Large scale implementation of DP for clinical diagnoses: experience, challenges, and lessons learned

Area of Science:

• Digital Pathology Implementation
• Health Informatics
• Laboratory Medicine

Background:

• Large-scale digital pathology (DP) implementation is complex, involving strategic planning, technology, and change management.
• The University Health Network (UHN), a Canadian tertiary clinical center, undertook a full-scale DP implementation.

Purpose of the Study:

• To provide a detailed account of UHN's DP implementation, including lessons learned, challenges, and mitigation strategies.
• To offer a realistic roadmap for institutions considering DP adoption.

Main Methods:

• A phased implementation approach: planning, procurement, infrastructure development, and validation.
• Focus on technical aspects: interoperability, storage, image quality, and vendor neutrality.
• Change management strategies: training, troubleshooting, super users, and dual workflow (glass/digital slides).

Main Results:

• All histopathology H&E and tissue hematopathology cases are being scanned; digital liquid hematopathology and cytopathology are in progress.
• Initial investment in infrastructure was substantial, with anticipated long-term savings from efficiency and AI integration.
• Continuous monitoring and feedback mechanisms were established for performance assessment.

Conclusions:

• UHN's experience highlights the importance of a structured, multidisciplinary approach for successful DP implementation.
• The implementation offers practical guidance, addresses challenges, and emphasizes continuous evaluation and adaptation.
• Future applications include AI tools, remote diagnostics, and data sharing.