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Predicting Opportunities and Challenges Prior to Transitioning to Digital Pathology: An Interview Envisioning Study with 11 Pathologists

There is growing interest in implementing whole-slide imaging (WSI) for primary diagnosis. Ten subspecialized pathologists (2-39 years of experience) were interviewed from diverse subspecialty areas in a large academic medical center. Relevant semi-structured interview questions included image quality, workflow, and usability during clinical use. Analysis revealed that WSI implementation would raise some concerns: 1) delaying turn-around time for preliminary diagnoses as well as final reports, 2) delaying access to order ancillary tests, which could impact scheduling for some patients for follow-on surgery, 3) making it hard to track what has been reviewed and at what level of magnification, 4) potentially increase wrist pain from using a mouse or neck pain while viewing the monitor, and 5) increase vulnerability when a computer, monitor, or network goes down. However, WSI implementation would enable 1) increased flexibility for slide access remotely during nights, weekends, and work trips, 2) easier consults among peers and with mentors, 3) easier detection and recovery when images are routed to the wrong person, 4) creating digital libraries, including previous slides from a current patient, and 5) giving greater access to images for presentations, publications, and to other clinical personnel. Implementing digital slides and associated workflow will introduce many challenges and barriers. Studies such as the current one are much needed to explore the pathologist’s perspective on these workflow and implementation challenges prior to and during the installation of the digital pathology systems. These perspectives are important to understand in order to improve the experience of the pathologists and lab personnel as they interact with these systems.