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Digitisation has brought efficiency at every step

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HCG Bengaluru has recently transformed into a 100 per cent digital lab for histopathology and computational pathology. The hospital becomes the first in the country to completely digitise histopathology workflow for primary diagnosis. The lab is also now accredited by College of American Pathologists (CAP) and National Accreditation Board for Testing and Calibration Laboratories (NABL), India, for its Digital Pathology facility in the fields of histopathology, cytopathology, frozen section facility as well as artificial intelligence-based breast algorithm. Giving more details on this development, Dr BS Ajai Kumar, Chairman and CEO, HCG explains to Raelene Kambli how the lab will function henceforth

How can digitisation benefit the entire functioning and efficiency of your lab?
Digital pathology is the technology of converting glass slides with tissue sections on it into a digital image and requires US FDA certification for the image quality and the system. This image can then be acquired, annotated, archived and shared in a network.

With the digitisation of the lab, the pathologist spends less time on reporting on digital images, and reports are more accurate with several annotation tools and measurements. For instance, radical prostatectomy with 100 odd slides would take easily about 90 minutes to report on a microscope, while on digital images, the reporting can be completed more accurately within 30-40minutes. This improves the efficiency of the pathologists and increases their productivity. The digitised images can be shared across a network and easy to get the expert opinions from subspecialists in our system. The patient receives the right diagnosis for the first time itself. The glass logistics is minimised within the laboratory, saving space for storage. The digital images are less strenuous as they are seen on a medical-grade monitor. With less movement of glass slides, the efficiency of technicians improves as there is no case assembly and submission to pathologists.

Archival and retrieval of slides are very easy. Previous biopsy slides can easily be retrieved and compared. The conventional way of storing slides takes at least a day to recover the slides; however, with digital images, it’s easy.
With bar-coding of glass slides and LIS integration, patient identification is ensured. Turn around time for reporting is faster. With digitisation and sharing of images, the efficiency of pathologists across the network can be optimised and effectively utilised.

How will the lab function differently after digitisation?
Digitisation has brought efficiency at every step, starting from specimen labelling, the capture of gross images, LIS integration of digital images and reporting. With digitisation, faster and accurate reporting and with LIS integration, the turnaround time will reduce significantly. Expert opinions are faster, physical transfer of slides and blocks is not necessary, thereby it saves time and cost. The pathologists now can read the slides on medical-grade monitors rather than on microscopes. They can collaborate with subspecialists in within our network and give a consensus opinion. With the AI-based breast algorithm, reporting is more accurate, objective and evidence-based.

Will there be new processes? If yes, please elaborate on the same.
The process of capturing gross images and incorporating them onto the digital scanner is one step for ease of operation. The process of slide and block making is refined now with the improved skill of the technical staff, and excellent quality sections are produced which get scanned. The change is in case assembly where unlike before the technicians load the slides into the scanner making the pathologist’s workstation go paperless.

How can patients benefit from this new development?
Digital pathology is a boon to the patients. At HCG, we believe in ‘RIGHT DIAGNOSIS THE FIRST TIME’ for effective management of cancer cases. We have a talent pool of subspecialist expert histopathologists. The digital images can be shared across the network through collaboration and opinion from expert histopathologists can be obtained.

Through digital images and annotation tools, the cancer classification and staging are more accurate and saves cost in glass logistics. Also, there is no risk of losing diagnostic material in logistics. The turn around time of diagnosis is faster. Most importantly, the risk of the wrong diagnosis, with wrong treatment and toxicity of therapy, can be mitigated.

With the AI-based breast algorithm, subjectivity in reporting of breast markers can be totally avoided as reports are from a calibrated IVD-CE certified app.

How will it impact the profitability of your lab?
With the increasing incidence of cancer cases and the complexity of cases, pathologists face the challenge of improving their efficiency and skills of reporting.

This also raises the need for subspecialist histopathologists. As per recent publications, as high as 20-25 per cent of cases are being wrongly diagnosed by inexperienced general pathologists, in a country like the US.
With improved efficiency levels, the pathologists are able to take up more cases for reporting, with accurate reporting.

So over the years, the recruitment of pathologists can be reduced, saving the cost. Digitisation curtails the logistics cost for shipment of slides and blocks can be saved.

What was the entire investment amount for the digitisation of the lab? What kind of ROI do you expect?
The investment is about Rs 10 crore. This technology requires huge investments and would take easily 2-3 years for scaling up.

Does this mean a cut on manpower?
Recruitment of less, but more efficient and skilled pathologists is what is needed.

How will you utilise your manpower in the lab now?
Bengaluru is the hub of histopathology. We have centres around the country and abroad, which have basic labs. Through networking and scanners being placed in these peripheral centres, reporting will happen from the hub in Bengaluru. Where we have expert pathologists, the cases can be shared with them anywhere through our network to get an expert opinion. So there is an effective utilisation of our pathologists across the network.

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