She did it all on her own, to keep serving her patients.
In this episode of Digital Pathology Podcast, host Dr. Aleksandra Zuraw is joined by Dr. Elizabeth Plocharczyk, a pathologist based in Ithaca, New York.
Beth shares her experience integrating digital pathology into her practice at Guthrie Cortland Medical Center and Cayuga Medical Center at Ithaca, NY. Her journey offers insights into the practicalities of adopting digital tools in a community hospital setting.
Dr. Plocharczyk’s account underscores the role of digital pathology in enhancing the efficiency and flexibility of pathology practice, especially in geographically constrained settings.
The episode provides a REALISTIC OVERVIEW OF TRANSITIONING TO DIGITAL PATHOLOGY, including overcoming potential hurdles and leveraging technology for more effective pathology services.
Be sure to watch or listen to the full episode, as Dr. Plocharchyk reveals all the details about the equipment she used, the way she validated the system as well as her budget.
This episode is particularly relevant for pathologists and healthcare professionals exploring digital pathology’s potential to improve practice management and patient care.
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Aleks: [00:00:00] Welcome to my digital Pathology Trailblazers. Today, my guest is Dr. Elizabeth Plocharczyk and she is a pathologist at Ithaca, New York. She’s affiliated with affiliated with multiple hospitals. And she is a true digital pathology trailblazer. So recently, digital Pathology Place started working with a new partner, smart in media. And when I was in conversations with them, I was just asking, who is using your camera? Just to understand better what you can do with it? They told me, I needed to talk, talk to Dr. Plocharczyk, so I reached out to Beth and asked about her digital pathology journey. And today I’m honored to have her as a guest on the podcast. And I’m so excited to have you here, Beth, because you have such a nonstandard digital pathology journey. Welcome to the podcast!
Beth: Thanks so much for having me. I appreciate the invitation.
Aleks: We are going to start with you with your background and what your pathology [00:01:00] practice looked like before digital pathology was part of it.
Beth: Sure. So I’m a community hospital pathologist? I practice in Ithaca, New York, as you mentioned. And let’s see, I’m anatomic and clinical pathology boarded, also boarded in dermatopathology and clinical informatics. So I do have an interest in technology use in medicine. But for the first approximate decade of my practice, I hadn’t used any digital pathology tools. I had a pretty standard practice, mostly surgical specimens, biopsies, excision, cytology, some autopsies, the medical direction of laboratories, and pretty standard run-of-the-mill community hospital pathology.
Aleks: So you have a lot of specialties and where you’re using them enough before digital pathology. It’s kind of a side question because you’re bored in informatics and [00:02:00] you said that ten years ago you were not doing any digital pathology.
Beth: Right, Right. Mostly my informatics training I was using for things having to do with data flow and medicine and making sure, you know, building interfaces with other practices. I have a pretty active outreach practice because of my dramatic pathology practice. So I do service a lot of clients all over the state who are dermatologists, and there are lots of heterogeneous medical record systems that we had to get our medical record system to be able to talk to. And so mostly my informatics up to that point had to do with interoperability.
Aleks: So you kind of with this background, you wear set for success. The digital pathology also is just part of, you know, a different ecosystem that goes into. But when did you decide to go digital? When was the point where you said, okay, it’s time to go digital? [00:03:00] And was it just for certain areas? Or how did you do it? And how did you know that digital was the way?
Aleks: Right. So after about ten years of practice, I found myself in a one-person practice. Normally, my practice was a two-person practice. And then, I found myself working alone and I found, you know, having to do all of the work with one person. It was very challenging to be able to be in multiple places at once. And even just simple things like, you know, scheduling a dentist appointment or, you know, taking some time to do some gardening at home, it was very challenging to be able to have, have the time and ability to be able to do those things. And so I, decided actually during the pandemic it was in 2020 that it was time to go digital. And I remember the moment that I decided it was time I was doing a [00:04:00] proficiency test on the College of American Pathologists website. It was a proficiency test in flow cytometry. I remember looking at the images of the peripheral smear or the aspirate smear, and it was the quality of the images was just excellent. The usability was easy. I was able to navigate the image and zoom in and zoom out without a lot of fuss. And I just remember this being a big change from what I remember digital imaging being when I was in residency. And so I thought, you know, this is a tool that can help me, help me in my practice. By that point, I was getting socialized to things like remote work because of the pandemic, being able to do meetings online, having other people that didn’t have to be in the hospital, could, could not be in the hospital with the pandemic, and remote work. And so I think just a confluence of factors fell together. [00:05:00] Also, at the same time, because of the pandemic, we had been doing a lot of COVID testing. And because COVID testing wasn’t available, we had to develop it ourselves. And so we had to use the laboratory-developed test way past way in New York State to be able to do this sort of testing. And that put in my mind, well, if we’re using laboratory-developed testing for COVID, why not use it for digital pathology? So all of those factors just came together and I decided it was time and that I needed to do it to be able to maintain my practice as a one-person practice or even as a two-person practice because times have changed so much.
Aleks: Yeah, too personal practice is not a huge practice. You know.
Beth: No.
Aleks: Okay. So you decide to go digital. Can you describe what was impossible before you went digital when you were just one person? Like what? What would you run into like the
Beth: Right…
Aleks: Places? Did you have to [00:06:00] drive to?
Beth: Right.
Aleks: How long to drive? Like,
Beth: Yeah.
Aleks: When did you when did you realize, hey, it cannot continue, like that?
Beth: Right? So I would say that there were certain aspects of my practice that very much geographically located me within the hospital. And one of those was frozen sections. If you have a frozen section and it’s [6:00] and you want to go home and eat dinner, you can’t do that if you’re you know, you’re waiting for that frozen section unless you have some sort of technology to be able to extend your reach. The second application that tied me to the hospital was site adequacy assessment for cytology specimens. We do a lot of rows in our hospital, rapid on-site examination and evaluation to triage cytology specimens for FNA’s that are happening in radiology or at the O.R. for evasions, for example. So I would say that there were several [00:07:00] of those cases per day, and I also needed to be in two different hospitals. And so sometimes I would find myself driving…
Aleks: How far are they from?
Beth: Yeah, we live in a rural area and I’d be driving to the other hospital and then I’d get a call saying we were frozen section. And so it would be problematic. I needed to be able to be in multiple places at once. I needed to be able to go home sometimes. So those were the two indications that tied me to the hospital. And then there was a third indication that tied me to the area, and that was dermatopathology. So being a dermatopathologist, I mentioned before that I have an outreach business and a clientele of dermatologists all over the state. And dermatologists are very particular. They like 24-hour turnaround time. And, you know, up into this, up into this time, you know, for the previous decade before I had digital [00:08:00] pathology, I’d not left if it covered a vacation.
Aleks: Oh my goodness!
Beth: Because I was so committed to giving them their 24-hour turnaround time. And, you know, the only way that I could have done that before was by being physically present in the place where the slides were. But because it’s not a huge part of my business, you know, it was, it’s not so burdensome to be able to do an hour or two sign out of just the dermpath cases, you know, while, I’m while I’m on vacation. But on vacation before I was previously, you know, gardening in my yard. But then I thought, wow, you know if I had digital pathology in whole slide imaging, I could sign out these cases. You know, from France or from somewhere else. And so that was the third use case that got me thinking about basically geographically tethering me from the region.
Aleks: I think it’s a super powerful something that I don’t know is not that highlighted [00:09:00] because it’s more connected with the pathologist’s well-being and with the pathologists being able to do their job rather than patients. It’s on the pathologist’s side to have a certain quality of life or to have a certain flexibility and, and what I am hearing then, okay, if you didn’t have digital pathology and you would still be on your own, are you still on your own or…?
Beth: No. It took me 14 months, though, to recruit another pathologist. And that’s another factor that was a huge, you know, player into this decision was, you know, the recruitment environment. Now still, but even especially in 2021 when I was recruiting, was very challenging, very difficult. There’s a huge shortage of pathologists and we’re all expected now to do more and stretch ourselves even further. So we just need the tools to be able to make ourselves even more efficient and to extend ourselves as far as we can do work at the top of our licenses. [00:10:00]
Aleks: Yeah. So without the tools, you would probably have to cut the number of patients I don’t know, unable to serve. So how many hospitals are you affiliated with?
Beth: Two hospitals and multiple physician offices. And then we also run the medical examiner program for the county. It’s a rural area, so you kind of have to be a jack of all trades in this area. And, you know, it’s it’s one of those things where if you, if you didn’t have you know, if you couldn’t if you couldn’t do it, it couldn’t get done or there’d be delays or it’s.
Aleks: It’s not that…
Beth: I doubt.
Aleks: It’s not the scenario with, I cannot work with this pathologist, then I’m going to go to another one. There is no other one.
Beth: Yeah.
Aleks: Yes. So okay, you identified a couple of areas where digital pathology would be a game changer. How did you choose the right tools? Yeah. When you were looking into tech, how did you [00:11:00] pick what to go with, and yeah, did you check a lot of systems or did you have recommendations? How did you go about it?
Beth: Yeah. So I mean the first thing that you do is determine your use cases. So those were my use cases. Rapid on-site, assessment for cytology, frozen sections, and dermatopathology. So I knew I needed relatively low throughput technology. I didn’t need something that was going to be scanning, you know, 200 slides at a time. I was looking for something that had, I was looking for whole slide imaging capacity and live view capacity because I figured that the rapid on-site adequacy assessment live view would probably be, meet my needs better. Then I decided that most people go for live view for frozen sections but I decided to do whole-slide imaging for frozen sections as well as for dermatopathology. So I was looking for a few different types of technology [00:12:00] I was looking at… The budget was a huge constraint for me because, you know, I was a single solo practitioner, so I set a budget and, and you know, those were the, the main to like functional specifications that I had is it had to need my budget, it had to meet my use cases. And then it also had to be easy to use I need a technology that, like I mentioned before, I’m often called when I’m driving from one hospital to another. If the technology was going to tie me to a computer, it wasn’t going to be functional for me. I needed it to work on a tablet, which, you know, I can take pretty much anywhere with me. And so I needed to be able to like pull over to the side of the road and pull something up on a tablet to be able to make, you know, make decisions rapidly off of that. I wanted to be able to use it easily on the tablet. I didn’t want to have to log into another system…[00:13:00]
Aleks: Yeah, and find your password, VPN
Beth: You know, I wanted to use my finger and move the image with my finger. I wanted to pinch to make it bigger. I wanted to pinch it to make it smaller. So that was it. That was pretty critical functionality to me. So I think it’s really important to define the functional specifications that you have to make sure that the technical specifications meet the functional specifications.
Aleks: So you say a lot of people go for a live view for the frozen section, but you decided to go for whole slide imaging. Why did you decide and did you have any problems with that?
Beth: Yeah
Aleks: What’s the reason why people, why people do live view for that.
Beth: There are lots of systems out there for, you know, frozen sections with the trundle that you can manually move from afar. I was priced out of those types of systems, for the live view that I was using for cytology. The Cytotec [00:14:00] would be moving the slide. And so the Cytotec has, you know, some idea of you know, Cytotec knows, knows what they’re looking at. And so I could say, hey, stop at that. You know, that group of cells over at [3:00] and go in there. So and, you know, I could be having that conversation with them, with the Cytotec, but with the frozen section, you know, being the only pathologists, I would pretty much be the only one that knowing what’s being looked at and I would feel less comfortable telling, you know, history tech on the other side. Oh hey, stop on that saying that looks kind of square and, you know, move over there and… That was one reason and then the price was another. And then the third reason was because, you know, I’m, I was getting this is my first foray into whole slide imaging and I wanted to sort of push it to see what could I do with whole slide imaging. I wanted to also have, you know, a little more value for the investment that I was making in the whole slide imaging rather than just for when I occasionally wanted [00:15:00] to go on vacation and out of the area and wanted to read those jampacked slides. So I wanted to be able to get a little more value for my money. So that was the the reason that I decided on whole slide imaging, for the frozen section use case.
Aleks: And the quality is good enough, right?
Beth: Quality is excellent. I am impressed by the quality of, you know, very affordable scanners and the time that it takes to scan is not prohibitive. It’s working out very well even for that intraoperative setting.
Aleks: So I know a frozen section images only from this, there is a data set, TCGA (The Cancer Atlas). They have a bunch of slides and several of them are frozen sections in general frozen sections are not as beautiful as FFP samples, but they’re not going to be more beautiful on glass.
Beth: Right.
Aleks: It’s not that [00:16:00] the scanner is making those sections more ugly. They just are like this and you have to work with them.
Beth: Right. That’s what you get.
Aleks: Right and the scan doesn’t make it any worse. So. Okay, going back to the budget, how did you, if it’s okay for you, can you tell us what your budget was for your school set? And then we’re going to dive into what you bought for this money. But first, what was the budget and how did you come up that this was a reasonable budget for you that would, not going to put you out of business or put you deep into that?
Beth: Right. So I was practicing alone at this point. So I did have a little bit of flexibility because I wasn’t paying another pathologist to be doing work. So I just set a budget that was $75,000. I thought, you know, for $75,000, I should be able to get a solution or several solutions that will [00:17:00] meet my needs and meet my use cases. I also didn’t want to like, dive really. I mean, one, I didn’t have more money than that to spend. That was the top of my budget. And then two, I thought, you know, I’m this is my initial foray into, into digital pathology. So, you know, I, I mean, it would have been nice if I had a lot more money to spend. But, you know, just knowing that I, you know, that this was my initial foray into it, I thought, okay, well, that’s I think that’s it’s a reasonable budget to set to be able to meet my needs, especially since my needs were low throughput. If my needs were higher throughput, I think that would have been a little more challenging on its own or if my needs were to completely transform my workflow. But they weren’t, you know, I just had these special use cases just to get me out of the hospital for very certain things that were timely to the hospital.
Aleks: Okay. So what did you decide to get and where did you distribute these [00:18:00] devices?
Beth: Right. So my evaluation process was, to see what’s out there. So, you know, I did Internet searches and, and, you know, looked in, you know, resources like CAAP today and just to see what, you know, what was out there. So I started contacting vendors and just talking to people, asking questions, asking, you know, how much their devices cost and, and, you know, I was very quickly dissuaded from many products because of my budget to be able to meet all of my use cases. So the vendors were very helpful. Even some of the vendors for the large FDA-approved devices that I was not able to access because of budget. You know, they actually would point me in other directions and say, hey, you should call this vendor. They had some nice products for you know, for somebody [00:19:00] like you who’s looking for something much smaller. And so that’s that’s kind of how it happened. I just evaluated lots of different scanners. I found. So I thought I ended up buying two whole side imagers and one like view scanner and the software platform that I’ve been using for the whole slide imaging. And so the two, our whole side imagers I chose were it was a Motix six slide imager and a Grundium Ocus 20, one slide…
Aleks: I know this one.
Beth: And I liked the fact that I could have two of these scanners, so I’d have some redundancy. If one of them went down, I’d be able to use the other. I also just kind of, you know, being informatics sported and kind of like tech nerd. I just wanted to play with the technology. I thought it was really interesting and cool. And, you know, the scanners, they were [00:20:00] affordable. You know, the, the MOTIC it was somewhere, it was under $30,000. The Grundium was under 15. And the live-view camera that I ended up getting was from the Smart In Media. It was their product or for-life view. One of the reasons that I then I also ended up going with the live view is because they also had a very nice web application that was available and also in my price range they had one that that’s not in my price range, but they also had one that was in my price range for just, you know, skin like to be able to store images on a cloud-based platform to be able to access that and log in and look at them and move them around on an iPad with your finger and determine what was going on. So I wasn’t able, you know, at this stage of the game to, you know, do things like, you know, interfacing with our medical records system or lots more sophisticated things that I hope to someday [00:21:00] be able to do with digital pathology. But this was just, you know, this is just getting getting my feet wet.
Aleks: Yeah, I like that. You say that the vendors were helpful and then seeing this a lot more in this digital pathology space, they want to help. And also they have, especially for people who are new to what’s out there, they have already served some people and they know the use cases. They know why people went with a certain system and didn’t go with the narrow one. And they can very quickly point you in the right direction. So yeah, I like that a lot. Question Where is the Grundium located, the Motic and where’s the live view?
Beth: Right? So right now.
Aleks: Because I’m looking at your microscope, but there is nothing.
Beth: No, nothing is coming up. So the Grandium is going to eventually live here. This is my home office. I have a home office and a hospital office. But right now it’s it’s it’s still [00:22:00] being validated for one of my use cases. And so I’m validating it in the hospital. It’s living right next to the Motic scanner – MOTIC lives in- in the hospital and then.
Aleks: So, their buddies right now.
Beth: Right. So when you know, wherever the slides are being made so that they can be scanned by technical personnel and then the idea with the Grundium is, is that our if I’m signing out at home and you know, my second pathologist is in the hospital and we’re in different places, I could quickly scan something to him so he could see it as well and, you know, weigh in on it. And that way we don’t have to do our our usual thing up here. What do you think about it? You know.
Aleks: Getting the phone to the microscope and trying to capture.
Beth: Their very first digital pathology, right?
Aleks: Yes. I remember when the first cameras came out, I was still in vet school and it was the first time because when we learned histology and then later pathology, [00:23:00] we had to draw this picture. like the but we had a special workbook with circles. Half of the circle was either a picture or a drawing. And then we had to look under the microscope. And then at some point, somebody had the first digital camera and we weren’t exactly trying to capture anything from the ocular.
Beth: Okay,
Aleks: Well, that was an interesting exercise. I mean, you know, people I see on social media, they get decent pictures. But…
Beth: Yeah!
Aleks: I just don’t have the patience or the dexterity to do it. I have I have a specific adapter for this. I have this Smart In Media as well. Okay. So another question regarding the equipment and how long have you had it already?
Beth: Let’s see. It’s been almost three. No? Yes, three years. Three years.
Aleks: Amazing! And how long did it take you to pick everything? Validate. Like from the day when you said enough. Do I need digital pathology to the day where you [00:24:00] actually could use it?
Beth: That’s a great question because there is also a pandemic going on, and I was practicing alone. It took me a while. So the day I said I was going to get digital pathology, was in September of 2020, and I set myself a deadline in December of 2020 to choose my technology. And I stayed on track and I chose it and I made my purchases. By the end of 2020, I had all of the technology the following month. So January 2021. And then the easiest thing to validate was, I think the thing I validated most quickly was frozen sections. I think that that one went easy because I was able to use a lot of archival material…
Aleks: Yeah, true!
Beth: And yeah, and I, I ended up validating that one first because of my need to kind of get out of the hospital.
Aleks: That was your, your most narrow bottleneck, I think. [00:25:00]
Beth: Yeah, Yeah. And we were valid. I was validating concurrently the live view which is living on our rows camera in the hospital. It’s on a cart that goes to cytology or just…
Aleks: I need to go to one hospital one time and make a video. How they have mobile digital pathology on the microscope, driving it.
Beth: Yeah. So I would say it took me about nine months to get all of the validations just completed with the data and all the scanning and you know, reviewing everything. I submitted it all to the States and I was using it even before I heard back from the state. But the state, you know, chimed in, I would say six or eight months later.
Aleks: Ok…
Beth: About that. So it took about a I would say, a good year of validating. But I’m I was a little bit constrained in my situation just to be able to get everything done.
Aleks: Yeah, you were on your own, of course.
Beth: Also for the ROSE, the onsite access, I’d say that we took me a little bit longer to validate as well because [00:26:00] the way we chose to validate it since it was a live view, was, you know, in real-time just kind of using it first and then doing our normal process and seeing how well they, how well they compared. So we had to wait till we had enough cases to be able and that took a few months to be able to get enough cases to compare them so well. Yeah. So we did the validation, submitted it and it’s, it’s been great. You know, it’s, it’s, it’s liberating to be to be able to use the technology. I like using it. I’m getting used to, you know, seeing the images. Some images are easier than others to see. I did decide at one point that I didn’t want to do huge excisions for subtle melanomas or subtle melanocytic lesions. I didn’t want to use the digital for that, you know, like multi-slide cases at least the way that I have it currently set up because it’s not integrated into the EMR. [00:27:00] It’s it’s not perfect. But for small biopsies, the basal cells, you know,, the frozen sections are fine. Everything looks very, very good on it. We had some trouble validating the special stains because we were having it, it took us a little, a little while to overcome that hurdle because the scanner was focusing in the plane of the section, where the marker was instead of on the tissue.
Aleks: Okay.
Beth: And so we ended up having to erase all of our marker lines on our slides and, you know, re-scan all of those and try again. And that works out to be able to do that.
Aleks: So marker lines like was with the pen.
Beth: Yeah. Like with the sharp dividing the area where the controls are versus you switching them.
Aleks: I understand. See. Yeah. Those cameras are vigilant about these things that are so obvious to us. But then a device [00:28:00] doesn’t distinguish.
Beth: Right.
Aleks: So okay, so you’ve been doing this for three years. Let’s say you wanted to go one step further and let’s, let’s imagine budget is not a constraint. What would you add to your digital pathology arsenal? Like to make it even more liberating, increasing the access to patient care. Where would be the next thing? And it doesn’t have to be an A-list specific device, but like a use case that you use, what would you make under that digital pathology umbrella?
Beth: The two next steps that I think are most critical to accomplish would be interoperability with the medical records system and higher throughput scanning. So I think that I would I would be able I would like to get one of those larger fancier scanners that can do all the GI biopsies or whatever. I think high-throughput scanning would be would be very nice. And interoperability with EMR is [00:29:00] critical because I think that if I were integrating this into my daily sign-out in a way that, you know, enables me to maintain efficiencies and, and, and, you know, read multiple slides in a day, not just, you know, a select few, I would need to I would want to be able to click on the image and know that the image that I’m clicking on is the one that with that case, I’d like to open up the report concurrently with it and to be able to dictate into the report. And so that’s my dream and that’s actually what I’m working on. Next is the interoperability in the EMR. So I’m hoping and hoping this will work out. It’s it’s very it’s challenging when you don’t have a big ship.
Aleks: So how are you approaching it? Are you looking for some third-party solution or are you trying to do custom coding? [00:30:00] What’s your approach to that one?
Beth: It’s, it’s one of those things. So we have an opportunity. And that our hospital system is changing EMR. So you know we’re moving to yeah we’re moving to a like a more modern medical record system than we’ve had before. So there are lots of opportunities with that and you know, with my informatics background, I’m very heavily invested in in the EMR, you know, getting it, making sure that it’s very functional and it works well for all the users and met it’s configured properly. And one of the things that I had been looking into with that is, you know, digital pathology and the way it integrates into the EMR. The EMR, it doesn’t it, you know, at this stage in the game, it’s only interoperable with the FDA approved vendors, the big expensive scanners that, you know, I don’t have access to. So this is one of the kinds where I’m trying to work with Smart In Media so I’ll, I’ll see if we can integrate [00:31:00] their product into it, because it was it was a little more budget-friendly for me and my hospital. So I’m hoping it’ll work. It’s you know, it will be a first. So if it works, it’ll be it’ll be very exciting. But it’s it’s new territory.
Alerks: My goodness. This is amazing. So, okay, this is the ideal world where everything is integrated. How does the day-to-day practice look right now with those parts of your workflow being digital pathology? Most are on the glass. You do it both from the hospital and home, depending on where you’re located, and we do digital pathology. How do you work with images?
Beth: Yeah, so for me right now, I basically, since there are two pathologists there, if one of us is in the hospital and there’s a frozen section or rapid onsite assessment, or if I’m in the hospital in my derm path cases are there or, you know, a courier can bring them here to my house, [00:32:00] then, you know, I’m my preferred workflow is glass, but it’s easier for me and the other pathologists feel pretty much the same way. But for there are times of day that we like to make ourselves more available to the radiology staffing, often on the peripheries of the day when our, you know, our when our normal histology like what we’re done with the glass, we have no reason to be in the hospital other than to be there for, you know, the frozen section or that radiology procedure and, in those instances, we use we heavily rely upon the on site adequacy assessment. So what will happen is, you know, there’s an early morning procedure or late afternoon procedure, and the pathologist is not in-house. They will, the cytotech will go up and do the rows, and send us a link via the Patho Zoom camera. We’ll log in. We look at it just like it’s a movie we watch. Like I’ll just watch it on my iPad, you know, say, [00:33:00] Yeah, that looks good. Yeah, it looks hematopoietic. You know, send some for flow or there’s some neu- neutrophils in there. Let’s culture it or yeah that looks hemotelial. Let’s get a cell block you know all the, all the traditional like rows that we’re doing triage so that that’s been great and it’s it’s a real it was a real appealing feature when I was recruiting for my other pathologist. You know I could say…
Aleks: Very much, would be for me if I was looking for a job and running.
Beth: You know, when it’s getting later in the day and you want to go home and have dinner with your family, you can do that.
Aleks: I thought. I just like doing that too.
Beth: We like to do that. And you know, it’s that waiting for a frozen section, is it going to stop you? Because so I very much enjoy doing that because, you know, the O.R.’s don’t always run on time and a lot of the cases that we get frozen sections for most of our frozen sections are plastic surgery [00:34:00] cases. So they’re not as senior critical as maybe some other cases. And so if more pressing cases come in, the plastic surgery ones get pushed. So oftentimes, you know, we might be seeing those later, later in the day when we’re done with all of our routine work and we have no reason to be at the hospital.
Aleks: So, do they like to text you and say, hey, open your computer and see? Open the code and…?
Beth: Yeah. Well, say, hey, so for the frozen sections, basically the, the, the workflow is the technologist who is preparing the frozen section will skim the slide, you know, give me a call or send me a text and say, Hey, we just started scanning the slide. It should be uploaded in a couple of minutes, and then I log in to the, you know, on the iPad. No matter where I am, it’s very easy to always have the tablet with you. And so I could be at a dinner, I could be in the dentist, it that doesn’t matter, you know, And I can take care of that frozen section, you know, as soon as it uploads, call the [00:35:00] surgeon, let him know what I’m seeing. Yeah. And then it’s. It’s just done.
Aleks: Perfect. Do you know what I did recently? I just got the Smart In Media camera, and I had the lecture for nonpathology students about pathology data, I did the demo for them and let them guess what slides I had on the stage and I just had them scan the QR code. Of course, the first thing that they started to do was draw on it and annotate and like draw circles in the heart. That’s the coolest interactive teaching tool as well. That’s, that was fun. Beth, You are working with community hospitals and how did they react to this new cutting-edge tech? And like what was their reaction to you proposing this going digital? Or maybe did you do it together? How was that when you suggested it?
Beth: Yeah, we have a very supportive hospital [00:36:00] environment, so administration gets it, especially I think COVID got us to a point where we were understanding, you know, utilizing technology to extend us and to be able to, you know, we were used to doing Zoom meetings where, you know, we’re sitting in our homes and, you know, babies walk into the room and climb up in people’s laps and, you know, dogs come across the zoom camera and cats are walking all over. And, you know, it’s it’s we just got used to that. We got used to doing, you know, our two reports now are all Zoom. And so we, they, you know the idea of using technology to people to extend the resource they saw what working alone was doing to me they saw yeah you know they saw how hard it was, they saw how hard the recruitment environment was. They saw how difficult it was to recruit for other specialties as well. So, I mean, I think that that administration gets it as a tool [00:37:00]. And they’re also very supportive and trying to help me with my crazy scheme of trying to become interoperable with the medical record system. So I think it’s very helpful to have a supportive hospital environment. They didn’t have extra money to throw at it, but they, you know, they knew that this technology would help me extend the resource so that I could provide more services. You know, I could make I could say, okay, listen, we can have frozen section hours, you know, that are longer because I’m available. You know, I want more of it, you know, like I can’t be available if I have to go to this hospital. We don’t want to limit procedures. I never want to be the right limiting factor in a procedure. And so I think that, you know, showing them this allows me to not be the right limiting factor is good for hospital throughput and bottom line and patient care and all these things too. So the hospital reacted pretty well. I think it’s it’s sometimes a little challenging with the [00:38:00] frozen sections because it does extend the turnaround time a little bit for me since I am using whole slide imaging. So they’re not you know, they’re used to being able to have the slide on…
Aleks: The slide is ready, the
Beth: Have the instant answer now. There’s a, you know, a slight delay of the few minutes that it takes to upload the image. And I think sometimes the surgeons who you know.
Aleks: I don’t think they go up to the most patient group of professionals either.
Beth: Yeah. They’re they’re pacing back and forth. And so I think that there’s you know it’s but I feel like once once people get used to it and, you know, once surgeons are coming in that have seen this in use for their entire careers or have seen, you know, me using this for the for their in my entire career or my entire career that they’ve been with me, then they’ll just see it as normal. And so I think, you know, over time it becomes people get used to it, the technology just like it. They will. The technologists in the laboratory love having [00:39:00] tech that, you know, that it’s even though it’s more work for them to scan stuff they see what it does. They see that it extends the reach and that’s it, you know, it makes things easier and allows for, you know, allows for other use cases as well. We’re using it now for tumor boards. You know, we’ve been looking at how can we use this to save money with our send-out costs. Can we use can we scan the images to the place, the hospitals where patients are going for second opinion rather than, you know, FedEx, things like tracking numbers and, you know, things like that? So I think that they see that there are possibilities with it. And I don’t think technologists love technology. Right.
Aleks: Right. They’re technologists. But I was not, see, I recently only learned about this requirement. And then when somebody’s going somewhere for a second opinion this the slide and, the the specimen, the diagnosis was made up has to go with them because their pathologist has to confirm that. And I learned that in the context [00:40:00] of yeah. Of doing this digitally instead of sending glass because sometimes it would take longer to ship the glass there than to bring the patient.
Beth: Yeah. Yeah. And it’s very expensive because, you know, you have to make sure that there’s tracking numbers on these specimens, that they are good, that they go quickly. Sometimes, you know, we’re sending them overnight and that can get very, very expensive, especially if you’re sending to multiple different hospitals every day, you know, which we do because patients go all over. And so I think that there’s it’s it could maybe even help offset some of the costs of purchasing the technology. If you can use these as justifications as you know, this is going to ultimately help us in the long run. And I think the real justification is the pathologist’s resource because we are the most scarce. You know, it’s a very challenging recruitment environment. [00:41:00] You know, it’s it’s now that people are kind of used to having a little more flexibility with work. There’s people are demanding it and so if if we can if we can help provide that and, you know, if there’s technology that can support us in that, then we should be exploring. And I hope we get there. I mean, the radiologists in our hospital are 100%.
Aleks: They do that, right?
Beth: Yeah, they do.
Aleks: In the same rural area that you are.
Beth: Yeah.
Aleks: Like what’s the deal? Pathologists can have that too.
Aleks: Yeah. And I feel like radiologists are pretty far ahead of pathologists and in the digital landscape, I feel like they’ve been digitizing things for much, much longer. And so, I don’t know, maybe in 20 years will be like the radiology level of, of normalization of this technology and adoption into our daily lives. But, but it’s it’s exciting to to be on the leading edge of it and to be, you know, adopting it in early and innovative [00:42:00] ways and try to mold it, to meet my needs and meet my practice. It’s very satisfying for two to accomplish it when it works stuff.
Aleks: Your practice owns all the tech and you have it where it needs to be used.
Beth: Correct? Okay. Yeah.
Aleks: I understand.
Beth: And I needed to do it that way because I wanted how rapid, my timeline was and how quickly I wanted to know, you know, I wasn’t going to be able to wait for capital cycles and apply for things. And it also, you know, is the hospital environment. They have so many priorities that are competing. This was my, you know, number one, competing priority. So I knew that if I wanted to make this happen, it was going have to be my practice that ponied up the capital for it. So that was that was my reasoning for it. And yeah it’s it’s been working out. The technologists are the ones who are truly, you know, doing all of the [00:43:00] scanning, using, using it in, in the day-to-day. And, and I’m just sort of, the end user beneficiary of it.
Aleks: I think it’s extremely empowering that you could like you say, okay, that was my priority and I did it. I chose what I needed to choose and I brought it to them. They said, Yes, and we can now do it because, you know, you were also in the position that you’re working with multiple institutions. And so you were the driving force. But I think that this story is empowering others in your position and others who work independently. Hey, we can be the drivers of this. We don’t have to just like say, yes, if somebody offers this to us, we can consider on our own if it’s going to bring more business into the practice if it’s going to increase the access to care, if it’s going to increase the flexibility of our life. And if the answer is yes, hey, let’s budget and let’s do it, I think it is so cool. [00:44:00]
Beth: Absolutely.
Aleks: I think it’s super cool. So, if someone else was in a similar spot and was thinking about getting into digital pathology what’s your advice, or like what are the traps that they should avoid I know something that maybe you would do differently right now.
Beth: So I think that I think compliance reasons scare a lot of people. I think people are very frightened of technology that’s not FDA-approved. I think people find that it’s that’s a barrier and it shouldn’t be. People should be able to access non-FDA-approved technology. You’re going to have to do the same validation anyway when you’re internally validating it. And the College of American Pathologists gives you really good resources. I mean, they tell you, you know, step by step what you need to do to produce the validation that’s considered acceptable, which is, you know, it’s just like any other laboratory test, right? So if you just [00:45:00] approach it like any other laboratory test and I think that just knowing that there are options out there that are FDA approved and that the validation, the internal validation that you’re going to have to do is going to be the same, whether it’s FDA approved or not FDA approved. So really, you know, like if you think the technology is good, then it’s good enough for me because you’re you.
Aleks: If you are you as a board-certified pathologist outside you can do a diagnosis on these. And, you know, compare it to whatever CAP says it’s I think it’s 60 cases yeah yeah, and right then that’s what it is right.
Beth: Yeah yeah it, I think that’s a huge thing because I remember, you know, very early on when I would tell people about this, they’d be like, but you know, you’re going to get in trouble with the regulatory regulating bodies and blah, blah, blah. And I’m just like, I don’t think so. Like it, you know, as they give you parts to do, [00:46:00] you know, laboratory approved tests and the state, you know, like I followed it and the state said, okay and but so I think it’s you know, it’s I think people consider it a barrier and it’s probably just because, you know, not a lot of people are doing it, you know, the way I did it. And it’s just sort of an individual who just needs it needs it to function. Yeah. And so I think just sort of if you if you have that need like one, overcome that barrier. And then I think that the other barriers that that people tend to have would be the financial barrier and also the barrier of making sure that your hospital administration or whatever that, you know, an administration that you’re working with is on board and can provide, you know, technical resources and is supportive of the technology and agrees that it needs, you know, HIPAA compliance and that, you know, data privacy standards and all of these things [00:47:00] that are out there, you know, that that, you know, making sure that that you have a supportive environment from that perspective to be able to to meet those barriers, I think is also pretty critical. there was I want to add one point: my access to the data platform where the images were stored was blocked because this was right when Russia invaded Ukraine and the hospital decided to block all, you know, all European, you know, web.
Aleks: Smart In Media is from Germany. Like, Yeah. Okay.
Beth: So Smart In Media was blocked and, you know, it took me it was, you know, why those things? It took me a couple of days to work through with my I.T. staff like, no, this is…
Aleks: It’s safe.
Beth: They’re not going to start ruining my dream.
Aleks: To do my job.
Beth: You know, it’s it’s Germany. It’s okay. [00:48:00]
Aleks: Oh my goodness.
Beth: But yeah, so things, you know, things like that and, and, you know, just evaluating things. Keeping it moving forward and just, I would say I’m very satisfied with the technology I purchased. It works very well for me. It meets my needs and it gives me sort of foot halls into the field that, you know, makes me ask more questions and make me think, makes me think of, you know, what I what we’re going to need the next level to do and what the next level to meet. And it’s just I’m approaching it very iteratively. And I think that that’s like that’s another thing too, is I would recommend for people approaching it iteratively. I can’t imagine trying to dive in and completely redesign my workflow. I think that’s another thing people get scared of. They’re like, gosh, yeah. You know, like, I love my microscope, I love glass, you know, like I don’t want to move away from that. But, you know, if you don’t like most of my [00:49:00] work is glass, that the digital stuff is just icing on the cake and I can and.
Beth: That’s okay, right? Because you know, maybe not now not so much anymore. But a couple of years back, it was like a hospital going digital all full, digital full, like no glass anymore. Everybody on the screen and people who like, don’t have the luxury of having an institution or like having a dedicated group coordinate that and coordinate the phasing out and then just going to digital think it’s not exist and it’s you just you just use it iteratively and differently. So, Beth, if you decided, okay, I want to grow my practice with digital pathology, be a tool that would help you grow it, like having a person where.
Beth: Oh. Yeah. And, like, our hospital system is looking at affiliating [00:50:00] with another hospital system. And that other hospital systems have had an extremely difficult time staffing their anatomic pathology lab. They have a hard time staffing pathologists, same thing, you know, recruitment environment. It’s also a very hard environment to recruit technologists, histotechnologists, cytotechnologists, it’s very hard to get all of these, you know, all of these things in place. So I can see a future where we are, you know, consolidating resources for anatomic pathology, for multiple institutions in a centralized environment and using the digital pathology not only to share cases amongst pathologists but to be able to do, you know, the frozen sections, the on-site adequacy assessment, even just daily sign out. I think if we can get to a point where we’ve got heightened…
Aleks: We can scan slides…
Beth: …science, good interoperability with the EMR, I can see a future, you know, especially if we’re expanding and growing. And [00:51:00] that will help that will help normalize the workload. It will help people be, you know, working at the tops of their licenses and be more efficient to be able to work from anywhere. And it’ll be attractive to recruit pathologists that we can tell them they can work at home if they want to work at home. And I think that that’s, you know, giving people that sort of flexibility, I think the next steps is the higher throughput, the interoperability with the EMR, and moving even more toward incorporating it into daily routines and and sharing across geographic distances. I mean, when you’re in a rural environment, it’s you know, you’ve got a lot of space.
Aleks: That’s true. That is true. And not everybody wants to come to work in a rural area. And this is amazing. I love your story. I love very much how empowering and how like you just did it. And that always gives [00:52:00] then that’s a super cool example. And shows that it can be done. You don’t have to wait for anybody. If you need it, just do it. There is a way to do it without going out of business and you can serve more patients and there are budget-friendly tools that can unblock the problem. Yes. Thank you so much for joining me. I thank you so much for telling my digital pathology trailblazers how you did it. You are a true trailblazer.
Beth: Thanks, Alex. I appreciate the opportunity. I love the technology. I love sharing it. The more of us that are out there doing it, the better it will get.
Aleks: Yeah. And then, you know, those who come after, that’s going to be what they see. That’s going to be what they’re used to. And there’s not going to be any there’s not going to be so much fear. There’s going to be so much [00:53:00] misunderstandings because that’s going to be what they step into when they start practicing.
Beth: Yeah, the barriers will go down. The hospitals will want to adopt it because everybody else is doing it.
Aleks: So yeah, now thank you so much and you have a wonderful day.
Beth: Thank you, you too.
Aleks: Thank you so much for staying till the end. Well, this episode was heartwarming when a person, the pathologist, a female pathologist from a one-person practice can help, can go digital, and can help more patients than she would without those tools. If you want to check two of the tools that Beth mentioned, grounding the new microscope and the Smart In Media live view camera, I will have them linked on the screen. Here are. You can check out in more detail how those tools work and I talk to you in the next episode.
