Today our special guest is Dr. Keith Kaplan, the creator of TissuePathology.com himself! The publisher of a platform that inspired the creation of Digital Pathology Place.
The Evolution of Pathology on the Web and Beyond w/ Keith Kaplan, MD | tissuepathology.com
The Evolution of Pathology on the Web and Beyond w/ Keith Kaplan, MD | tissuepathology.com
The Digital Pathology Trailblazer on the Web
Dr. Keith Kaplan, a surgical pathologist and a pivotal figure in the digital pathology community, has significantly contributed to the field with his groundbreaking website, tissuepathology.com. His passion and dedication have made his platform the first resource many turn to when searching for anything related to digital pathology.
From Traditional to Digital
Dr. Kaplan’s unique journey in pathology began in Chicago, shaped by his military service and academic path at Northwestern University. His early exposure to telepathology and digital imaging during his military tenure set the stage for his impactful venture into digital pathology, initiating a transformative career trajectory.
TissuePathology.com: A Pioneering Platform
Dr. Kaplan launched tissuepathology.com, driven by his enthusiasm for utilizing the internet to disseminate knowledge. This platform quickly became a leading blog in the digital pathology realm, motivating others to establish their blogs and engage in the dynamic digital pathology conversation.
The Evolution of Digital Pathology
Keith’s work with robotic telepathology and his involvement in deploying digital pathology solutions across various settings highlight the significant advancements in the field. His stories of early digital pathology efforts, including the deployment of systems for military applications and the subsequent adoption in civilian medical practice, showcase the progressive integration of technology in pathology.
Embracing Change: The Digital Shift
Recently Dr. Kaplan’s practice transitioned to digital pathology for primary diagnosis. The integration of digital pathology has streamlined diagnostic processes, enabling faster and more efficient patient care despite initial reservations about moving away from traditional microscopy.
Future Directions and Ongoing Challenges
Looking ahead, the future of digital pathology will be impacted by AI and the ongoing pathology workforce shortage. Keith emphasizes the need for the pathology community to adapt and embrace new technologies while also addressing regulatory, ethical, and practical challenges.
THIS EPISODE’s RESOURCES
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transcript
Keith: [00:00:00] You’re getting a robotic microscope you can send cases to AFIP you can put it on the stage and you can go home and they’ll look at it and send you a report by the morning and these guys would say look you know this all sounds well and good but if it’s not glass you can kiss my ass. Now 25 years later I have to admit I understand where they’re coming from I’m the age they were then and you know look look like anything after doing something repetitively day after day after day now for almost 30 years to not have the foot pedal to not have your working draft to not have your pile of slides it’s a little disruptive definitely fortunately I think the technology is good enough that the transition was actually pretty seamless…
Aleksandra: Welcome Digital Pathology Trail Blazers today I have a super special guest, for me personally because this is the person who inspired me to even start digital pathology place, and for everybody who [00:01:00] ever searched for anything digital pathology related his website is going to pop up as the first resource Dr. Keith Kaplan welcome to the podcast how are you today?
Keith: Thank you, Thank you! It’s great to be here it was great meeting you in person in New York over the summer and I’m glad that we’re able to pull this together after so many years now so I appreciate uh the opportunity to speak with you and your audience.
Aleksandra: amazing and yes we met in person Keith let’s start with you please introduce yourself probably everybody knows you already but for those who are new to the digital pathology Journey let me know how you started what’s your background and what do you do now.
Keith: So I’m Keith Kaplan I’m a surgical pathologist uh with Versant Diagnostics. Versant Diagnostics owns several pathology groups in Illinois Maine and Virginia currently uh we are part of several groups in the Chicago land area born and raised in Chicago did my medical school at Northwestern University here downtown [00:02:00] and attended a medical school on an army health profession scholarship so I did my internship residency and then subsequently fellowships at AFIP in Washington DC and that’ll be a kind of an…
Aleksandra: I study there for my boards
Keith: Okay it was a great place it was a great place to train great experience and then um fortunately I did my payback all at Walter Reeds so I spent nine years active duty military um without ever leaving the Beltway it was a great experience I was exposed to great people and great cases and great colleagues many of whom I’m still in touch with today so and part of that actually led to my uh introduction certainly to social media and starting the blog so um I’m currently as I said in private practice in Chicago now
Aleksandra: And you started working digitally but we’re going to get to that in the later part of the podcast but yeah how did you get introduced to the digital [00:03:00] world was your blog the first one when did you start tissue pathology so everybody who doesn’t know go to tissuepathology.com and this is the blog we’re talking about this is the trend-setting pathology blog uh that was there when I started my digital pathology journey and this was what inspired me to start my blog then later you know grew into um more audio and podcast-heavy and video-heavy social presence. social media and internet presence but yeah tissuepathology.com how did this happen?
Keith: You know it’s interesting uh as I said when we lived in DC there was actually a Blog that I came across probably around 2003 or 2004 called whyIhatedc.com and uh we didn’t live in the district but I worked in the district and you know we would go downtown and whatnot and uh he he was ranting and raving about life and DC [00:04:00] traffic, parking, uh taxation without representation um all of the issues in in a large metropolitan area um but interestingly the way I came across that wasn’t on the web but actually in an article in the Washington Post I think it was on page two or three of the section B the metro section um and they were writing about this blog and I thought that’s kind of interesting we were still calling them web blogs as sort of partial websites or Chronological diaries of information usually done by individuals and I thought this is really interesting that the Washington Post and I enjoy reading the newspaper to today certainly did at that time was covering this blog and actually you know aside from talking about what the blog was about the article went on to say that and this was a couple years if you remember before the first I phones for example in [00:05:00] 2007 so we didn’t have the power of mobile Computing then for sure but the idea of web 1.0 where you would bookmark sites and follow people and people are starting to share ideas and contents The Washington Post article went on to say that you know with these platforms and these Technologies everyone can be a pseudo journalist and write their opinions people are going to have the opportunity to be photojournalists put together their own photo essays people are going to be able to virtually everyone in the whole world could be their own food critic their own music critic their own movie critic and we would share all of these ideas and I thought it was just very interesting that here was somebody I had no idea what his credentials were and you know that’s a separate issue but that he was writing about this stuff and the Washington Post took notice of that so I started thinking about how can I use these tools and technologies [00:06:00] um in pathology and certainly we’ll get back to this emerging technologies in pathology because we actually were doing some Digital Imaging not whole slide but we were starting to dip a toe in the water with robotic telepathology actually in the military at that time.
Aleksandra: I know I have this timeline where it says that AFIP decided to do robotic telepathology for the people who were deployed right who were…
Keith: Correct
Aleksandra: Basically fighting in the field.
Keith: So my introduction to digital pathology sort of had an unusual beginning um as a senior resident, I was um selected to be awarded an award from the American Association of Clinical Chemistry for an an article that we wrote on laboratory indicators of ethanol consumption and um I had to ask permission and get funding to go out to San Francisco to the AACC meeting which I really honestly had no other business being at [00:07:00] um to get this award and um I did so and after after the award ceremony I walked the large Convention Center there in San Francisco there were all the chemistry analyzers and reagent companies and people are selling cubits and all of the things associated with clinical chemistry, it was a big big floor plan and lots of machines and equipment and people and so forth but off in the corner of the convention center were a couple of people who look to be about my age then about 25 years ago um on a small tabletop and they had a computer set up and somewhat naively I just walked up to this table and I happened to grab the mouse and I moved a picture around on the screen and I asked what just happened and they said you just drove a microscope slide 300 miles away in our shop in Newport Beach California and I said I think the Army needs about 24 of these. So, that was my first Introduction [00:08:00] to robotic telepathology and actually even before that, we had had old Apollo Karabi Tela-systems um that were largely in pieces and boxes underneath the IHC bench by that point but the Army had tried this and they tried it actually decades…
Aleksandra: Karabi like the the company by Dr. Weinstein?
Keith: Correct!
Aleksandra: Oh, my goodness this is like me doing history research on digital pathology and that’s like at the very very beginning of the timeline like in the ’80s where he was showing it was still… it wasn’t even digital it was just telepathology because it was a satellite right
Keith: Satellite it was video and satellite and they had some proof of concept between El Paso and DC as early as 1986 I think if I remember the history correctly and of course, Dr. Weinstein had been doing things between MGH and Logan Airport a decade or two before that so yeah that that [00:09:00] system that was in pieces and boxes was actually a Karabi Telemetric System at the old Walter Reed Hospital and we tried to put that back together we didn’t quite get there but then I saw a motorized stage motorized objectives through a company called alumia that became Trestle and then and then Clarient and then Zeiss I believe and um it was probably technology quite frankly ahead of its time at that point because this was the late 90s a lot of us weren’t even accustomed to online banking um we had very primitive communication systems and Pathologists were pretty wary about exchanging information over the web and rendering diagnosis based on uh a slide hundreds if not thousands of miles away but that came over time of course and we’re well far down the road from that now so um I was introduced to Dynamic telepathology um at that point and brought that back to the Army me and um. [00:10:00] Eventually we deployed 24 systems all over the world and they were all uh being directed towards AFIP and then folks were consulting with each other with those systems across the um Army Medical Department Network
Aleksandra: Did you use them were you using them on a regular basis?
Keith: Yeah we did a number of consults at Walter Reed and we use it for our resident and fellowship training and I think when I left AFIP in um 2005 something like 2400 cases had traveled across the uh Army Telepathology Network that we had started.
Aleksandra: So that was 2003, you’re saying…
Keith: When I left it was 2005 and unfortunately um that coincided with the base realignment and closing and the eventual closure of AFIP um but between effectively 2000-2005 the cases that were formal consults AFIP we could track and then folks who had trained [00:11:00] together and knew each other could share cases sharing each other’s static IP addresses with their microscopes um so we had them in all the teaching programs we had them in Korea, we had several in Germany we actually deployed a system to Iraq during the Gulf War and that system actually uh had a Slide Loader I wrote a paper about this had a slide loader associated with it because we set up a histology Lab at the 31st combat support Hospital so we were doing telepathology from Iraq and its, you know it’s interesting this is a lesson learned about digital pathology today at…
Aleksandra: For those who are watching on YouTube I’m like slowly slowly opening my mouth more and more when I hear these stories.
Keith: The history is fascinating actually and Toby Cornish and I and others have written the history about this um and the experience AFIP had talked about doing this as I say decades and decades ago but the technology wasn’t necessarily available or reliable so um the [00:12:00] Advent of being able to do Dynamic telepathology kind of changed the workflow a little bit because if you were going to send me a case you could call me text me email me and say hey can you open up your browser and point it to my microscope and take a look at this case as opposed to a mail-in service where you mail in the slides with the letter Dear Keith, and then it comes here and I look at it when I have a minute to look at it so is this instant of realtime consultation between Pathologists so it’s great for the referring Pathologists maybe a little bit more demanding for the Consulting pathologist in terms of being on the hook real time and dealing with time zones with Korea and Europe and so forth but um so we had that experience um in terms of telepathology and the first whole slide systems were just coming out then and I think everyone recognized that you know um as I said back in [00:13:00] 2003 I think this was going to be the Holy Grail of digital pathology and certainly the dynamic has its place as it still does it for frozen sections or interoperative assessments of cytology but in terms of high-volume throughput full slide imaging.
Aleksandra: So basically uh that was 2005 then 15 years later the pandemic came and you already lived through this workflow that was like did you think like oh that’s what we’re going to be doing now or were you surprised or like what was your what were your thoughts when there was the you couldn’t come to to the hospital anymore?
Keith: You know we weren’t fully digital by then but I know that it probably sped up the adoption for a number of folks and I think you know the lessons we’ve learned since then um from uh the centers for Medicare Medicaid services and other public health agencies that it was safe and effective [00:14:00] to use um got us over a pretty significant hurdle you know one of the reasons I started tissue pathology back in 2007 is we saw that there was already a little bit of clash between what the technology could do and what regulators said we could do with it and this whole idea of using it for quote and quote primary diagnosis you could see was already going to be kind of a troublesome issue we hadn’t even got to clinical business practices we hadn’t addressed reimbursement but we knew that there was going to be an issue somewhat analogous to Radiology although I think they had a better path to certification but there was going to be an issue so it was kind of an easy target if you will in terms of FDA clearance for Whole Slide Imaging Systems and that was my platform to discuss what those issues were and bring those to the forefront and try to push that envelope forward a little a little bit in the way that I could with our tissue[00:15:00]pathology.com uh messaging.
Aleksandra: So how did you start you just like set up a website and started writing your opinions on things I remember I somehow dug out your old uh old articles there and it was I don’t know from when it was but it was on the first uh scanners that were coming out and you going or giving people your impression from a conference about um about the new technology coming up so how did you start.
Keith: Yeah, so after, after I, after I recognized that the Washington Post was writing about blogs I became interested although it didn’t act on that much when I um took my first job here in Chicago when I um left the military in 2005 there was a physician in that Health Care System who wrote an anonymous newsletter um and would rant and rave about the [00:16:00] administration and different specialties and um you know I thought that the lesson learned from that was if you’re going to do that you have to be very transparent you have to own it you have you can’t do it anonymously so if I were to write something regardless of what it was if it was on fishing or model trains or pathology you had to be very transparent so that was actually kind of a good lesson learned and at that hospital, at the time there was actually a cardiologist who had a Blog and he was sharing EKGs I thought that was kind of interesting he was an Interventional cardiologist so he was sharing EKGs and talking about EP procedures and thought this is kind of interesting um but really didn’t do much and um you know to answer one of your previous questions actually Bruce Friedman from the University of Michigan had a Blog called Lab Soft News um and I had met him years prior at the informatics conferences in Pittsburgh in the late 90s and um so here was a so I think probably by then a professor an Emeritus at the University of Michigan doing this I thought well if he can do it, I can do it and um the College of American Pathologists had reformed um a a conference called uh CAP Future State which happened to be here in Chicago in 2007 Bruce and I met and talked and he basically dared me um to start a blog and he said that you know he would payfor the first several months hosting on uh the platform which was Typepad at that’s going way back and um I don’t even know if WordPress existed and…
Aleksandra: Do you use WordPress?
Keith: um yep I use WordPress now but back then we were all on Typepad which was a very primitive sort of um primitive formats and backgrounds and things with very little customization but it did the trick and so uh Bruce dared me to do it we talked about it a future escape and um that summer then in 2007 um I started it the other sort of lesson learned getting into [00:18:00] private practice at that point um we were a hospital own group we had obviously we had our clinician colleagues we had pathology colleagues we had Administration um we had all the trials and tribulations of the practice of medicine and I realized you know Physicians are pretty highly regulated creatures we have state requirements we have local requirements hospital requirements if I ever wanted to do something gets a research approval that that was a committee if you wanted some new equipment that was a committee so there was a lot of Regulation and control um then there was spousal approval needed for certain things so I thought well maybe if I sit at my keyboard here um this is something that doesn’t require any approval no board approval no part…
Aleksandra: Oh my goodness, you’re saying this and you’re mimicking my um like logic like this or last year’s logic when I was like oh I would like to contribute more to my community of toxicologic Pathologists [00:19:00] and like you say everything has to be approved by the educational committee by I don’t know and then it doesn’t fit in the newsletter then it has to go somewhere else to the paper and then it has to be peer-reviewed and I’m like how about I
just make a video about it.
Keith: Right, right!
Aleksandra: And then just share it with people and if they want to watch they can watch
Keith: Right, and you know, and as you probably have as you probably learned maybe you’re your curve wasn’t as steep um but I will say probably you know the summer of 2007 maybe for the first six months it’s it felt like I spent a lot of time talking to myself.
Aleksandra: Yeah, I think it always feels like that when you start.
Keith: When you have a lot of followers and likes and comments and it takes some time to get discovered and build up your audience so as I as I told other folks who have since followed some of which uh no longer do it if you’re going to do it you know it’s probably 6 to 12 [00:20:00] months at least in my experience to kind of build up your following and getting noticed have the vendors notice you um and start to gain some traction so um yeah that first six months it was a lot of talking to myself but it was you know the ability after signing out cases to just have my time and to think about things and whether it was the interesting case of the day or um something politely politically correct diplomatically about the hospital or the Health Care System again being fully transparent owning what I said being mindful of not biting the hand that feeds you but criticizes it um I think you know was helpful to me in terms of other forms of personal and professional um development um and something actually um I don’t I don’t know if I’ve ever
written about this that much but um in medical school a colleague and I [00:21:00] started uh a school newspaper which actually uh I think ended during covid unfortunately but in Northwestern we started a newspaper called the beat and had a little EKG logo on it he became a cardiologist he was the uh self-proclaimed um editor and he would write medical articles and uh I remember he was interested in cardiology and he um spent a lot of time talking about uh anti-cholesterol drugs, cholesterol-lowering drugs Lipitor was very popular we participate in Lipitor studies and um my the job was to write other articles and so fortunately, I had the uh Chicago Bulls teams of the 90s to write about and Michael Jordan and Basketball Championships so I was kind of the sports guy and um I also sold the I also sold the advertising to pay for the darn thing um see you had some experience already I went out and made up a little flyer and I went out on Michigan Avenue in downtown Chicago [00:22:00] and got thrown out of Lorden Taylor and Marshall Fields and Nordstroms and was almost arrested for soliciting a few times and um once Having learned from that experience I uh you know started selling to the dry cleaners and The barbers and getting coupons for student discounts and then it became very popular and we were actually in the black uh and we could print the newspaper regularly I think monthly um so I wanted to get back to that, I hadn’t had that in the 10 years there and um it was fun to just sit down and write and pontificate and you know I made a lot of mistakes I made a ton of mistakes I’m sure um but you know you learn from your mistakes if you can do that then you can move on so…
Aleksandra: This is so cool. Was selling difficult for you when you started selling the newspaper?
Keith: It was as I said I took the completely wrong approach I didn’t understand the market. I didn’t [00:23:00] understand that going into large department retail stores was not a good market for a student to run uh medical school publication but then I figured out that and I had a paper route as a kid and I, I sort of probably should have understood this wrapping those papers and seeing who they were advertising to and what was being advertised but um once I understood who the market was and who the target was and I could get them to buy space for coupons or discounts or buy one get one at the sandwich shops around campus that sort of thing and they could see some return on their cost um for these coupons and these advertising it became very successful you know going into Nordstroms and Lordon Taylor are trying to sell a student-run Health Care uh newspaper wasn’t the right target so yeah!
Aleksandra: Maybe but did you apply those lessons then to uh your business of tissue pathology.com [00:24:00] because then you know it always starts as like a passion project and then when it once it gets traction it um kind of attracts enough attention like the newspaper there is content and uh people want to be shown next to this content so how did it turn into business? Did you even intend it to be a business at some point or did it turn into one organically?
Keith: I had no intention of doing so I had no idea that it could be monetized um and fortunately or unfortunately I think a lot of folks who have tried to start since um that I say have largely come and gone I think started it with the intention of monetizing it and I encourage them not to do that you know build up your content you know get 18 months worth of stuff in there to start to get the Google juice is going and start to get discovered and shared and linked and all of those things and then it’ll happen um and so [00:25:00] um you know for the first several years there actually weren’t any sponsors for the first two years and then they started calling me and saying
and this is pretty funny actually started asking how much is it to sponsor your blog and the first time I was asked that question I said what’s a sponsor um and a marketing person said you know when you go to the basketball game or the baseball game and Do you see the Pepsi sign or the Coca-Cola sign that’s a sponsor said oh I said I don’t know I don’t know what it’s worth so that was all as you say very organic um and largely inbound marketing um but one thing that you have probably found and if you haven’t yet I’m certain that you will be one of the deliverables if anybody wants to start up a Blog um competition is healthy the um one of the major um Lessons Learned or subsequent [00:26:00] um deliverables of having a social media presence a virtual or online presence is that you start to get invited to give talks to attend meetings somehow along the way, you become a key opinion leader, you become a thought leader and um you know as you will see if you haven’t already you don’t have to be right all
the time you just kind of have to put it out there with your thoughts your your coherent thoughts you know this is what I think and this is why I think it
Aleksandra: Keyword coherent
Keith: Coherent, coherence…
Aleksandra: Yes
Keith: So you think okay well you know AI is going to save us all that may not be right that may not turn out to be right um but as long as you can put together that argument people are interested in that terms of hearing that viewpoint and then maybe you’ll speak with somebody with a counter viewpoint and so you get you start to get invited to attend meetings and um give talks and then that further actually leads to [00:27:00] the business because people want to be associated with that presence and people you know kind of pushing the envelope and stimulating the discussion um and again you know is I think it was Neil’s Bore Quantum uh physicist Nobel-winning Quantum Physicist and perhaps Yogi Bear you know they said it’s difficult to make predictions particularly about the future and so you’re not always going to be right and um but I think having an opinion and trying to stimulate that discussion and there’s a great disparity as we know online between those who produce and those who consume so there aren’t a ton of people out there necessarily putting it out there not that they don’t have an opinion they just don’t share it in that format
Aleksandra: It’s work you know it’s work to do it consistently I slip of the wagon all the time but you know we keep coming back I like the like this theme um of what you’re saying that trans the transparency um honesty you know that it’s your opinion that you stand by and that there are counter opinions and that’s okay and that’s the point of putting stuff out there to spark a discussion and whatever this discussion is going to lead to um in contrast to the examples you gave at the beginning that you know people were ranting uh and was the because it’s like easy to hook somebody with this but it’s definitely not a sustainable strategy in our profession and not something I would like to do either know was the tech difficult was the tech of setting up an online thing for you difficult and not only like the setting up but also figuring out okay how do Google and search engine work how as you know you can put a lot of stuff out there but if it’s [00:29:00] not structured in a certain way it’s not gonna show um it’s not going to show as let’s say as it should um or at least not proportionally to the content that it’s out there tell me about your search engine optimization um learning curve and I’m asking um about that because your uh platform is very much text based and this is what what the search engines I mean now we have AI so I don’t yet know how it’s going to change there’s like you can have this generative search where it doesn’t point to the website um but yeah tell me about being discoverable online with pathology content in general well.
Keith: It’s interesting you know going back to 2007 um uh other platforms were in their infancy Facebook was in its infancy um as I pointed out in a talk in 2008 there was an article in The Economist [00:30:00] at that time that said Twitter was not a viable business because it had no Revenue model and Twitter would not survive another couple years and then it sold for 40 billion or something a couple of years ago so um there wasn’t a whole lot known I think once I started to get into it and started to say um and seeing actually after a few weeks and then few months people from South Africa people from Australia and not just people from down the street or inside the hospital getting noticed I thought okay now what are they seeing what are the triggers here what is bringing them to the site and then what is getting them to subscribe to the email and what is getting them to like the comments or reshare it on their sites um and so the technical setting up you’re right you know not difficult because it was pretty primitive but then I actually by 2010 2011 I remember meeting with quote and quote [00:31:00] SEO consultants and people who had started to look into this for text searches um and textual information and it’s something that actually goes back to you know the late 90s when we were doing remote telepathology and the web was still in its infancy I remember sitting in the Resident room on you know probably a Windows 95 computer with a big CRT Monitor and just kind of trying to figure out who’s putting this information online and how reliable is it I remember one night sitting there on call waiting for a Frozen and I typed in um Pelgar Hewitt I thought no way anybody’s ever heard of Pelgar Hewitt and nobody’s gonna have any information about this and I’m sure enough I type it in and there’s pages of images and there’s support groups for patients with Pelgar Hewitt and there’s publication about it and there’s atlases online with [00:32:00] hematology images and I thought okay maybe that’s a little unusual let’s try May-Hegglin or Dohle Bodies and it was the same thing and I thought wow this is incredible there’s so much information but is the information credible is the information reliable I don’t think we use the term disinformation probably as much back then if at all but you know there’s information and disinformation so I wanted to make sure that what I was putting out was um referenced was sourced and if it was opinion that they there was some foundation for those opinions and so I just kind of stuck to that I didn’t try to plug in keywords or things that they didn’t fit to just try to get eyeballs and then it grew again just speaking about information in general I love this quote by Mark Twain he said
“If you don’t read the newspaper you’re uninformed. If you do read the newspaper you’re misinformed”
And some people would argue that today so I just wanted to [00:33:00] make sure that you know again what I was putting out there was referenced was sourced and I didn’t try to put in things just to try to try to increase the SEO score the optimization when I met with the Consultants they said you know you need to you need to have more images you need to have more links, links, links, links, and I really didn’t bother to do that um unless I felt it was necessary so you know fortunately there was enough good information I guess that people started to recognize it and follow it and you know we still had RSS Feed so we had everybody had their RSS reader and you know I could see who was signing up for an RSS feed and we just turned that off several years ago now but…
Aleksandra: I know because I was part of it and then it stopped coming.
Keith: Right so you know now it’s email and now it’s on your phone and you know now it’s mobile and those were in the days people would bookmark things and you know you would and that was I think and I think you’ve done this very well that was really [00:34:00] pathology 1.0 that maybe pathology 2.0 which I trademarked the idea of using web and social media to share information content exchange ideas and as you say you know for better for worse for the past 17 years it’s largely been textual I haven’t leaped audio, video podcasts you have so the Next Generation…
Aleksandra: You know this your strength is probably text because I started as a Blog and then I was struggling to put out consistent research well referenced articles because I mean I have some articles and now it’s you know uh easier to try to write articles from blogs from um sorry podcasts that have a content that lends itself to an article but then when I started the podcast I thought oh that’s just so much easier for me and also the for format that I have is an interview podcast where I interview experts who are experts [00[35:00] and you know by that I learn and those conversations are just a lot easier for me to uh produce as content so that’s why I gravitated very heavily to it was at the beginning it was just audio and then we just started recording videos as well and um the YouTube presence started which is whole another game like YouTube SEO I’m like oh my goodness I should start another degree in YouTube thumbnail creation so but I’m I think I’m like you, I’m like how about I just make a good video first and then we take it from there.
Keith: Right, so I’ve just started getting into video creation the past couple years uh train spotting railroads uh fishing videos with my GoPro camera so I’m just now getting comfortable I think with editing and music and framing shots so it’s everything is an evolution and you know I guess the bottom line is I guess [00:36:00] about 2010 Bruce Friedman and I and another blogger in Chicago here Mark Pool who had a site at the daily sign out we actually wrote a paper on 10 Lessons Learned as pathology bloggers and I don’t think they were in any…
Aleksandra: I need to link to that one in the show notes.
Keith: I think it was in the Journal of pathology informatics in 2010 and I don’t know if we ranked them in any particular order but you know one of them was blogging is a discipline it’s it’s one more thing it’s just like your job and your daily chores and your responsibilities and paying your bills and showing up where you need to be on time it’s a discipline and um if you don’t control that you know the the blog will win or it will be neglected and um so you need to make those you carve out that time and do that starts to become sort of a war of attrition I think you know if you don’t keep up with it so you know it’s It is probably one of the key lessons I think you already recognized that content is key and perhaps [00:31:00] there’s a place still for text and I think certainly there’s a place for um the audio the video and the podcast I watched a number of your podcasts and they’re really great and as I say I’m honored to be here today to be a part of that but this is definitely pathology 3.0 now where we can talk to each other directly and share ideas and not just uh comment on each other’s posts and that sort of thing so that you have to keep up with it and I Think Through The Years content is key and you know for both of us really there’s a lot more competition than I certainly had back in 2007 I wasn’t competing with Instagram I wasn’t competing with Tik Tok I wasn’t competing with Facebook and Meta there was a lot less competition there were millions of bloggers but there were a lot less you know people just scrolling through endless streams of videos and clips and information and you know and so I think one of the other [00:38:00] key things and I think you do this very well is filtering out significant information from white noise and you know sticking to you know key Concepts and um key thoughts and key thought leaders and what’s happening in the market currently and I think if you continue to do that it will be very successful.
Aleksandra: That is my plan and thank you so much for those words of encouragement so let’s transition from the blog and the publishing platform to your practice because recently as I learned from an article in LinkedIn you started signing out digitally and uh my like when I was um crafting my questions and I thought huh that’s interesting he didn’t practice digitally before and now he’s practicing is it a big challenge but now after you told me the story with the Telepathology and all the other things it’s like okay it’s just the normal things to do but still tell me your impressions um tell me [00:39:00] how this to sign out Digitally.
Keith: Yeah so it’s a project that actually went back to probably 2017 uh looking at scanners in the core lab selecting a vendor thinking about uh deploying this who would get it network issues um hospital heterogen dealing with different hospitals within the core lab Network and then uh was probably appended a little bit by covid of just physically getting into places to set up servers and computers and monitors um and so we went live last May uh with the Phillips Intellisite Pathology Solutions the Core Lab has eight Philips scanners and um I think as I said in that article most of us are doing I think about 80% of our work now um digitally because there’s a greater Geographic distance now between the core lab and the hospitals most of us had our own histology lab across the hall where maybe there wasn’t as much of a business case but now with consolidation [00:40:00] and um maximizing resources it makes good business sense to do that obviously hematology and cytology cases were not part of the FDA clearance so we don’t do those that way so I still have I think as you can see the microscope on my desk.
Aleksandra: I know… a microscope is there.
Keith: There’s still a slide file back there for the old stuff um and so um about 80% is dig digitally it was a very strange sort of set of occurrences uh we went to a new lab information system although same vendor and largely the same platform uh we went digital and then we also went to voice recognition
Aleksandra: Yes!
Keith: So we eliminated in-house transcription Services
Aleks: Tell me about that.
Keith: So we went from well you know we went from the microscope to a foot pedal to paperwork and slides to a desk that has much less stuff on it um and a big Monitor and uh no and less microscope [00:41:00]and no foot pedal and no transcriptionist I have to say it was a little disruptive I wasn’t here for the apps in in in full disclosure I wasn’t here for the full uh go live the full first day I was very dog hunting um in South Dakota so I sort of missed all the initial angst and trouble a lot of the bugs were worked out by the by the by the time I got back from that trip but the um it’s very disruptive and I, it’s funny I thought you know again now 25 years ago we were deploying these telepathology systems all over the Army I was a I was a senior Captain but I was a captain and I would call-up full bird colonels and I would say “Sir you’re getting a robotic microscope you can send cases to AFIP you can put it on the stage and you can go home.” And they’ll look at it and send you a report by the morning and these guys would say, “Look you know this all sounds well and good but you know if it’s not glass you can kiss my ass.” [00:42:00] And um now funny, 5 years later I have to admit I understand where they’re coming from I’m the age they were then and you know look like anything um after doing something repetitively day after day after day now for almost 30 years to not have the foot pedal to not have your working drafts to not have your pile of slides it’s a little disruptive definitely. Fortunately, I think the technology is good enough that the transition was actually pretty seamless
Aleksandra: Yeah, I can tell.
Keith: And as I said last month earlier this month digital pathology is just pathology I don’t think we have to…
Aleksandra: Yes I saw that article as well it is just pathology by it I think it doesn’t really matter like which vent or which technology it has to match the speed of glass and it has to match the speed of microscope because I can totally understand somebody like you [00:43:00] or you know any of my more experienced colleagues that have been doing this for uh tens or for decades under the microscope and they take off the stage and they’re super fast I would be freaking annoyed if I had to work with something that’s slower I’m like I want to get my stuff done if this slows me down I’m not going to use it and so I totally get that point because you know I am not the most patient of people and if I have that with any other technology, I’m like no I don’t want it to give me something else or I’m doing it the old way um but obviously, here I totally drank the digital pathology Kool-Aid and the technology is there right now um so lucky to be an advocate for something that’s actually already good enough.
Keith: And I, you know I don’t I don’t think you let good be the enemy of perfect um I think you have to look at and this is one of the big hurdles and quite honestly you know I think if you had a full histology lab in your institution as we did [00:44:00] until last May where you could smell the formalin across the hall and the xylene and you could literally walk 50 feet and place an order for an immunohistochemical stain and get it that afternoon it wouldn’t make sense to have a scanner there and scan the slide and send the image across the hall in a core lab model which is increasingly becoming more popular you’re farther from where the slide is produced you’re farther from where the patient is being seen these networks are getting larger through mergers and acquisitions so if you look at the total time my argument would be it may not be as fast as glass um putting a slide on the stage and just rendering an image to the back of your retinas and making a diagnosis if you consider that you can scan a slide for example an immunohisto chemical slide and you’re going to get that two hours sooner than you would via a courier particularly in bad weather like we had recently or something to that effect than the total time to diagnosis [00:45:00] is shorter maybe even navigating it on the screen isn’t as fast today um but the total time to diagnosis and we wrote a paper I think in you know in the late 90s doing robotic telepathology with frozen section and certainly not as fast to click through each stage at that time with a static IP address and push and pull those images but if you couldn’t be there or you weren’t available then it’s very reliable and we now know that you know it’s safe and reliable and accurate um and we have the FDA studies since before that so I think you have to look at the total time to diagnosis and your ability to do it so you know we still do it only in the hospitals where we still do…
Aleksandra: So you don’t do remote sign-up.
Keith: We don’t do remote sign-out, outside of the hospital so the images are in another state but um in Indiana but the um all of our sign-out is still done and you of course there are other issues and folks have gotten around this, or implemented this [00:46:00] where you have your LIS(Laboratory Information System) remote you have your images remote and you have the securities in place and the control and access and so forth we’ve made the decision to leave the monitors in the offices and leave the LIS accessible from your desktop and do it that way. So you, I think we’re checking all the boxes in terms of compliance there in a professional office setting but you know I think as time goes on that will evolve as well and we’ll take the lessons learned from these experiences and we’ll continue to do that but it’s interesting you know you’re you’re absolutely right and somebody told me this probably in 2008 I could remember very clearly I was in the frozen section room late at night and somebody called and said when do you think this is going to all take-off and I said you know I always said five years five years and they said look it’s never going to happen Keith until it’s as fast as glass and that was probably you know and to your point, I think that’s accurate but I think if you look at the total time to diagnosis [00:47:00] as fast as glass might mean waiting two hours for a stain now or two hours for a batch of slides and in that time you can do quite a bit of work so there have actually been a number of community practices in our system for the past several years um now doing full digital it’s not the large academic medical centers they’ve caught on now since but um actually the community guys started to…
Aleksandra: I notice this model as well and a model with like there is a central hystology that digitizes the slides and an independent Community Practice uh where the Pathologists work remotely and um sign out digitally you know what I thought was uh curious because that the CMS (Centers for Medicare & Medicaid Services) after the public health emergency and that was I think last May and they said okay pathology can uh keep the remote sign up but not on glass the remote sign out is actually only on digital which I thought that’s [00:48:00] interesting I think um so when I was doing the timeline I mentioned the first like hurdle that I learned about was the PAP Mill Scandal where people actually were able to take the slides home and it was in the environment that you have at home you know running kids and it resulted in too many false diagnosis so that was like CLIA (Clinical Laboratory Improvement Amendments of 1988) says no way no working from home and here they say yes but no glass so that is cool. I like it. I think it’s going to drive digital pathology even um into more practices basically giving people more access to care
Keith: And we have to remind, we have to remind ourselves that uh CLIA 88 uh following CLIA 67 uh stem from issues of remote sign out with papsmear screening and subsequent problems so I think I think we’ve taken those Lessons Learned and that’s why we made the decision to leave it in the hospitals um [00:49:00] on the compliant monitors and you know still having access to your LIS we don’t have full LIS integration yet with our digital pathology system that will come over time I gather but you know I think it’s important to still be in a professional office setting and again you know as I say about one and five at a minimum, you still need your microscope so and you still need glass slides so but you know it’s uh having made the change to get back to the original point has made the change in May um it was pretty seamless uh transition even uh not one of the older folks but even the more older folks um have just seamlessly adopted it’s been very interesting to watch after perhaps in retrospect a lot of hand ringing you know are we going to see all the tissue is the color going to be accurate are we going to see the label all of these issues uh that was addressed over the past two decades it’s fun to see it now in practice [00:50:00]
Aleksandra: Cool this is amazing and so going back to tissue pathology what are your plans for this year? What is the future of tissue pathology.com and Beyond
Keith: Yeah good question and um you know I had uh an introduction to what we wanted to talk about today as I thought about this the plan is uh what the plan has always been uh there is no plan so um I don’t really do any kind of strategic planning uh in January of every year um you know we try to respond to the market um a number of years ago we changed the branding from digital pathology block to tissue pathology.com and the kind of change that signage and that messaging because we were starting to get FDA approvals um and it wasn’t as focused on that and now there’s really neat other emerging Technologies genomics proteomics I’ve been ranting and raving so to [00:51:00] speak about next-gen sequencing and molecular replacing morphology so I think that’s going to be a hot button issue um the term AI machine learning, deep learning what are the implications for that um right now we have a terrible pathology shortage maybe we won’t have a terrible pathology shortage and then what are the implications for AI or enhanced workflows or prescript scening algorithms I mean the AI thing is fascinating because you know we’ve been doing pre-screening automation on pap smear you know for more than two decades when I was director of cytopathology…
Aleksandra: I know these were the first of the FDA-cleared image analysis algorithms that were on pap smears and
Keith: Right so we worked out you know the issues with liquid-based cytology and monolith Technology liquid based screening uh for the purposes of finding the 22 most abnormal fields and then subjecting those to human reads uh and we’ve been doing that [00:52:00] as I say we had we had thin prep screeners going back to 2000, 1999-2000 so we’ve been doing that for decades and now you know we’re gonna hopefully start to do that in histology with some reproducibility and consistency and the data looks very good for that so but maybe it’s also a term that’s slightly overused in terms of what it can do and what it will do and that um as a number of folks have pointed out the efficiencies that are gained by AI what will you do with that extra time are those going to be protected hours where you can go back to the days where we could write papers and think critically about things or you know um are they going to give you 20 30% more work you know so those are the kind of issues but um so you know kind of we go with the flow I, I’m Pro I’m doing more original content than I have been historically you mentioned content unfortunately now we have enough dedicated devoted partnerships [00:53:00] with corporate sponsors who share their news um so you know one criticism is that blogs are a news filter um and we actually put that in our lessons learn that blogs are a filter I actually like to think of blogs as an aggregator as we do where you get the news of the day and you can go to one spot and see what the latest developments are rather than you know trying to search something in PR news wire um for the news of the day and what
the Hot Topic is so I like to think of ourselves now as a news aggregator…
Aleksandra: I definitely see I definitely use your platform like that I basically open and see okay who did what uh what’s the and and it’s I like the new layout that you have as well and obviously this uh link is going to be in the show descriptions and so I like that it’s these tiles and you can pick the one that um you know you’re most interested in so for me it’s going to be AI it’s going to be digital pathology it’s going to be the partners that I also work with to see okay because I don’t really [00:54:00] have that news part uh on my platform I have more the education opinion kind of uh right piece so I definitely go to yours to check okay what’s happened recently.
Keith: Well as I say I think you found a niche and I think you’ll continue to find your niche um again this has been a progress over 17 years kind of finding a niche and worrying about what I was going to write day to day to fill up content and optimize the SEO and do all those things so um you know it’s definitely a work in progress but the plan is um there is no plan so we’ll continue to to uh hopefully uh stick to the mission the mission has always been the same since that June day in 2007 to educate and inform the pathology public and um that’s what I’m going to strive to do every day.
Aleksandra: Thank you so much you know what I see also those the Pathologists who also have [00:55:00] like a different thing that they’re doing they all just love pathology and they love practicing pathology and you never like stopped practicing pathology in this came across today in the conversation like okay if you uh are thinking of doing this to monetize just don’t do it right you do it too, because you have a mission because you want to inform people and I have seen that across a couple of my guests that they like never gave up the pathology work so thank you so much! Thank you so much for doing this for so long, uh we need to meet again when you have the 20th anniversary of tissuepathology.com to celebrate
together and I wish you a fantastic day!
Keith: You too thank you again for the time and the opportunity and thanks to everybody for listening.
Aleksandra: Thank you so much for listening to the end you are true [00:56:00] Digital Pathology Trailblazer and you might have even started your digital pathology Journey with Dr. Keith Kaplan’s blog but if you are more visual learner let me show you where you can find all the Digital Pathology Place courses that are currently available both free and premium and where you can have access to your OnDemand Digital Pathology Education in one place I’m going to
leave the link in the description below so when you arrive here all the free resources are at the top we also have a bunch of free courses including digital pathology one-on-one as an audio course and when you sign up for any of them they’re going to be added to your course library and if you want to check out the premium courses here you will find a free trial of our premium memberships where you will find digital pathology information that is going to help you succeed in any digital pathology endeavor so go ahead sign up for the courses and I see you on the inside.
