m not terribly worried about that. That’s a totally different conversation versus. Hey, you got cancer. What do you think? We should get one of these molecular? And the patients, most of the time, are like, I don’t know, doc, you know, we should get a molecular. And so, they order it and it takes 30 to 60 days to get that result back.

Man, those are long, that you’re waiting on this molecular. And a lot of times, I shouldn’t say a lot, but 5 [00:32:00] – 10 percent of the time, it’s going to come back and say, quantity not sufficient. There’s not enough tumor RNA present to generate a result. So for 30 days, this poor patient’s… 

Aleks: been waiting for nothing… 

Adam: Yeah, you know, and now they’re back to square one.

They say, well, what do we do? Oh, I guess we’ll revive you, you know, six to 12 months and see what happens, man. This there’s a better way to skin this cat and I think that’s where digital can really help us. 

Aleks: Definitely. And also like,  cancer is such a huge, like it encompasses all those entities and in the,  like the common sense of this word, it basically is like a death sentence.

And if you can, it’s still like super loaded, I mean, we’re a pathologist or in the pathology space. So,  the first thing when somebody tells me, Oh, this and that person had cancer, I’m like, what kind of cancer? But you should not ask that. It’s like an impolite question. 

Adam: I do the same thing though. 

Aleks: What kind of cancer, right?  So I had thyroid cancer  [00:33:00] and thyroid cancer is like, it’s not even classified cancer anymore. Like several of these subtypes are not called cancers anymore.  Anyway, so that’s my question. But for a patient with a totally,  different reality, and if you can be armed with the information that can actually like,  lead the conversation into, okay, there are different options than dying.  You, you’re gonna be fine. We can watch, we can do whatever. So… 

Adam: Absolutely.

Aleks: We mentioned AI couple of times. Do you guys use ai? Are you thinking of using AI and how are you doing it or thinking of doing it?

Let me know. 

Jason: Epic, I’ll take the first swing and then I’ll let you add a little more color. So, Aleks, we’re, we’re using AI, we’re thinking about using AI and we’re gonna continue to use AI.

So,  so, so we had some great ai…

Aleks: you’re my kind of people. 

Jason: So we, we have some great AI [00:34:00] partners that a little over a year ago,  you know, I sat here and I’m like. I’m here and, you know, and at this point I’ve been here, not even a year and, I’m, I’m here and, oh, we got this partnership, this partnership and, and, and as I’m hearing the relationships here, I’m like, teammates, we’re giving away a lot for, for, for no reason, you know, whether that be, access to our platform, whether that being access to our doctors and all that, and because what, what clued me in was the thought that, you know, those algorithms do a lot, and again, we are, we are partnering with several folks that we, we like what they offer, but the reality is, is you have to have access to digital tissue for those algorithms to run.

And then I realized, like, we are in a much better position than most laboratories in the country because, I mean, we’re, we’re sitting on millions [00:35:00]  of digital tissues of standardized data right now, you know, so just, just think about that. And, so what we have done is we continue to, kind of push the envelope with, with some of our AI partners and make sure that they know that we are bringing just as much to the table, if not more than they are.

And that’s been a really, really fun and exciting year for us this past year.  Adam, do you want to put a little more meat on that bone? 

Aleks: If you can mention the partners, that would be great. And like how you set up a partnership,  that would be fantastic. 

Adam: Yeah, I’m happy to.

I mean, from, from our standpoint,  on the DI, I mean, you have three main types of artificial intelligence.

Everybody, it’s just like you take cancer, everybody does it again, but actually. 

Aleks: Everybody says AI. 

Adam: I’m from an AI standpoint. You’ve got, you know, three main types. So you got diagnostic, which is what I think most people think of when they think of AI. 

Aleks: Yes. And that’s what they’re afraid of. That’s like, oh, it’s going to take [00:36:00]  our jobs away.  And is it going to be as good as the doctor or not? And how will we check? Because it’s going to be diagnosing us. 

Adam: And I, I understand that, but I, I, but I don’t necessarily subscribe to that fear. I think there’s always going to be a pathologist engaged, I think, AI, you put it on the diagnostic side. 

Aleks: I think if you have enough, like, understanding of the technology and the way these tests works, even the diagnostic ones, which are computer aided diagnostic and not like stand alone diagnostic, then this fear disappears.

But they,  and I was like, semi getting semi annoyed at conferences when I get this question when I speak again and again I’m like we’re really we’re beyond that point, right? But then At the same time, there’s more and more people,  joining this ecosystem, so that’s their first encounter. So, kind of naturally, they have the same questions that we might have had, when we started learning about this, so I, I don’t [00:37:00] get annoyed anymore at that.

Adam: I mean, radiologists went through the same thing, you know, so they’re, we still have radiologists, we always will have, same with, I think, pathologists, but it does, you know,  you know, it’s nice to have a second set of digital eyes to look over everything that you’ve already screened just to make sure nothing has been missed, particularly on the, you know, on the edges on the shallow pieces that we’re just human like everyone else.

So, I mean, I’d rather be overly sensitive, which is what it is and less specific. So I can green through a lot of. You know, intraprostatic ejaculatory duct that it’s highlighting because it looks ugly, which it does look ugly, but obviously we’re pathologists and we can screen through that. They know, I see what you’re looking at, but I’m not worried.

So, we used Aira Matrix,  right now for the diagnostic side. What they have coming down the pipe as well, I think is really gonna help augment and change. Right now, because we’re digital, we’re able to exactly quantify the amount of tumor volume over core length. It’s no longer an estimation. [00:38:00] From a pathologist, you know, looking from dot to dot and just eyeballing it, it actually quantified.

Aleks: So did you have to like report the, the eyeballing? What, is it part of a, a press, yes, a report? Like how much,  

Adam: Well, you always tell what, what percent in core, right? Like, so it’s… 

Aleks: Like visually? 

Adam: Yeah. That’s how you would use to do it. Right. 

Aleks: Ok… 

Adam: You would just look, you would put a dot on one end… 

Aleks: Thank you for using a quantification tool.

Adam: Yeah, it’s great. Like I think that’s fantastic, but there’s still lots of other areas within the prostate cancer space where it’s still eyeballing like on three, four, seven, four, three, seven percent pattern for how much of that, you know, is it 5 percent or is it 40%? Well, with the new Aira Matrix platform, they’re able to give you exact numbers.

They’re able to look at things like on your high grade cancer cases. Even, even though it may be 90 percent traditional athener, there may be a 10 percent norendocrine or small cell component. And so you have to screen for those patients moving forward. You have to treat those patients differently from a, from a [00:39:00] chemotherapy standpoint, platinum-based chemotherapies versus traditional.

So all of this is stuff that we’ve never really had access to in the past, where we’ve just been kind of pigeonholed to, to what we’re able to report. But the AI, I think is going to be able to, on the diagnostic side, rather than just So, hey, by the way, this is cancer. It’s also going to be able to start helping us quantify what if looking at as far as worrisome features with that signet ring, like we talked about quantifying the amount of perineural invasion.

We’ve never been, we just say perineural invasion plus or minus, but there’s going to be an opportunity for a lot of robust studies moving forward based on the AI driven data. 

Aleks: So I am,  I, I like wanted to,  ask exactly if like how much of this,  guesstimation with eyes you’re doing and,  working a prostate cancer, because I’m personally allergic to this way of,  evaluating anything quantitatively with your eyes, which is like, [00:40:00]  I know it’s physiologically impossible.

When you look at the literature, like the amount, like the, the difference that moves to be present in the image for an, a human eye to quantify it is around 25%. So like everything that you quantify in smaller increments is inaccurate because of biology. And yet I think it’s a, like a systematic, misconception also in, in, in the literature.

Incorrect way of validating, especially quantitative tools against a pathologist. Because,  like I remember for PD L1 evaluation,  I took part in that for like,  one research project and they were basically like giving you some other pathologists evaluations and you had to like learn what they were evaluating when you were far away from them.[00:41:00] 

Like, how, how are you learning this? It’s stupid. And so I’m semi allergic to that, particular thing of visual guesstimation. So yeah, AI, imaginal, some quantitative tools. And I’m a friend of, especially for this and, you know, moving forward, because we don’t know, we never had the chance to know how important this information is, it was like there as kind of a descriptor of something, but you never could mine it in a, in a way that,  gives you a path forward.

And now you have this data, it’s quantified and, and you can take it and, check through any patterns and you like different paths forward. So, this very feature of AI, I’m a fan of. So, okay. This is the, you mentioned three types. We talked about diagnostics. 

Adam: So, yeah, you’ve got to convert the, the slide into a digital image before you can have access to any of this.

Right. So you’ve got to get off. Off the [00:42:00] sidelines and into the game. So now, okay, so now we’re in the game, we’ve got the digital image, we have a diagnostic AI, I’ll just talk to you about some of the features. There’s also, there’s tons of other, whether it’s nuclear density or morphology and stuff that we’d never had the opportunity to actually explore, but it’s going to tie into the other two types of artificial intelligence.

And that’s predictive as far as the AI being able to predict who’s going to respond to a certain targeted therapy. And prognostic, as far as being able to evaluate the case and say, hey, based on what AI is looking at, we think this patient would be safe to monitor or they, or they need to be treated.

Where AI, I think, is going to far outpace, you know, the human mind would be, there’s going to be certain characteristics that are definable within each cancer. We, you know, we’re able to only comment on the glandular morphology, but. Each of those glands is comprised of cells. Each of those cells has a nucleus.

Each of that nucleus has chromatin, the actual DNA, [00:43:00] the genetic material, and how all of these things tie in together, how they look, is going to have, an impact as far as being a, from a prognostic standpoint, a correlative level to say, hey, we know this feature is correlative to more aggressive disease in African Americans above 60 years old.

We know when, you know, we know when the cytoplasm looks like this way. In Asian Americans, or, you know, less than 50 with a BRCA2 mutation, that this can behave this particular way. And we’ve already got AI now that’s able to predict underlying genetic abnormality. So we, we were collaborative with Tempus Labs as far as using AI to help predict MSI high, microsatellite instability-high, just based on image analysis, teething out features that we can’t, but the human eye tees out.

Aleks: I’m a fan of this application as well. I’m like, really, this is something that’s gonna change. 

Adam: It’s gonna be a way that we don’t have to burn through any more tissue. We already have the image. [00:44:00] What more information can we harvest out of that image that goes beyond strictly glandular morphology? And set that against a quantifiable scale that’s reproducible, that is AI.

Like it, it can continue to, and it’s only going to improve the longer we continue to do this and beat it more data. It’s only going to improve. And I think from a pathologist standpoint, so it can help, the artificial intelligence can not only help us identify, you know, the cancer, make sure nothing gets missed, but now that we also have it, it’s able to overlay our read as well.

So I know Adam thinks this is a three, four, seven, that being said, these features are all correlative to more or less aggressive cancer. And that’s really what our clinicians are looking for. It’s just, they need some, they’re looking for guidance, for help, like based on my pathology standpoint, we don’t really care how you got there.

From a pathology standpoint, what do you guys think about this cancer? Is it going to be okay? Is it not? I’m talking purely in the prostate space, but if it’s  [00:45:00] bad, before we put this patient on hormone deprivation and drive their testosterone to zero and we increase their comorbidities as far as cardiovascular risk and bone fracture and osteoporosis and all of the things, like we know that is not an indolent therapy.

Are we even sure the patient’s benefiting from that? So if we can use AI to help better vector these patients and do it in a timely fashion, these are not 10, 20, 30 day turnaround times. These are turnaround times that are instant. So when you get your pathology report in 24, 48 hours, it’s going to become an including, it’s going to be inclusive of these predictive and prognostics as well.

So I think, you know, we’re about to make radical change. And the space, it’s, I think it’s impossible to predict where we’re going to end up on there, but you can see all the potential right there, but in order to do any of it, got to get in the game. And so that’s where we’re, like the pastoral point, we’re kind of, we’ve got our space, [00:46:00] but we’re happy to share and utilizing the infrastructure that has been built out that, you know, TruCore is relying upon to actually run a business.

And that you’re able to emulate that as well, so. So we’re trying to, we’re trying to help as best we can.

Aleks: See, and I think, so, I recently, a friend recommended me the book and the price we pay, the cost of health care. And like, why is American health care so expensive and how to fix it? And, I’m kind of starting to look at that, from the perspective, okay.

If this is more streamlined, more targeted if you don’t have to run molecular, like if you, let’s say, don’t need to run next-gen sequences because you already have a predicted mutation, and instead, you can just do a simple PCR to confirm it, like how much money is this going to save?  like a lot, right?

And this is just one application. Then like,  [00:47:00]  so I think at this moment, like with the different quantification tools, there is still like the next step. Okay, all this correlation data mining and research that’s going to be happening, with this data that we, you know, have, single instances of stuff that has already been discovered.

And how I see it, once this is done, then this is just going to be plugged in into the viewing software. And you can have this in your report without needing to be an expert in that. Without needing to, like, burden your mind with, okay, is this the, what kind of demographic is this patient from? No, you look at the slide, you make your diagnosis, and all the other surrounding information is incorporated. Then, what the next clinician is going to get as information, its still some work. It’s going to be a cool time. It’s going to be super dynamic time. [00:48:00] 

Adam: That lore is not always better, right? 

Aleks: No. 

Adam: You’ve got a, you’ve got a urologist and he’s seeing 40, 50, 60 patients a day. The last thing he needs is a 30 page next gen sequencing somatic result that doesn’t tell it actually what we’re supposed to do.

And that’s where I really feel like we can harness that technology as pathologists. It’s an opportunity to streamline, like at the bottom, right, every patient that gets seen and biopsied in any of these clinics has to come through pathology. So that’s an opportunity for us to kind of level set. And then all the information that comes out.

Let’s focus on presenting that in a clinically actionable fashion. So we’re not just giving you information for information’s sake, but this is information that you as the practicing surgeon clinician, you need to know mutation is present. The AI identified it and we either need to confirm or deny us whether, you know, whether you’re talking about somatic, you know, deep sequencing and all of that stuff.

Okay. Or is the predictive AI going to be enough to be [00:49:00] determined? We’re not quite there yet. 

Aleks: It will be enough, but still like even. For those who, like, it’s a new technology, right? It’s good to test, it’s good to have, like, years of data confirming. So, I’m fine with, like, confirming the prediction with something, but something that’s faster and cheaper is already, like, such a milestone.

Adam: To your point, at least you’re not shotgunning out every patient. To get this 4, 000 test…

Aleks: Exactly!

Adam: You’re actually using some vectoring mechanism to be better stewards of the money we’ve been allocated. So, I couldn’t agree with you more. We can do better, albeit if we have, if we have a helpful hand in this. 

Aleks: Yeah, I think it still, you know, requires some imagination, some knowledge of like what the potential is.

Because always when you start the digitization journey, it’s okay. How much is the scanner going to cost? How much is the, like, there is an investment, like in any new technology? And,  without adoption, the next steps are not going to come. [00:50:00] 

Adam: It’s not cheap.

Aleks: So I am cheering, you know… 

Adam: Largely not reimbursable right now.

So it’s, you have to be creative and finding ways to make this thing and make your organization more efficient by incorporating this, so. But there’s no doubt about it. This is where we are going and I think it’s pretty, you’d be hard-pressed to convince me. It’s not a better way to go, for the patient, for everyone else involved.

Oh, I totally drank the Kool Aid and I’m like total bias for finding way,  why it’s more beneficial because there are many.  Question…

So,  like, do you, are you, engaging with new partners or do you already have your, set of partners that you’re working with on AI or, how does, like, working together, looking from a technology perspective?

Adam: Well, on the predictive side, right, we, we work with Artera, which is, I mean, they’re in the MCCN guidelines now, they have level one evidence with a 2B recommendation, like it’s good. [00:51:00]

Aleks: Congratulations to them. 

Adam: Yeah, it’s really good. And we were able, right, to, because we’re fully digital, we were able to bring them on our platform.

And so instead of having to ship glass slide to their lab in Florida, have it scanned and have, you know, the report. That’s going to take seven days, I guarantee it. So we’re able to, to do it instantaneously because we’re already digital. So there’s going to be more and more people into that space. And the way we look at this, I don’t mean to step on your toes Vasco, but like the way we look at this is like we can be like the hub, you know, like we’re, we’re, we’re a tool that we can bring all of these different AI companies together because we’re the pathology space.

And then we can work collectively, and collaboratively with our clinicians to say, which of these. Do you prefer we can get those ordered in real time? Because again, we’ve already made the image. So I don’t know Vasco if you want to add to that or not. 

Jason: I completely agree. My job is to ensure that we have the plumbing in place and the relationships out there. [00:52:00]

And whenever any company,  says, Hey, we have this new widget or this new tool. My job is to engage them, talk to them, see if we can,  come to commercial terms. But the most important thing is that our doctors. Think that it will improve patient care, you know? So the idea of driving patient care is the thing that, that, that drives us because without it, then it doesn’t really matter.

We we’ve had, I mean, more than I could even begin to list Aleks of, of people that wanted to partner with us or our reach and our platform and all that. And we’re like, Hey man, we looked under the hood and this is coming from the doctors. We looked under the hood and. This, this one just, I mean, we could kind of get there, but now we’re, you know, we’re not, you know, and obviously,  they, they take that,  very seriously as well in terms of partnership.

So, you know, the idea of, let’s say,  future pathologists joining us, you know, Or pathology… 

Aleks: Yes, I [00:53:00] want to ask about this as well, like, because…  

Jason: I can, I can wait till then. 

Aleks: No, it’s, it’s my, literally my next question. So you’re kind of leading the conversation where I want to go, right. And, but so on, you know, these are questions that I don’t get, like,  you would not read them in like LinkedIn comments or on my posters.

This is not something that people like. Openly put out there yet, but I get questions like, oh, how can I work digitally? I have this and that, life situation. I already have this experience. Is there, like which companies, do I talk to? How, what do I need to learn? How can I do this? So, and it’s not even from people.

So,  I’m gonna turn 40 this year. I still consider myself like,  maybe transitioning to mid-career from early career. Yeah. And the. I like to believe that people [00:54:00]  that, come after me, so younger people, that’s going to be their default. They lived through COVID during their education, they figured out ways to do stuff digitally.

And,  me, I’m like, okay, if, I ever need to have another job, if it’s not a remote digital job, it’s not a job for me. I’m not taking it. Right? And I assume. A lot more people who are younger than me than those who are older than me would think that way already as their way of thinking. But I have people older than me reaching out and asking, Hey, like, can I work digitally?

I’ve already worked for so, so many decades. Like I would like to work digitally. So what are the opportunities for pathologists? And is there like a profile of a pathologist that fits this?  Tell me a bit more about that.

Jason: Yeah, so we, you know, you mentioned, Hey, are you exploring other AI partners and all that?

Look, everything is always  [00:55:00] on the table, you know, we are always looking for best partners, best clients, like, I mean, always. Hey, so I just want to make that point very clear. I would tell you there is one impediment to going digital and that is fear of change. Okay. So, and what, let me walk that dog a little bit.

So as Adam mentioned, and maybe you mentioned as well, Aleks, the cost to go digital is not insignificant. In fact, it’s actually more burdensome on our great lab employees. You know, I mean, not only do they got to do all the stuff they’ve always done, but now they got to work scanners and you know, and all, all that kind of stuff.

It is, it is anyone that says it’s more efficient in the lab space. They haven’t done it, or at least I haven’t seen it, you know? So if anyone out there is saying that they’re more efficient in the lab space, give me a call. Cause I’d love to hear what you’re doing. [00:56:00] But, on the professional side, that is where you get the efficiency. You know, so, you know, we have to find a way, particularly if you are a pathology group that you have your own thing up and running and you just want a digital lab solution. Well, we have to find a way to cost share that burden because again, most of the upside is with the pathologist in terms of increased efficiency.

You know, for example, if you were going to say what a normal pathologist can do in a… our pathologists do 50 percent more,

So you can’t expect to come in and think, Hey, you know what, I’ve done this for 30 years. I know how much I am supposed to make per case and then apply that same mental model and, you know, kind of a compensation to the digital platform. So to me, fear of change [00:57:00]  is that, is that number one. And that’s what’s great about the pathologists that are employed in TruCore because they get it.

They have been in there. I mean, some of them As long or longer, you know, as long as Adam there, you know,  you know, from, from,  from the very beginning and they’re excited and see where we go. So, if you don’t get over that fear and say, Hey, this is what I’ve always been paid and this is how it should work, then I don’t think you’ll get there intellectually because the cost is there.

Aleks: This is a great point. Also, because like,  it’s, it’s kind of counterintuitive because it also comes from like, Why should you be paid like per case? Like what, what is this unit? Like why this, the currency, it shouldn’t be that way, but it is that way. So in this particular time,  it’s going to be like, like you say, okay, I was paid so much money per case.

Now I’m going to do more cases, but [00:58:00]  it’s not going to be the same amount of money. Like, where’s the logic? Well, there is no logic because there is no logic in paying somebody per case. Then you like try to go as fast as possible and it’s not just in pathology, it’s the same in radiology. I guess it’s the same like in any diagnostic space.

Adam: It’s all RVU based. 

Aleks: Yeah.  And you know, tests that are just diagnostic tests where you pay per test. That’s a different story than a pathologist or a doctor interpreting, whatever they need to interpret. Right.  so like late degree flawed remuneration model, but it is what it is. So you have to come to terms with it when you go digital and it doesn’t match one on one anymore.

Jason: Yeah, that, that’s right. Aleks, the other thing I would tell you is, you know, and I affectionately refer to these types of people as, oh, they’re blockbuster, you know, but we’re, we’re, we’re, they don’t want to change, [00:59:00] you know, and we could talk about the compensation. And that is one thing, like, like you’re saying on the per, per case basis.

But Adam has told a really good story here on this podcast about what we are doing in terms of turnaround time. And then I think even more important, those internal second opinions, you know. Because we offer such fools and a quality of life play, we have access to, to fantastic pathologists. But the broader point, you know, the, the, the turnaround time and the,  you know, the instant access to internal second opinions, but then it’s the increased diagnostic information, the increased amount of information that you’re going to get by being on the digital platform.

As we, partner with the AI partners, we are partnered with. And then as we continue to find even more innovative ways there. So, you know, you’ve got a good thing, blockbuster. [01:00:00]   You know, you’ve been doing it for decades and you like what it is and you don’t want any of the downrange stuff, then, then I wish you the best of luck. But man, if you want to jump in this space, we are, we are ready to partner with you. 

Aleks: And I think this space is also going to drive the change pathology is being reimbursed, is being done. I don’t know how, but it will because it will not make sense anymore to treat it like a, you know, test that you can run in a lab. So this is amazing. 

Adam: I like documentaries and the History Channel, you know, like the companies that made America and all the things. One of those was, they were doing a special, I don’t know if you saw on the blockbuster, and they had an opportunity to buy Netflix for 50 million, and just forget it, you lost your mind.

You know, like, and they walked away. 

Aleks: See, exactly. 

Adam: How many billions is Netflix worth right now? It’s hundreds of billions, I think. It’s crazy. So. It is what it is. But, I think, I do want to kind of [01:01:00]  footstep, well, as a practicing pathologist in doing all of this. So, yes, to your point,  Aleksandra, like, you, you may read more, but this thing is such a much more efficient way to read that it doesn’t feel like, it does not feel like, we always joke, because he’s always like, back in the salt mine skull, like, get down there, get, like, the salt level, it’s not that, it’s actually really nice being able to, to not have to spend so much time looking for a slide, mirroring that to your LIS.

Yes. Putting all the spending, focusing, all of that. All the time you spend just focusing compared to actually, you know, actually reading the slide, it’s crazy. You don’t realize it when that’s how you’ve been trained and that’s all you’re known to do. But when you make that conversion, holy moly. Like you said, Aleksandra, if my next job is not digital, it’s probably not the job for me.

I could not agree with you more. I don’t think I’d go back. 

Aleks: Very much. So, I,  in the toxspec space, so toxicological pathology,  [01:02:00]  which is,  pathology, veterinary pathology support for drug development, you get boxes of slides. And then you have to compare, you look for like your target organ. You always look at all the tissues from all the animals.

And then you look for the, organ that is being affected by the compound. And if you have several of them, you have to, like, pull them out of those boxes, put together, compare, like, different groups, and then mix them so that you’re blinded. And I’m like, it’s like a day of logistics to look through your target.

And now I click, and it can sort it. And I’m like, okay. Thank you. Thank you. Even if like AI never touches my life ever, I’m already so grateful that more boxes are coming to my house, sent by, you know, FedEx or whatever. So, just like the logistical efficiencies, also, you know, in the diagnostic phase or doing some tasks, sharing these, thing. [01:03:00]

It’s, it’s just like, please, I don’t want glass on my desk anymore. Like, I want to keep it clean. I finally have a chance to have a clean desk. I like a clean desk. 

Adam: That’s right. 

Aleks: So, you know, one of the little things, but in the drug development and tox path space to when, studies have like thousands of slides and, and let’s say you have like even for five target and you have to take it all out, it’s like, no.

You have like whole team,  at zeros. Being hired to store, and I mean at the hospitals as well, like to sort this in the right order. And, and then I heard, I saw a colleague post on LinkedIn recently that he, he was cleaning his desk and he found like some old slides from before he went digital.

Like they’re now missing wherever they were supposed to be. 

Adam: You’re exactly right.

Aleks: So what do you think,  the future [01:04:00]  and we already, you know, we’re, we’re talking about and, and expressing our thoughts about it, but like, in a summary kind of fashion, a future of pathology and what would you advise?

And the people who want to be innovated, who want to start doing this and get on the stream with us and start making this change. 

Jason: Let me take a quick swing. I’m going to be repetitive with what I just said and then Adam, I’ll let you close this out in terms of the future. What I would tell you is take the leap.

Change is difficult. Change is scary. You know, there’s a lot of things. I got a good gig here and all that.  but when you think about slipping into the hospital and carrying that micros, you know, microscope or whatever the case may be versus what we can offer in terms of quality of life and then the improved,  increased information that we can, that we can also provide you, [01:05:00]  I would just say, take the lead.

It’s an, it’s been an exciting ride. We’ve gone down a couple wrong roads. We’ll go down some more wrong roads. But,  in, in total, man, we are moving across and,  it’s, it’s a fun, fun journey. 

Adam: Yeah. That’s, I think that’s great. So I, there’s nothing I’m going to say, you know, groundbreaking or earth shattering that does, I think this was all fairly intuitive, like that, we’re going to have to find ways to work smarter, become more efficient as the number of, like you mentioned, not just pathologists in the U.S., but pathologists in the world. Continue to dwindle and finding ways that, you know, digital can actually affect underserved, underserved countries and things like that, like we can become more of a global ecosystem when it comes to pathology. There’s no reason we can’t do that now, but we’ve got to find a way to become more efficient to do that.

And there’s, it’s obvious that,  [01:06:00] you know,  digital pathology is going to be the, the tool and the mechanism to, to get us there. I think when you’re looking at,  as a, if you’re, if you’re a pathology resident and you’re watching this podcast and you’re like, well, that’s awesome. You know, I now have basically, you’re telling me AI is going to replace me.

I don’t think that the kid, I think we are always going to be needed. I think where we’re going to become, and this has been in the, this has been in the cooker for a while is we’ve known that it’s not going to be okay just to say you have ovarian cancer or you have prostate cancer, we’re, we’re coming down the pipe where we’re really going to start defining these cancers by their underlying, whether they’re rare pathogenic mutations or, you know, microsatellite mutations, we’re going to, we’re going to start defining these cancers, not just by organ of origin, but also by their underlying molecular signature, because that’s correlative to how that you’re all, or that clinician is going to treat that patient. [01:07:00] 

And so, I can see us using digital pathology AI to become much more efficient on the front end, allowing us to divert more attention to identifying who needs deeper, you know, deeper molecular, screening. And then the incorporation of all of that information in a timely fashion into a sync pathology report, so that we’re not overwhelming our clinicians with all this data.

Aleks: Yeah, with the, text AI, with the generative text AI, that’s going to be like another component that’s going to shake the space as well, where I’m super excited about that. 

Adam: I am too. I think it’s an exciting time to be a pathologist. I think this is, you know, there’s been a few of these, you know, obviously, Burk, then we come like, immuno staining was a big one, special strains is kind of a big one.

I think this is a monumental leap forward for pathology where we’re going to be able to really start. It’s going to happen one way or the other. So do you want to be on the tail end of it or [01:08:00] would you rather be at the front of this thing, helping to drive and kind of shape the, what this space looks like and how we’re incorporated into the space moving forward.

So that’s why I’m excited to be a part of this at where we’re going right now and,  looking forward to it. 

Aleks: Yeah. And you know what,  going, just one comment about,  being afraid to change and change management being like, this is the biggest, obstacle in any technology change,  and in medicine, especially, but,  there’s another book I read, it’s called Mind Magic, the Neuro Science of Manifestation and How It Changes Everything.

This is,  written by,  James R. Doty, he’s an MD,  a neurosurgeon. And he tells a story like he,  had nothing, came from a poor background, then he became a neurosurgeon, and then he had this great company, and then he lost everything, and he was at the bottom again. But then he kind of qualifies, like, I was still a neurosurgeon, and I was gonna be fine.

Like, [01:09:00] regardless, like, we’re still pathologists, we’re gonna be fine, like, you can try it, and if it doesn’t work out for you, at least you gained some experience. And you’re like, go back to the microscope. And in terms of like career decision and things like that, it’s not that like, once you touch digital, well, you will not want to go back unless you have like a very bad experience, which I don’t think is the case anymore.

Because,  maybe that was the case, you know, in 2018, 19, when I was starting. But now it’s fast enough for me. It’s as fast as a microscope. There are still pathologists and like, we’re going to be fine. Regardless. 

Adam: And we had a, OPS group commander, he went by Bam Bam Stapleton, great guy, actually one of the best in the world.

Aleks: I love their army names. 

Adam: Yeah.  yeah, he’s a great dude. F22 driver. Actually passed away from,  mildly dysplastic syndrome. But he was still flying the Raptor. And post-bone marrow transplant, the whole thing. Just an amazing individual. Unbelievable. And one [01:10:00] of the things to me was, you know, I work. You learn a lot more from a negative than a positive, right?

That’s kind of interesting. He’s like what he was getting. Paralysis by analysis does you no good. You’ve got to get in the fight. So that goes, we’ve made the mistake. We’re going to make more mistakes, but we’re going to learn from those as we’re moving this thing incrementally down the field. So, it, you know, it is what it is.

Fear and love. That’s why most decisions are made. So we got to just get over that fear, get in the, get in the fight and we can help you do that. We’re happy to help you do that. If there’s, if there’s something we can, don’t, don’t make your own mistakes. If you can learn from our mistakes, it’s a much better, much smoother prayer.

Aleks: Thank you so much.

Thank you so much for joining me, explaining,  like the change you’re, you’re doing in the digital pathology space. I see you as true pioneers and an entity, like also a  [01:11:00]  business entity,  to learn from, to look up to, to see how, to learn from your mistakes so that, people who want to embark on the journey don’t have to do their own.

Adam: Thank you.

Jason: Aleks, hope you feel better. 

Adam: No kidding. 

Aleks: Thank you. 

Adam: This is your last podcast. 

Aleks: No, no, no, no, no, no. We’re gonna keep doing it till all the, like the whole healthcare is digitized, till there is no more digital pathology, till there is only pathology like radiology. 

Adam: That’s right.

Aleks: Nobody says digital radiology.  I don’t know from which source I’m citing this, that only 10 percent of the,  pathology departments are actually digitized. It’s probably a lot less. And so I, I still have, I still have a lot more podcast episodes ahead of me. So stay tuned. 

Adam: Thanks for bearing with us on their scheduled through though.

Aleks: Of course. Thank you for serving the country. [01:12:00] 

Jason: All right. Take care. 

Aleks: Thank you so much for staying till the end. It means you are a true digital pathology trailblazer. So this podcast episode was recorded remotely, but I just recently came back from the digital diagnostics summit organized by Lumea, a company that works with PathNet.

And, with Adam and Jason, and I actually met them in person and there’s going to be a vlog video about it, but if you want to get a sense what this conference was about and why it’s worth, there’s going to be a playlist link. So have a look at it. And I talk to you in the next episode.