The COVID-19 pandemic has resulted in several disruptions to pathology over the last few months. Changes in caseloads and workflows are likely to continue for some time, and pressures could increase further with an influx of delayed cancer diagnoses once screening programs resume and people who have been holding off making appointments go to see their doctors.
To learn more about the impact the COVID-19 pandemic is having on pathology, what the future of pathology might look like, and how digital pathology could help to ease some of the challenges, Anna MacDonald of Technology Networks spoke to Mark Lloyd, Founder and Executive Vice President of Inspirata.
Anna MacDonald (AM): What sort of pressures has the COVID-19 pandemic exacerbated or brought to pathologists?
Mark Lloyd (ML): The core challenges relate to 1) the work pathologists were doing pre-COVID, 2) the changes asked of the profession during the crisis, and 3) how we aim to get back to a level of “new normalcy”.Prior to the pandemic, anatomic pathologists evaluated tissues for disease. The crisis put an abrupt halt on elective surgeries and most organizations experienced drops in cases to a fraction of their previous tissue volumes. Pathologists at such organizations were either furloughed or asked to work from home where couriers delivered their cases, or moved to the Clinical Pathology lab, when appropriate, to meet the increasing demand for serological tests (primarily COVID-19 testing). As elective surgeries are starting to recover to pre-pandemic levels in many locations, this “backlog” of cases will be very demanding for the anatomic pathologists with limited capacity. It will require late hours, staffing increases, and other measures. Digital pathology is here to help pathologists working remotely. It can also increase their productivity and facilitate case sharing to address the backlog of cases.
AM: What changes can pathologists expect to face over the next few months in terms of their working environments and workflows?
ML: Many pathologists can continue to work remotely with digital pathology which can help them avoid challenges related to physically being in the hospitals. Digitization also gives them the tools to sign out cases in the evening and over weekends to help them catch up with backlogs of cases. A strong digital platform enables their workflows to remain intact, even as their environment is changing. In situations that previously required many pathologists to be in a single room looking through a multi-headed microscope, digitization facilitates social distancing without changing how many pathologists interact to sign out challenging cases.AM: The FDA issued guidance on April 24, 2020, for the use of remote digital pathology devices. Could this relaxation of regulations continue once the pandemic is over?
ML: Many pathology thought leaders are pointing to the success pathologists have had with digital pathology during this period of relaxed enforcement. They argue that Pandora is out of her box and pathologists simply will not accept these regulations returning. Regulatory experts argue that the successful relaxation of the regulations is evidence that digital pathology was over-regulated to begin with. While we will need to wait to see how the CMS and FDA will react, what is abundantly clear is that a lot of real-world data accumulated for the use of digital pathology during this period supports the ongoing relaxation of regulations for digital pathology once the pandemic is over.
AM: Greater adoption of digital pathology has been contemplated for some time. What objections have prevented wider use of it so far? How has the COVID-19 pandemic changed perspectives?
ML: Change takes time; particularly in medicine. Users in the medical and scientific worlds are often evidence-based. Once users see how something can help them, they are willing to try it. The COVID-19 crisis has been a powerful catalyst to show pathologists they don’t need to be huddled around a multi-headed scope. Instead, they can work remotely, without the need to wait for glass to be delivered. Under the new circumstances, pathologists who were in waiting mode regarding new technology because what they have been used to was “good enough”, now realize that digital pathology has many advantages that are valuable to them during this crisis and beyond.
AM: What do you think pathology will look like post-COVID-19?
ML: Pathology will rebound with the rest of our healthcare systems globally. But it has, and will continue to, experience pain. Digital was once thought of as a curiosity. More recently, it was considered a technology that was coming, and the question was “no longer a matter of if, but when”. Presently, it has become clear that digital pathology has a great deal of value in a nimble, responsive, modern society that is often challenged in very fundamental and impactful ways. COVID-19 has shone a spotlight on what was previously known only to a smaller group of early adopters. Digitization is our future and the quicker we can get there, the quicker we can reap the benefits.