Mackenzie Health becomes a leader in digital pathology

RICHMOND HILL, Ont. – Mackenzie Health, a technologically advanced hospital that has already achieved a HIMSS EMRAM Level 7 ranking, the top tier, has taken another step forward in its “smart-hospital” strategy with the launch of a digital platform for pathology.

“We’re one of the earliest adopters of digital pathology in Canada,” said Richard Tam, executive VP and chief administrative officer at Mackenzie Health. “This is going to lead to breakthroughs in timely diagnosis.”

Pathologists typically examine tissue samples in cases of cancer and other serious diseases. The sooner the referring doctors receive a diagnosis of the tissue sample, the faster they can start treating their patients.

Currently, in most hospitals, pathology cases are examined using glass slides and microscopes, by pathologists inside the hospital. Often, they’re sent to outside pathologists when a second opinion is needed or when an in-house pathologist with the required sub-speciality is not available.

Unfortunately, the process of sending slides by courier and receiving a diagnosis can take days or even weeks. It’s time-consuming to package up the slides, send them off by taxi or courier, and wait for the pathologists to finish their readings and reports.

However, the practice can be transformed by a digital platform – where the samples are digitized by a special scanner and sent to the experts via online networks. Once online, the process of sending samples to a specialist – either in-house or at another hospital – and receiving a diagnosis can be reduced to a few hours.

“The digital pathology network is an enabler of faster, more effective diagnosis and treatment,” said Amir Soheili, program director, Clinical Support Services, at Mackenzie Health.

“Glass slides can also get damaged or lost,” explained Soheili. And they can only be sent to one site at a time, where they are examined under a microscope by a single pathologist at a time.

But when the samples are digitized, they can be rapidly sent to several pathologists simultaneously, who could be anywhere in Ontario – or worldwide.

Not only is speed a factor, but so is the accuracy of the diagnosis. On this score, it helps to have the help of “sub-specialists”, who are sometimes located at various hospitals or facilities in the United States or Europe.

Sending glass slides to experts outside the hospital and obtaining reports can often take weeks, said Soheili. But again, using the digital network, the turnaround time can be reduced significantly.

In the near future, Mackenzie Health’s seven pathologists will also benefit from the addition of artificial intelligence (AI) software, which will spot areas of interest in the samples for the pathologists to note. The AI software will act like intelligent assistants, helping with the diagnosis.

The hospital has been working on the project for two years in conjunction with its technology partner, Philips, which is supplying the technology solution. Mackenzie Health conducted a validation study over the last year, using about 1,000 pathology cases, to ensure the technology meets the standards of its doctors. Continuous validation and quality assurance will remain key elements within the Mackenzie Health Digital Pathology initiative, as the hospital considers itself to be in the start-up phase of the project.

Overall, Mackenzie Health conducts approximately 16,000 to 17,000 pathology cases each year. It expects that number to double when it opens a second hospital, the Cortellucci Vaughan Hospital, in 2021. (The organization recently received a $40 million donation from the Cortellucci family, which owns construction and development companies and has been active in philanthropy in the Vaughan area, north of Toronto.)

The two-hospital system will be greatly assisted, said Soheili, by the digital network, as attending physicians and pathologists will be able to share digitized images and reports from one site to the other.

When outside opinions are needed, Mackenzie Health now relies on pathologists at three or four outside hospitals. The hospital will be inviting these pathologists to join the digital network, to speed up access to patient pathology samples and the delivery of reports.

As well, Mackenzie Health will be open to pathologists across Canada and internationally who are willing to join the network.

“We’re hoping to be the catalyst for digital pathology in Ontario,” said Tam. Unlike radiology, which has been using computerized networks and tools for decades, digital pathology is just getting off the ground in Canada.

Tam noted that Mackenzie Health is one of the first hospitals in Canada to have a full digital pathology platform consisting of scanners, workstations, software systems and a high-performance network.

Some hospitals have pieces of digital pathology systems, he said, but not all components.

At the core of the system are specialized pieces of equipment, like high-resolution and rapid-throughput digital scanners. Tam explained that each pathology slide can take up a gigabyte of storage space, and a study may consist of 20 to 100 slides or even more.

That requires high-capacity storage and fast-transfer of data on the network. But it’s also helpful to have workflow tools for the pathologists, to help them manage the readings – something that’s part of the Philips system. “It helps them share the workload between members of a whole team,” said Tam.

Workflow software can intelligently split the reading of exams among pathologists, and if one specialist is busy, can re-route the work to another. This results in a much more efficient division of labour.

At Mackenzie Health, reports and radiology images are currently available to patients themselves through an online application called MyChart; the digital images of pathology cases will be available to patients through the same application in the near future. That will allow patients to more easily share information with other physicians and caregivers, as needed.

To help drive the digital pathology program forward, Mackenzie Health recently recruited Dr. Andrew Evans as the new chief of Pathology and director of Laboratory Medicine. Previously, Dr. Evans was division director, Telepathology, at the University Health Network in Toronto. He is a leader in the application of new technologies to the practice of pathology.

Tam noted that digital pathology also has benefits in lockdown situations – like the one we recently witnessed with COVID-19. For several months, hospitals significantly reduced the numbers of healthcare professionals working on-site, and reduced the flow of patients through their doors, to protect workers and patients from infection.

However, assisted by a high-performance digital network, pathologists will be easily able to work from home, receiving studies digitally and reporting online.

“When we have access to the data in this way, we remove one of the barriers to care,” said Tam.