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Zoomed In #3: Putting The Pathologist At The Center

By Proscia | December 9, 2020

In this episode, Proscia’s Digital Transformation Officer Dr. Monica Santamaria-Fries draws on her 30+ year career in pathology and laboratory management to explore what matters most to pathologists and how digital pathology is helping them to achieve it. From improved quality of care to physician well-being, Monica speaks to the impact of digitization on the pathologist’s experience and why putting the pathologist at the center will continue to drive pathology’s widespread digital transformation.

Listen or read the full transcript below.


Bruce Hall, Host (00:10): Welcome to Proscia’s “Zoomed In” podcast series, where you hear the latest trends in computationally-enabled digital pathology.

BH (00:21): Hello everyone, and welcome to our next episode of “Zoomed In,” Proscia’s podcast on all things digital pathology, Bruce Hall here, and I’m really looking forward to today’s conversation because we’re going to cover a topic that’s so important yet often doesn’t get enough attention when it comes to digital pathology adoption. While we often hear a lot about the scanners and technologies needed to drive the change to digital pathology, we don’t hear all that much about the pathologist’s experience, so that’s what we’re going to focus on today. I’m joined here with our guest, Dr. Monica Santamaria-Fries, Proscia’s Digital Transformation Officer and a pathologist herself. She actually just presented on this very topic at the recent Pathology Visions conference hosted by the Digital Pathology Association. I’m sure she’ll have some great insights to share with us. How are you doing today, Monica?

Monica Santamaria-Fries (01:08): Hi, Bruce. Doing great, thank you. Thank you for having me here today. I’m really looking forward to this conversation

BH (01:15): And we’re very happy to have you on the podcast. Monica, I know that your Proscia’s Digital Transformation Officer. Can you share with us a little bit more about your role and your background more generally?

MSF (01:25): Sure. Let me tell you a little bit about me. I joined Proscia in July of 2020 and was excited to offer my strong clinical and administrative background to the team. And in this new role as DTO or Digital Transformation Officer, I really aim to help leading laboratories build the most effective and informed strategies for integrating digital and computational pathology into their workflows, and also to help evolve the field of pathology to better adapt to this new future. Before joining Proscia, I practiced pathology for over 30 years with a Permanente Medical Group in Northern California, where I was the Chief of Pathology at the Kaiser Permanente Santa Clara Facility, Clinical Laboratory Director, and in the last two years, Assistant Chair for the Regional TPMG Pathology Department, a group of over 120 pathologists distributed in 20 facilities in the Bay Area. I should also note that the topic of today’s conversation is one that I’m especially passionate about. As a practicing pathologist myself who believes in the power of digital pathology, this topic really strikes a chord in me.

BH (02:23): Thanks for that great background, Monica. And I can certainly see with your lineage, how digital pathology would be very close to your heart both personally and professionally. With that said, let’s jump right in. When it comes to the pathologist’s experience, why is digital pathology adoption so important?

MSF (02:39): When you look at what matters most pathologists, factors like quality of care, improved patient outcomes, and physician wellness all come to mind, and digital pathology is able to help pathologists achieve all of this. So at a very high level, it’s really able to enhance the pathologist’s experience. Let me unpack that a little more. As my colleague, Mike Bonham, our Chief Medical Officer likes to say, “With digital pathology, we’re digitizing the data out of the filing cabinet.” And this allows us to extract and understand massive data sets from pathology samples that can be applied in the development of computational applications to help drive faster, more accurate, and consistent diagnosis, and also to provide further insight into prognosis and personalized therapies for our patients. So we’re really giving pathologists the tools they need to improve the quality of care and ultimately to improve patient outcomes. It’s also really important to consider physician well-being, especially in the context of the looming pathologist shortage. And physician well-being is not only important in terms of physician satisfaction, but it’s also essential for delivering high quality patient care.

BH (03:41): Very interesting, Monica. To what extent is burnout playing a role here?

MSF (03:45): Burnout, as people listening to this podcast might know is an ongoing part of many physicians’ lives, and it’s not just in pathology. A recent report from Medscape on pathologists’ lifestyle, happiness, and burnout cited a burnout rate for the pathologist of 33%. And most of the survey respondents attributed this burnout to excess workload. So, when we consider that digital pathology is driving powerful operational efficiencies – from caseload balancing to intelligent case assignment and even the ease of sharing and collaboration – we can see that it can be a big driver of physician well-being. Similarly, especially more recently with COVID, digital pathology is enabling better worksite flexibility, and it’s really the only way that pathologists can view cases remotely and work from home. So, this means that they can continue to serve patients during these times and gain a little bit of flexibility in their workdays so they can help with their kids and schooling, cook dinner, and walk the dog. It’s really all about work-life balance.

BH (04:43): Well, what great insights, Monica, and thanks so much for bringing up the ideas of burnout and work-life balance, which are so important in these challenging times we find ourselves in. As you know, “Zoomed In” is a podcast series dedicated to the adoption of digital pathology. And in past episodes, we’ve talked about where we are in the digital pathology adoption curve. I wanted to ask you from the pathologist perspective, what do you see as the key challenges in adopting digital pathology?

MSF (05:10): Yeah, that’s a really good question, Bruce. So, let’s set aside the typical challenges that pop up with any big transformation. Of course, factors like cost and buy in come in. But I think at this point, it’s very interesting to focus on what I consider to be a claims disconnect between the pathologist and the tech industry. For example, when it comes to the role of the pathologist, the pathologist would say that he or she is a care team consultant and not just a slide reader. Meanwhile, the tech industry often considers the pathologist to be an interpreter of sides. As for quality of care, the pathologists would argue that he or she does great work, but the tech industry likes to argue that it could be much better. Pathologists tend to believe that the image handling should be more microscope-like, and the tech industry doesn’t quite understand it all that well.

BH (05:55): Wow, very interesting, Monica, to hear the challenges from your perspective compared to the tech industry. Any other challenges?

MSF (06:02): Also significant are second reads. They are quite necessary according to the pathologists, even though the tech industry would like to consider them more wasteful. And finally pathologists are already collaborating. They’ve been doing this for a long time, and the tech industry views the collaboration as a big advantage of going digital. So when you look at these disconnects, I think they might explain a bit of why digital pathology adoption is where it is today. But to be clear, I am by no means suggesting that the tech industry is doing a bad job. In fact, we’ve seen a lot of progress in the way of market and product fit, and we’re seeing more and more large-scale adoptions each and every day as a result of this. So through all of this, the tech industry is continuing to learn about the pathologist experience, and I’m really excited to watch the impact as this continues to evolve.

BH (06:52): What a great series of challenges you articulated from the pathologist’s perspective, Monica. And we really appreciate that. But now let’s put you on the spot if you don’t mind. How, in your opinion, do we overcome these challenges and accelerate the adoption of digital pathology?

MSF (07:08): That’s a really good question. How do we overcome these challenges? So if you think about it, any digital transformation, whether we’re talking about pathology or retail, is about talent and not so much about technology. This is a title of a really insightful article that I read in the Harvard Business Review last May written by Becky Frankiewicz and Tomas Chamorro-Premuzic. And the idea really resonated with me. What they say is that as good as technology may be, it ultimately requires people to put this technology to use in a way that adds value. So if we keep this in mind, I think we need to increasingly put the pathologist at the center of the digital pathology transformation. This means addressing their most important needs and building solutions that fit into and enhance their workflows. For example, we need to really pay attention to the monitors, ergonomics, input devices, and image handling, all of which I think are key for any successful transformation.

BH (08:05): So the hardware and environment that the pathologist will interact with. What else?

MSF (08:10): You should also consider an image management platform that works for and integrates with your laboratory ecosystem. This platform should launch computational applications, including image analysis. And finally, we really need to put it all together and have the pathologist experience as the user at the center. This should be a big consideration. And finally, we need to hear the pathologist’s voice. Pathologists have a lot of concerns, many of which I think we need to listen to it because I think they’re valid and they question if digital pathology can really improve the quality of care, drive efficiencies, and improve physician satisfaction. And I think they should be heard and addressed to really secure pathologist buy-in.

BH (08:56): The last couple of points you made about user experience and the pathologist’s voice are right on the money relative to how we accelerate adoption. But can you take us a little deeper into some of the concerns that pathologists themselves have about digital adoption?

MSF (9:10): Yes, definitely. Let’s look at a few concerns that pathologist may have. They may wonder if digital pathology will negatively affect the quality of care they deliver. For example, does it introduce more errors? Is there human error related to the software? Are they missing focal lesions that they might not have missed with a microscope? I think these are all valid points, and they all need to be addressed to get the pathologist comfortable. Pathologists will come to see that, as we spoke about earlier today, digital solutions introduce a lot of advantages that improve quality of care. And this includes AI-supported diagnosis, less exposure to blind spots, which everybody has. And you know, ease of collaboration.

BH (09:49): Monica, can you talk a little bit about the expectations around productivity with digital pathology?

MSF (09:55): Let’s talk about productivity because pathologists really wonder if digital pathology will force them to work at a slower pace or create dual workflows and the need for microscope backup. And once again, by listening to these concerns and addressing them properly, we can help the pathologist see that digital and computational pathology can actually increase productivity.

BH (10:16): And finally, what about digital pathology and job satisfaction?

MSF (10:21): Pathologists may wonder if digital pathology will reduce their satisfaction. One concern I hear a lot is whether computational applications will make pathologists obsolete. But the reality is, like we’ve discussed, digital pathology is helping to increase satisfaction by introducing worksite flexibility, reducing workload variation, and just so much more. Computational applications are really enhancing diagnosis and enabling pathologists to focus more time where it really matters and not replacing them. It’s just really about making the pathologist comfortable with this transition.

BH (10:53): I guess Monica, when we add it all up, it comes back to quality of care, efficiency, and physician satisfaction – three things that really matter to the pathologist. Your perspectives on this have been invaluable, and this has been a fantastic conversation. I really appreciate all the perspectives you’ve given us on digital pathology adoption. Unfortunately, we’re just about out of time for today. But before we sign off, could you tell our listeners where they can find more information, and as importantly, how they could get in touch with you personally, if they’d like to continue the conversation?

MSF (11:22): Sure, Bruce. We have some really great resources on our website, which you can find at You can also reach out to me directly at And finally, I encourage anyone interested in learning more about digital pathology to check out the Digital Pathology Association at

BH (11:43): That’s great. Monica, we’ll leave it there. Thank you so much for being on this edition of “Zoomed In.”

MSF (11:48): Thank you, Bruce. And thank you for having me here.

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