China is facing an enormous pathology crisis. As I covered in more detail in a previous blog post, this boils down to two key challenges: the imbalance between a large demand and a short supply, and the insufficiency of expertise today. General pathologists are in short supply throughout China, but, on top of this, China lacks specialists with disease-specific expertise. Having traveled through China, one thing is very apparent – digital pathology has an emerging role in addressing these needs both through telepathology and image analysis software.
Telepathology offers the biggest potential payback. While I stayed almost exclusively in major cities while visiting the country, well over 40 percent of China’s population lives in rural areas. The facilities in these areas are often staffed with too few pathologists to handle either the volume or the types of cases they see daily. Telepathology can serve to connect these hospitals to larger metropolitan institutions of the necessary expertise. Even within these metropolitan hospitals, telepathology provides the advantage of enabling pathologists to work from anywhere, reducing downtime and ensuring that time-sensitive cases can be reviewed efficiently. While in Shanghai, I had the opportunity to meet with the chair of a major pathology department who indicated that it was not unusual for her staff to get in at 7 in the morning and leave at 9 in the evening. It is for groups like these that telepathology provides value by allowing flexibility in where pathology work is performed. Radiologists have been viewing cases remotely for a decade – this practice can dramatically benefit pathology as well.
Telepathology isn’t just useful for managing case loads. A key advantage of telepathology is that it creates a network of expertise that extends beyond the silos that Chinese hospitals have traditionally been stuck in. These silos, which are created by the geographical distance and insufficiency of communication between institutions, are not unique to China but are exaggerated by the vastness of China’s size and its relatively recent and ongoing adoption of high-speed telecommunications. In addition to the experts at China’s top hospitals, telepathology provides access to the specialists around the world with expertise in the diagnosis of specific diseases. These experts, both domestic and international, have an opportunity to see a more challenging subset of cases and potentially develop an insource network that is both more interesting and more lucrative. Examples of these exchanges include the relationship between UPMC and KingMed, and UCLA’s partnership with six hospitals across China.
Image analysis software can also serve to address the challenge of expertise and even part of the resource availability problem that many Chinese hospitals face. The breadth of what one defines as image analysis is large, including anything from immunohistochemistry (IHC) quantification to region of interest (ROI) detection to diagnostics. As a consequence, the key benefits of image analysis software for a Chinese hospital also vary. One core benefit is that image analysis improves the reproducibility and therefore the confidence in the diagnostic process, potentially minimizing the necessity for a second opinion. In many cases, these tools can also provide a method to reduce the amount of time spent on mundane tasks – a great example is an ROI detection tool that enables a pathologist to rapidly find and assess target regions of a sample. While these tools are universally useful, the workflow problems facing China make the benefits correspondingly more significant. And of course, one day, the advent of diagnostic or near-diagnostic tools may provide an avenue for diagnosing some of the tougher cases in-house with increased accuracy.
Realistically, three key challenges exist for the wide-spread implementation of digital pathology in China. The first is that the technical implementation of these solutions can be a hurdle. However, advances in the digital pathology solutions themselves as well as an increase in expenditure at Chinese hospitals have helped to mitigate this challenge. The second is that the mere redistribution of work only shuffles around the burden. The adoption of image analysis software adds to the traditional pathology workflow. The key is to use image analysis to make the process more efficient. Therefore, serious thought on the logistics and desired results should be given for each implementation of a pathology solution. Finally, the healthcare industry in China must find an appropriate means of commercialization that balances the expense to the hospital and the cost to the technology provider in the implementation of a digital pathology system. Each of these challenges needs to be addressed in order for digital pathology to become a tangible solution to China’s pathology crisis.