Rajendra: [00:00:00] Digital Pathology could easily be solved if it is done properly. We had to come in as Pathpresenter as the pathologist who is thinking about this all the time like this is something that we need to resolve so we worked with other people at other institutions and then we sat down and they created the solution which was a solution to how do we make this one seamless and secondly how do we make sure that all the places where the mistakes could happen like the wrong patient information was added how do you avoid all this so that you make it in much better legal mistakes will still happen but at least we decrease the number of mistakes that can happen because you’re reducing the number of steps where a human is actually taking data and putting it in somewhere else
Aleksandra: Welcome, Digital Pathology Trailblazers today. My guest is Dr. Raj Singh, the founder. I don’t know, Raj, what your position now, is as a Pathpresenter. But before we talk more about you and the book Pathpresenter, do you remember the first time we [00:01:00] interacted because you were one of the first guests on the podcast when they started the podcast? That was when the presenter was a baby platform compared to what it is now.
Raj: Now it’s been a good journey and there has been so much help and support from a lot of people that are very interested in moving the field. I think that has helped us grow in a very positive way.
Aleksandra: Yeah, so we met, I think it was 2019. That was the first time I think I published something on LinkedIn about starting a blog and you interacted with me and said, “Hey, would you like to see this platform?” And I’m like, “Okay, let me see the platform.” And this is how we got introduced. At that time, it was just a tool for making presentations, for conferences where you were able to show whole slide images and not just screenshots of slides, right? So that you could show something at the conference. This was and I think the title of the podcast was I’m going to link it down [00:02:00] below as a tool for killer pathology presentations. But since then it has grown tremendously. I mean, to me, you’re a famous person in the pathology world, but for those who are just entering the digital pathology world, let’s start with you. I let you introduce yourself and tell the listeners about your background and then we can talk about what happened to Pathpresenter in 2019.
Rajendra: Thank you, Alex. Certainly, this is a great opportunity to talk about digital pathology and make as little as you as because previously I’m a pathologist and I’ve been a pathologist for no more than 25 years, so it’s been a lot of time in this space. I did my residency in India and then back again to residency in the U.S. and then I did a fellowship in internal pathology and then started working as a pathologist in 2007 in the US. And I’ve always been an academic pathologist. My main job has always been to sign note cases. And the other main part has been to train new doctors and [00:03:00] pathologists as they come into the space. And that has been the two areas of focus. And like we talked about in the last episode also like Pathpresenter was initially not supposed to be a company, it was just a project that neither doing so that we could fill in the gap on how we can educate our residents and fellows in a much better way, and that we created this software and so that we could use whole slide images that can be uploaded onto the cloud and then anybody could come in and then use those images, along with a lot of tools like creating presentation, creating quizzes, creating digital slide boxes. Whatever, I normally do, then I’m teaching my residents since I must be wandering to simulate the same thing that nobody was doing. So we created this platform that allowed anybody to upload slides from any scanner, see them in one viewer then create presentations. Create digital slide boxes, and do these quizzes, and assessments. And it took off quite a bit because we were filling in a gap. [00:04:00] There was no way people could do this on the cloud or online because there are so many limitations, like multiple file formats to read issues. How do you integrate PowerPoint and digital whole slide images? Nothing was resolved at that point, so we were trying to fill in the gap at that point, of how to bring in digital pathology to enhance the way we teach and educate our future pathologists. So that was when Pathpresenter started, and that is the point at which we interacted. And at that point, I know in 2019. The journey of Pathpresenter has always been about filling in gaps in the use of digital pathology. So when we did this education part, then the FDA came along and then they saw the platform and they said this could be used to collect a lot of data for validation of AI work. So then we created a research platform that allowed the FDA and other institutions to like, gather, gather data from all around the [00:05:00] world. And the importance of gathering data from all around the world is because you want diversity in your dataset. You cannot use, from one place to create or validate any AI model. You want the diversity in your data set to create modules that work in the real world. And we were a platform that allowed this data to come from anywhere in the world into a central location and then allow the organization to like to use that data, you know, in a way that they would like to use it. So like, how do you bring all the data into one place? How do you bring in researchers to, like, interact with the data? How do you create annotations that can be validated? How do you download those annotations and then use them to either create or validate in the end with them in some of the, you know, in some of the platforms? So that was the creation of the research. We call it a research module, but it was more of a module that allowed the collection of data from building and validating AI models. So that was filling in another gap, in the use of digital pathology [00:06:00]. And then, Dr. Parwani was at Ohio State University when we both of us were talking and we thought like the main like, the digital pathology has been talked about for ten years. The first use case for digital pathology was for consultation for a second opinion consultation. But there was no way, currently, even in 2020 to easily do consultations using digital pathology. People were either if you had a glass ready was putting the glass slide in the FEDEX envelope and sending it over to the consulting hospital. Even if you were using digital slides for a consultation. At that point, the only way to share this slide would go to a Dropbox or a box folder. Upload the whole slide images into the Dropbox or box folder, then let the institution know that we have uploaded the slides then somebody from the institution would go into their Dropbox folder and download those whole slide images, download all the paperwork, and then go back to their desk and [00:07:00] then enter all the paperwork and then link this slide to the paperwork and then go ahead and give it to the pathologist for them to sign case out. There are so many problems in these. Like you, you’re sending this over, whatever Dropbox or box when you don’t have a viewer, so you don’t even know what you’re sending. Secondly, when you’re done uploading this patient information, downloading patient information, and re-entering it into the LIS (Laboratory Information System) there are a lot of places where you could make mistakes.
Aleksandra: Yeah. And also not necessarily a secure way of dealing, with sensitive information.
Rajendra: So it wasn’t a very effective way of sending consults, although the main use case of digital pathology was also said to be like it was very easy to send consults and use it for providing consultations. So then we sat down with them, with Dr. Parwani and then the team sat down and together, and we then said, let’s create something that that solves this issue. So we then created this [00:08:00] consultation module, which was an institutional web page. So what we created was an institutional web page. So it could be OSU (Ohio State University), it could be MSKCC (Memorial Sloan Kettering Cancer Center), it could be M.D. Anderson, it could be Stanford. So they would have an institutional web page, which they could provide to any institution that wants to send them cases.
Aleksandra: So they send the link to them.
Rajendra: Yeah. So that institution would be able to log in to their webpage and it is a very, very secure HIPAA-compliant web page, that has been created with all the security in building the back end. The PHI (Protected Health Information) could easily be uploaded, the slides could be uploaded. And remember, like when pathologists are signing out cases as a pathologist, I know I want to see the gross image. I want to see the clinical image. I might want to see the radiology images. I might want to see any prior cases of the patient that the patient might have already undergone. So we need all that information to come along with the case. So we created this module, this web page where [00:09:00] institution could easily upload all this data in a very secure manner, bring it to the cloud and then through an HL7 engine, and then actually bring those cases and integrate them into the LIS, give them to the institution for downloading again. But that defeats the whole purpose. So we created this entire solution, where cases go on to the web portal and then the HL7 engine would be able to take that entire information first, create the patient’s information into the LIS so that all the patient’s data gets into the LIS. Now we have an internal accession number within the LIS for the patient and then link all the patient’s lives and radiology images to that internal accession number within the LIS. Their knowledge was very easy for OSU to assign the case to a pathologist so that they would just go into the LIS and then see these cases that were coming from multiple institutions directly into the LIS, open the viewer, and see the case and report the case. And that was what [00:10:00] led to the building of the consultation platform.
Aleksandra: Okay. So let me just rephrase. So did you just build a bridge from that consulting institution to any institution that wants to get the consultation? That’s…
Rajendra: That’s how, that’s if essentially right, so what we have, we have given them the portal, which is a bridge, and we can connect a bridge that allows them to bring in consults from anywhere in the world into the institution in a very seamless manner, and also allows them to communicate. Like, this is the bridge that will allow them to communicate with the referring pathologist, with the referring lab. There are many times when I would like to talk to the pathologist, like, what is what I want, what I might need some additional information about the patient. I want to talk to them. I want additional things. I want additional information because these are usually difficult cases. These are not straightforward cases. I need additional information to make the final diagnosis. All these communication channels have to be built in a very robust way that is [00:11:00] very, very secure and follows all the rules for HIPAA. So All communication channels were built in, once the report was created, how did the referring hospital get the report back very easily? All those things that are supportable. Then the internal workflow was created where now an institution can just go into an OSU portal or any other institutional portal, and upload those cases there. The cases directly get routed to epic B, the beaker system that OSU has the cases then assigned to the pathologist. Pathologists just go into that beaker as they would routinely do for their internal cases, they will see those consultation cases are also there and then if they need to communicate, they can easily communicate using the portal and then sign the case out. And then the HL7 will take that case and then send the PDF, report to the web portal from where the cases were uploaded. So that the referring hospital can then download the report. [00:12:00]
Aleksandra: Okay, so I want to contrast two things here because there is the option to for remote sign-out for pathologists that was allowed during the pandemic and it’s now still allowed. But this is something we’re kind of more familiar with. If somebody wants to practice remotely or if there is an option, you know, to stay at home one day a week, this is within your hospital, within where you’re working. What we’re talking about is the remote second opinion, where like anybody in the world can send cases to a referring hospital, it’s second opinion, third opinion, whatever. Some specialty opinions that they’re referring hospitals do not have access to where they are practicing. Right. Can be all over the world. So my question is, what is like how big is this use case globally and in the U.S.?
Rajendra: Like, this is a very, very big use case for the [00:13:00] digital pathology. Like if you look at these big institutions, like if you look at M.D. Anderson or MSKCCC, or Stanford or OSU or John Hopkins, like that is one part of the equations or one-third of their work is consults. One-third of the work, and…
Aleksandra: 33% is from somewhere else, they’re consulting.
Rajendra: Somewhere else to that. So that is one part of it. Secondly, if any patient is going to any hospital even if I’m sending a patient to Cornell, I’m sending a patient to NYU, the patient cannot be admitted into the hospital before the pathologist has seen the case and agreed with the diagnosis.
Aleksandra: Oh, okay.
Rajendra: So that is another so that is called a referral. So when the patient is moving from one hospital to another, the pathologist in their otherwise would be first to look at the case and confirm the diagnosis, and then only the patient is allowed to be shifted from one hospital to the other. So that is the second use case of this one kind of system. But also [00:14:00] they have to remember that 70 to 80% of people are sending cases. They are not receiving cases yet. For us, when we talk about receiving cases, they’re talking about the big academic institution, or if you go to smaller labs, if you go to smaller pathology groups, you can go to smaller hospitals. They are sending cases. So for them, also this becomes very important because they need a route to send cases to these hospitals. So we are also working with this one hospital for them to build this kind of portal where they can upload the case into the portal and then say, I want to send this to M.D. Anderson, I want to send this to Sloan, and I want to send this to John Hopkins. I want to send this to somebody in Europe. So they also needed this kind of a solution, where they can send it’s not only about receiving cases, it’s also about sending cases. Or they’re going to say, you could use case for digital pathology for receiving cases, sending cases for referrals. And all that has to be figured out is how you can do this in a very seamless.
Aleksandra: It seems like [00:15:00] it’s a perfect use case that can be attacked from all the other angles. So how I see it in the big hospitals, well, they’re already probably digital, so they know how to read digitally. But the case they don’t have to be bothered with digitizing the cases because the cases are being digitized in the smaller hospitals or in the institutions that they’re looking for the consult and the institutions where they are looking for the consult, they do not have to be fully digitized. They can have one dedicated little thing to digitize the slides that they want the consult on. Right? So there is no requirement that all the pieces of this chain are fully digital and have deployed everything. It’s basically like like a bridge. That bridge bridges different use cases. At least this is how I see it from what you’re telling me right now.
Rajendra: A great example is one institution in Houston [00:16:00] that is a smaller hospital compared to M.D. Anderson. It’s big. But it is smaller compared to M.D. They send 1800 patients to M.D. Anderson every year, 1800 patients every year. The distance between these two hospitals is 50 miles. Many times like, just when they were sending cases to glass slides and if the glass slide went on the Thursday, the patient had to wait almost till Wednesday or Thursday before they could even be transferred to M.D. Anderson, four or five days gone for no treatment at all.
Aleksandra: For something that’s 50 miles away. So it’s like.
Rajendra: 50 miles away
Aleksandra: So it’s like less. than one hour of driving to get the patient and get the treatment that they were waiting for. A couple of days with glass…
Rajendra: Yeah! And so we have to work with this one hospital to create this portal where they could upload the slides immediately, and ask M.D. Anderson to come in and review those cases within one hour. Somebody reviews that gave them the case. The patient can then be transferred the same day rather than waiting for four or five days just transferring the patient.
And this is not one [00:17:00] patient-to-patient talking about 1800 cancer patients.
Aleksandra: So let’s focus on this. Like before a picture you said here in this case before, it would be okay. The patient can get to the hospital immediately within one hour. But they’re waiting for the diagnosis to be confirmed by the admitting hospital. How was it looking before at their receiving institution? And like, if you say it’s 30% of the work that those people, those big institutions have that is referred from other hospitals, how was this integrated or not integrated into the workflow before there was the option to do a digital as through the remote second opinion option.
Rajendra: Yes, so they had a couple of three or four or five people working on just consultation. So, what these people, if you go like, you can go to one of some of the major institutions still today, this very, very similar work is done [00:18:00] basically. So the glass slides would come in, in FedEx envelopes or like I said, if it was a whole slide image, it would come in through Dropbox or a box folder, along with all the paperwork of the patient so they would send all the paperwork of the patient. Now if it is a, let’s say if it is a glass slide, then what they would do is they are going to somebody when they’re going to take the glass slide out from the, from the FedEx envelope, take the paperwork out, going to the lab information system. First, enter all the patient’s information into the lab information system and create an internal accession number. And now then, they will digitize those slides on a scanner, then get those, see them in front, then the slides to be linked to the information in the lab information system and then provide it to somebody within the department to sign it out, that was if you’re sending it glass slide. Think of all the steps, mistakes can happen basically. Now if you’re sending digital slides to the other institution have a scanner and they’re sending digital slides. [00:19:00] They don’t have so they use FEDEX, so they will end up they will go on a Dropbox or a box folder or some Google Drive or whatever they’re using at that point and they will upload this down to that cloud portal and they will also upload the patient information and then they will send an email with the link that this information has been uploaded into the system. Can you please take care of this? So somebody at the referring hospital will then go into Dropbox, box, or Google Drive, download the slides, download the paperwork, take that paperwork into the LIS system, upload the slides back into their cloud, and then link it with the paperwork and then give it to the pathologist.
Aleksandra: I’m already overwhelmed with the description.
Rajendra: That is how things have been done for the last 50 years. And that this was such a low hanging fruit that digital pathology you could easily solve if it was different, if it is done properly, but it was, we had to [00:20:00] like come in as Pathpresenters as a pathologist who is thinking about this all the time. This is something that we need to resolve. So we worked with I know we worked with other people at other institutions and then we sat down and created this solution, which was a solution to how do we make this one seamless? Secondly, how do we make sure that all the places where the mistakes could happen like the wrong patient information was added in the wrong place, were linked to the paperwork? And, how do you avoid all this, so that you make it in a much better legal way also so that mistakes are decreased, mistakes can still happen, but at least they decrease the number of mistakes that can happen because you are reducing the number of steps, where are human is actually taking data and putting it somewhere else. We are making everything through HL7 messaging. So it becomes very inter, where the number of places where mistakes can happen is then brought down basically.
Aleksandra: So keywords that I hear here is [00:21:00] low-hanging fruit and seems like a no-brainer solution. My question here is how is this regulated compared to primary diagnosis? How is the second opinion regulated relative to the primary diagnosis?
Rajendra: So making pathology Radiology there are different rules for second opinion consultation. In pathology, when you are doing a primary diagnosis, you need like, if I’m, if I’m, let’s say, I’m working in a hospital and the hospital has two places. One is in New Jersey and the other one is in New York. Then you, you know, many places out there, like there are two centers either in New York, they might have in something in Connecticut. So if I need to do a primary diagnosis for those two centers because they both belong to my hospital, I need a license in both places. I need a license for New Jersey and I need a license for, New York. But if it is a consultation case that is coming from Texas, [00:22:00] I don’t need a license from there, from Texas. For a consultation, one thing is I don’t need a license to sign out a case that is coming from another state.
Aleksandra: Okay. And what about globally? Do you, does that make a difference if you receive a case from Poland or India, does it matter right? Your credentials and licensing that you have in the place where you’re practicing are good enough to provide?
Rajendra: And so that is the first thing. Secondly, when I’m doing a primary diagnosis, like, I have to do it on a system that has either an FDA-approved system or if I don’t have an FDA-approved system, I need to make sure that I’ve followed the CFP validation protocol guidelines and I’ve done the study with the 60 cases or indication that I need to do. And if I have done that validation study, then only I can use it for primary diagnosis. But for the consult, I don’t need to do all that. [00:23:00] I can start with a consult if I have. If I have, if I have a system to look at a slide, I don’t need to go through a CFP validation protocol or an FDA-approved system to sign this case out. The consultation that we don’t need to go through all this. You can do the consultations without having to go through this protocol. So that’s the second difference.
Aleksandra: So, question? So basically, as a pathologist, board-certified pathologist, if you deem a slide on a particular device diagnostically valid, this is on you and you can provide this the second opinion.
Rajendra: Second opinion consultation.
Aleksandra: So you can like, I don’t know if you have a nice tablet that you see all the seller details, that’s fine as well, right?
Rajendra: That’s fine as well.
Aleksandra: Okay. Okay.
Rajendra: But for primary diagnosis, we have to go through at least the CFP validation before we can start using the system for primary diagnosis. You don’t always need an FDA-approved system like that is some omitted [00:24:00] that many people have a primary diagnosis. If you have well and good, but if you don’t and nobody has a complete FDA-approved system like you might have a scanner and a viewer that is FDA approved, but you might not have a monitor, so you still have to go, even if you buy a n FDA approved systems, you still will have to do the CFP validation study no matter what. There’s another difference.
Aleksandra: In theory, if you right now. Wanted to become just a consulting pathologist. You can, like, go home, take your tablet, and say to the world, Hey, hear me, Dr. Rajendra Singh. I’m going to be consulting whoever wants to work with me. I’m ready for you.
Rajendra: Yeah, that is the current situation. There is no like, regulation that that you cannot do this.
Aleksandra: See, that’s like a collateral benefit from the professional standpoint. If people, you know, at a certain point of their career, if they would like to do it, they can do it [00:25:00] without all the hassle of setting up a lab and having it, you know, CLIA approved maintaining their licenses all over the world. And that is amazing. That is really…
Rajendra: And for the CLIA to approve that the rule that is now in place is when you’re signing our cases you can if you’re using glass slide you still need to be in a CLIA-approved place.
Aleksandra: Yes.
Rajendra: So nobody can send cases like in a glass slide to me at home and I cannot just sign out from home. But if I am signing out digitally and my hospital has approved my home as one of the places from where I can sign out cases. I can still do them even if my home is not CLIA-approved. That is the current one. The limitation is I need to put in the report that I signed this case from, from location like this.
Aleksandra: Okay.
Rajendra: It should mention very specifically where I send the case out from. The reason CLIA has put this in is because they don’t want people to sign out cases from hotels or airports [00:26:00] Those are not secure places.
Aleksandra: Secure places, Exactly.
Rajendra: So, that is the reason you have to put in, so, you can still sign on digitally from a place anywhere that the hospital is approved to sign or from the hospital has to approve and take responsibility that pathologists X and Y can sign on from this case. And we are taking responsibility because we know that the environment there has been created to ensure that all the rules and regulations and the security is taken care of.
Aleksandra: So, let’s talk about, what is the return on investment of this solution. To me, it looks like, there is, I mean you still have to invest in digitization in one form or another, there is a little bit or less regulatory burden. But what does the return on the investment look like?
Rajendra: So for a like a, for a regular case in a primary diagnosis, when it is when the CPT (Current Procedural Terminology) code is around 8305 [00:27:00] or 8312, and what insurance companies normally pay ranges from like $85 to around $150. That is what they would pay for an 8305 or something like that. What a consultation in charge somewhere from $450 to $400 per case, sometimes even more.
Aleksandra: Okay.
Rajendra: You can see there is a big difference in the amount of money. And you are not even preparing the material because most of the material is already prepared and given to you. So you are not investing in a lab and all that to create that glass slide and all the technical, most of it is already done and you’re getting that in, in all that information directly to you. So you are, so, there the price difference despite virtual ranges some institutions charge $400, some. If there is a contract more.
Aleksandra: That is 4x the normal, sign-out.
Rajendra: 4x the normal…
Aleksandra: Okay.
Rajendra: Because these are difficult cases and you need the experts to, to like expert opinion for these cases to be evaluated. [00:28:00]
Aleksandra: So the return on investment here is actually on the expertise itself and not all the things around that… People like, try to, I don’t want to call it capitalize on. But when you calculate your return on investment, you like to take into account every step of your histology work the I don’t know, producing of the glass slides like every single thing. And in this case, it’s the expertise and not everything else.
Rajendra: It is the expertise, but think of it in a bigger way. Right now let’s say, my institution is getting cases from the Middle East. So we are still limited because we are just talking to one place. But now if you have this kind of solution, your entire work becomes, your source for cases. But now it’s very easy for somebody from Argentina to just go into that portal and send me a case. Previously, that was [00:29:00]0] not possible because we’re not talking to so many or now think that the whole solution can now suddenly have the whole world as the people that can send cases to them. So the return of investment is coming from increasing the geographical spread where you can now provide your expertise and… So, you can certainly go from one or two or five countries to like 170 countries where you can now provide the expertise because it’s a very similar process for every country. All they need to do is go into the web portal, upload the case, and then send it to you directly. So within the portal that we created for many of these institutions we working with, there is a registration button on that portal that allows an institution to go in and register. If you want to send cases to you then the institution that offers the main hospital there, can see who is registered and they can approve the registration. So it’s not Pathpresenter does all that it is on the portal that the two institutions can directly [00:30:00] talk to each other.
Aleksandra: So on one end, for the institution that gets the cases, you increase the geographical territory where they can diagnose patients from. But for the rest of the world, it’s giving access to expertise that’s not available elsewhere.
Rajendra: Yeah.
Aleksandra: Which is amazing. Which is like directly benefiting the patients in countries where you just don’t have those specialists. I mean, in my country…
Rajendra: Don’t have a specialist, then even if you’re sending it, you wait for months, two weeks to a month to get a diagnosis, which sometimes is too late.
Aleksandra: So in my country, we have, I think, more or less 500 pathologists in the whole country. And we have like over 35 million people, which it’s not even that bad when you look at the rankings in other countries. I thought it was like, what, 500? We have like, I don’t know [00:31:00] how many are in the U.S., 20,000, 12,000. I don’t know. You will know better.
Rajendra: It’s somewhere in the 20,000 and mostly. I’m not sure about the numbers alone, so don’t quote me on that.
Aleksandra: Exactly. And so Poland is not even that under the list there are places that have a lot fewer pathologists. And, you know, you have under-resourced places. But you have places where the resources, like the private resources for treatment, are there, but the expertise is not there. So making this bridge is also something…
Rajendra: So, basically in pathology, because outside of the US, all pathologists, mostly generalized pathologists, and one pathologist are doing everything. So they do like Dermpath, they do the G.I. path, they do the Neuropath. So, for them to become an expert in one specific. It is very difficult and compare that to the U.S. the whole thing is completely specialized. Like, there is no [00:32:00] pa… very few pathologists that do everything, every pathologist is either focusing in one organ system. So they tend to become much better in that one organ system. So the knowledge base and the expertise are much higher in the US because of the way they just practiced in the US.
Aleksandra: So if somebody, will now want to use it and who is it for? Is it for like because like you say in the U.S., you have people that are specialized? It doesn’t have to be in a big academic center. It just is enough that somebody is specialized, is is it enough? Like, who can use it?
Rajendra: It all depends on like on the institution. What are the goals of big institutions, If you look at all these bigger ones or the major ones, not even the bigger ones, but the major ones, they want tools, to provide the expertise to whoever they need to work with them. So it’s, a win-win situation, where like outside of the U.S., there are so many patients and [00:33:00] patient like and pathology that need some kind of support from a specialist in the U.S., so it can for it’s a win-win situation for the department in the U.S. because now they can showcase their expertise to more people and get more work. For people outside of the U.S. or even within the U.S., many departments might not have some specialists there might be some departments that have nobody was still not doing skin, nobody doing neuro, neurology, or neuropathology, but these are worth specialized areas. So even in the U.S., then you see a lot of cases being moving from one place to another because their department doesn’t have that kind of expertise within the U.S. So I would say to the U.S., it’s not that at all. And even within the U.S., there are many places where something is lacking. They might have a majority of it, but some specialties left. So that disbalances out. I can send my case to anybody at Brigham. I can send somebody at Stanford [00:34:00] who I think is the best person for making my diagnosis. I can send the cases to anybody now.
Aleksandra: Amazing.
Rajendra: So it is always been about filling in gaps. Like if we did the same thing in education, we did the same thing for the research platform. We did the same thing for the consultation platform. So every time, every time, like the reason Pathpresenter has grown so much in the last few years is that every time they are looking at this area, then we see like wires in something being done in that area, and then we sit down and we create a solution for that area. And that is what people like with Path.
Aleksandra: So it looks like your understanding as a pathologist very much drives the product development process and roadmap and the question here is, how were you able to do it so fast? Because when they look at the digital pathology landscape, Pathpresenter is budding, like [00:35:00] mushrooms for different platforms. You have a whole ecosystem. And so let me tell you what, I know that you have the presentation platform that I’m using very much for teaching and my courses. I know the FDA platform that you already mentioned. I know you guys have a publication platform where you were able to publish books with whole slide images in them. Then I learned about Biobanking which is a platform that is dedicated to pharma and research. Now we have the remote second opinion platform. Is there anything else that they missed? What else is in your ecosystem?
Rajendra: And then the basic use cases, is the primary diagnosis. So we have the complete guide for the primary diagnosis also. So now is was already there. And then the recent thing that has come up is like for pharma companies, this you do how do you do some kind of a clinical trial? For, for companion diagnostic [00:36:00] drug? That is something that we are now thinking of working on because many pharma companies are very specific companion diagnostic drugs that are very useful for certain kinds of diseases. For example, is the drug by Daichi and AstraZeneca for Low Her2 neu breast cancer? So now if they want to get the patients for these normal new breast cancer, very easier way, easy way because we have this global platform that allows people to upload any data from anywhere in the world. So very easy use cases like you create this platform for the pharma company, create their platform, then any hospital or any patient from anywhere in the world can upload the slides into the platform. There will be an AI that will be running on the cloud that will look at the slide and then see whether the slide is associated with the Low Her2 Neu. And if they see that this is a new Low Her2 Neu patient, then the hospital and the [00:37:00] pharma company and connect to see if that is, they can provide the drug to their patient. So there is no not even a pathologist involved here. It’s allowing the pharma company to bring that drug to patients that might be sitting in South Africa, that might be sitting in Australia. By just allowing the pathology or the patient or the hospital that is treating the patient to upload their slide onto the pharma company web portal. And then the AI would run automatically on it and then predict whether there is a Low Her2 Neu And if it is a Low Her2 Neu then the communication can start and you could be doing this kind of. So yet again trying to see where is the value of digital pathology, where can it help pharma companies, and where can it help a pathologist. Where can it help an ecologist, and where can it help a patient? So everything is focused on the best use case of what we are creating actually. And like one thing [00:38:00] that I always want to like to tell many everybody is, you know, I think this could be a good way to against the introduction thing. Many pathologists are still skeptical about whether we should implement digital pathology, and many pathologists are still skeptical about whether they should implement digital pathology. There are many pathologists’ chairs and departments that are still skeptical that we should. They think this is not like the investment is there because they are always talking about return on investment. So they cannot find the value to like a, justify the investment that needs to be done for digital pathology. But one thing that they all need to remember very, very is AI is being built in a very big way and there’s so much AI work being done and it is not about AI that will help the pathologist that makes a diagnosis. We are not talking about that. We’re talking about the AI that is being built to help a clinician or an oncologist decide what treatment is going to be best for the patient and what is the prognosis for this patient. And modules are coming up. Everybody knows [00:39:00] that because you can see that there is a lot of work being done in this area where AI can predict what is the best treatment for the patient, where AI can predict what is the prognosis of the patient. So when these modules become available to clinicians and patients, they are going to pick up the phone and call the pathology department and say, I need a digital slide of my case. And at that point, the pathology department will have no power. They will just have to provide a digital slide no matter whether they want it or not basically. Whether if they’re not integrating their digital system at that point, they will immediately have to find a way. By a scanner digitize the slide, so they can give it to the oncologist. So it will almost be like they’re being arm-twisted to go digital at that point. Rather than wait to be armed-twisted, why not do it now when you have complete control and power about how this system should work and how it can benefit the pathology department and the [00:40:00] pathologist, rather, then in the end, when you will be forced to do it, there is this is coming. There is no way out. This is coming basically. So, if you have seen it and you can do it, you can take control now or you will have to do it in a couple of years.
Aleksandra: And you’re going to be forced to do it because you don’t do it. You are denying care.
Rajendra: And you’re going to do that actually, that if the patient is saying I need a digital slide or the oncologist or the clinician is saying I need this digital slide there is no way out. Even the hospital sees you’re going to say, give it to them right now. You cannot give them the glass slide They will go somewhere else. So, you’re going to lose the patient.
Aleksandra: See? Amazing.
Rajendra: So they have to, they have to understand that this is the right time to implement digital pathology when they are in charge when they can control how the whole thing is being built and benefits the pathologists and the pathology department as well as the clinicians and the patient.
Aleksandra: So from all [00:41:00] the platforms are older, like subdivisions of Pathpresenter, which one drives the most adoption? At the moment.
Rajendra: It’s like, initially it was education definitely because every department was almost using it for either the free public platform automation version of the platform for education. But in the last 6 to 12 months it has suddenly become the consultation and the clinical platform. Again, because when, when we are so, like the good thing about Pathpresenter, we don’t have anybody on the marketing team. It’s all word of mouth.
Aleksandra: I know.
Rajendra: And we, when we show, whenever we are showing this platform we’re not trying to sell the platform to the institution or to the pathologist, we show them why this is useful to you, why this will help you as a pathologist, as a pathology department, why this will help your clinicians, why this will help your patient. And that has been the goal when we showcase this platform and we show it we never had to sell it. Everybody says we wanted this [00:42:00] yesterday. They don’t say you wanted this today but we want what you were showing us yesterday. These clinical and consultation modules suddenly become the main thing that is driving Pathpresenter uptake in a much, much faster way.
Aleksandra: Yeah. And that’s also like super straightforward regarding the return on investment and it’s a no-brainer, I would say. So before we finish this discussion, I need to talk about this. I know you guys put that on the back burner because you have so much work in the clinical space, but being a veterinary pathologist, I need to ask you about veterinary medicine.
Rajendra: Like for veterinary medicine they know that the education platform is right now, ready to use. And we have tried to talk to the veterinary organizations and the veterinary pathology department, but we haven’t still received that kind of enthusiasm or success to actually how do [00:43:00] you use this for veterinary education in pathology.
Aleksandra: I just need to create something for Raj on Pathpresenter, right?
Rajendra: Yeah, yeah. So I’m like, I’m very open to any… It’s an open invitation to any veterinary organization, or pathology department that is dealing with veterinary pathology that we would be very, very happy to showcase the platform to you and show you how you can use it to enhance your education, not only for your department but also like veterinary pathologist is such a very important part of drug development. Such a very important part of, how pharma companies are using this digital pathology in not only drug development but educating pathologists on how they use digital pathology in a way that could help them in their careers. So we are open to working with them, showcasing them what is already there so that they can start using it in a very effective manner. The open public platform is, is a free [00:44:00] platform that has 55,000 users on it right now, under 170 countries that use it daily.
Aleksandra: Yes. I use it and I know that several veterinary pathology online educators are using it as well.
Rajendra: It will be working with them to bring content on it in.
Aleksandra: Amazing. Thank you so much, Raj. Thank you for the update. And I’m not going to wait another three years before we speak next time because then you have too much to say. And there the Pathpresenter grows even more. So we should agree on a more frequent cadence. But thank you so much.
Rajendra: Because the other thing that we are very focused on is how do we now bring the new technology, which is the large language models in the vision transformer models to the workflow.
Aleksandra: Let’s talk about that.
Rajendra: So we are not talking about using them again to build AI modules to make diagnosis predictions and probably because there are so many spectacular [00:45:00] AI companies working on that, but we are still we are like workforce specialists. So we want to see how we can bring efficiencies to the workflow by using these models. So within the next six months – 12 months, you will see a lot of this now coming into batteries.
Aleksandra: What can you say something? Can you already reveal a little bit about which direction and which part of the workflow you’re going to be tackling?
Rajendra: I think it’s mostly about how pathologists can sign out cases in a much better in faster way, in a much better faster, and safer way. Those are the three things that we’re focusing on better, faster, and safer.
Aleksandra: Okay. I am super curious when this comes out, I need to get you on the podcast as well. So thank you so much and I hope you have a great day.
Rajendra: Thank you very much for the opportunity.
