Short summary

A mixed method study about the implementation of digital pathology at the four Departments of Pathology in the Region of Southern Denmark with the aim to assess changes in individual procedures and workflows at department-level as well as changes in productivity due to the implementation and furthermore to produce information that can be used as basis for decisions on how to implement digital solutions within health care in Denmark and other countries in the coming years.

Rationale

Introduction

The Region of Southern Denmark will as the first region in Denmark start to implement digital pathology in 2020. This digitization is going to have a fundamental impact on the activities, the tasks and the workflow for the staff in the departments of clinical pathology at the hospitals in the region. Thus, the ongoing digitization of hospitals and health care in general may have the most fundamental consequence on the staff in the departments of pathology. Therefore, the experiences from these departments may provide valuable information about the impact of digitization of hospitals, which will be relevant for the implementation process in general in the coming years.

Digital pathology or whole slide imaging encompasses the digitization of entire histology slides. Digitization of pathology includes four sequential parts: Image acquisition (scanning), storing, editing, and displaying of images as described by Pantanowitz (2010). Digital pathology has led to new opportunities not possible using conventional microscopes, including digital collaboration or telepathology, integration with electronic workflows and health records, and diagnostic support based on computational tools like artificial intelligence (Zarella et al., 2018).

In March 2019 the Region of Southern Denmark decided that the company Sectra Danmark A/S was going to be the supplier of a new IT system with image acquisition (scanning) and programs for editing and displaying of images for digital pathology (Region Syddanmark 2019). The region of Southern Denmark includes four departments of Pathology. All four departments are all involved and included in the digitalization of pathology in the Region. The total number of certified pathologists is around 50 and about 20 residents. The digitalization encompasses only histology and at the moment not cytology. In this project the department in Sønderborg and Odense are participating.

Until now pathologists at the hospitals in the region have been receiving and viewing glass slides by use of a microscope. If a second opinion is needed and more pathologists need to view the image, supporting staff prepares the slides for shipment and these are then transported to another pathologist, who receives the slides and makes the assessment. This involves risks of delay for the patient and damaging of the glass slides during transportation (Baidoshvili et al., 2018).

By use of digital pathology several steps in the workflow change and some of the human tasks are replaced by automatic digital transmission. The glass slides will be put into a scanner and the digital images will be assessed on a screen by the pathologist. In case consultation by a sub-specialist pathologist is needed, the specialist receives a digital request and a link to a shared viewing session, Baidoshvili et al. (2018).

The basis for implementing digital pathology in the region is the expectation that the need for pathology tests will be increasing in the future (Region Syddanmark 2019). The Region of Southern Denmark expects an annual increase in the number of tests of 4.5% (Region Syddanmark 2019A). This increase is related to both the expected increase in the number of patients with cancer and the political focus on cancer in the future standardization of pathways for patients with cancer (Sundhedsstyrelsen 2017). At the same time recruitment of new pathologists is a challenge because of a lack of consultants in pathology. As part of the call for a new regional IT solution for digital pathology in the Region of Southern Denmark three goals concerning the implementation of digital pathology were appointed (Region Syddanmark 2019):

1. Ensuring the future of pathology in the region. This objective includes the aim that the guarantee for fast response to patients on pathological tests are met even though the number of tests are increasing and that the potential of artificial intelligence can be exploited in the Region of Southern Denmark.

2. Effective sharing of data between the hospitals. This objective includes that digitization can lead to easy sharing of data between the pathological departments and the hospitals, and that diagnostics can be made based on digital images across the departments.

3. High level of reliability. This objective includes easy access to digital images and low costs of transaction of data.

Aim

On the basis of the goals of the investment in digital pathology and the existing scientific literature the overall objective of this PhD project is to assess changes in individual procedures and workflows at department-level as well as changes in productivity due to the implementation of digital pathology in the Region of Southern Denmark. In addition the project has the aim to produce information that can be used as basis for decisions on how to implement digital solutions within health care in Denmark and other countries in the coming years. The specific aims of the project are:

1. To assess the attitudes, expectations and experiences among the different pathology apartments in the region and among the clinical staff to capture data on readiness for and adoption of digital pathology.

2. To describe and analyze the methods used in the implementation process by assessment of consistence with theoretical change management and technology adoption models.

3. To estimate the impact of digital pathology on the workflows and the time used per activity.

Description of the cohort

Participant in this study are employees at the four Departments of Pathology in the Region of Southern Denmark, who all will work with digital pathology.

Data and biological material

Questionnaire data, semi structured interviews, field study and schedules with registred time used on each diagnostic case.

Collaborating researchers and departments

Department of Pathology, Leeds Teaching Hospitals NHS Trust.

• Bethany Williams

Institut of Marketing and Management, University of Southern Denmark

• Marianne Harbo Frederiksen

Department of Pathology, Sygehus Sønderjylland

• Niels Marcussen

CIMT, OUH

• Kristian Kidholm