Meet April Larson, MD, FAAD, Director of Clinical Implementation and Advisory Board at PathologyWatch

April Larson received her medical degree from the University of Utah and completed a research fellowship at the Tom C. Mathews Familial Melanoma Research Clinic at the Huntsman Cancer Institute. Since completing a dermatology residency at Dartmouth-Hitchcock Medical Center over ten years ago, she has devoted herself to patient care. 

April, who is currently director of the clinical advisory board and clinical implementation at PathologyWatch, always had a desire to pursue medicine; both her father and older brother are plastic surgeons. While she was itching for a career in medicine, her first choice was family practice. It wasn’t until she met an intern during her first rotation in her third year of medical school that she changed her mind about dermatology—and the connection was instantaneous. 

Can you describe that defining moment when you knew dermatology was the right choice?

I heard a lecture by Sancy Leachman, MD, PhD—this charismatic, amazing physician-scientist—as she described how the first melanoma gene was identified. She told this compelling story of everyday events and interactions that led to an advance in the understanding of melanoma cancer genomics. The impact of that discovery struck me. It was my first encounter with academic medicine. I eventually worked as a research fellow for Dr. Leachman in her melanoma clinic. 

How did that experience impact your work with PathologyWatch?

This opportunity is helping me get back to my roots in academic medicine: to use science to improve our diagnosis and treatment of patients. When we are talking about patients’ lives, can we be satisfied with 75, 80, or even 95 percent success? In medicine, we will always be searching for better ways of taking care of patients. That’s the idea: trying to push forward the knowledge we have to improve patient care. It’s how you can have a more significant impact on people. As the director of the clinical advisory board and clinical implementation at PathologyWatch, I am focused on advancing patient care and access by using technological solutions to enhance the laboratory services offered to dermatologists and their patients, both nationally and globally.

Based on your experience as a former client, how do you believe PathologyWatch is instrumental in helping dermatologists improve patient care?

We achieve this in two ways. First, I see digital pathology as a key to improving dermatology diagnostics through the enhanced correlation of microscopic and clinical skin findings. We provide digital slide images that are easily reviewed in real-time as dermatologists are making critical decisions for their patients. 

Second, we help improve dermatology processes by integrating with many EMRs, which streamlines the clinical workflow. Sometimes, the technology that is supposed to help us ends up slowing us down or gets in the way of patient interaction. I understand the stresses and pressures that regularly happen in these dermatology clinics. And I know dermatologists and their staff are trying to provide the best care in a fast-paced environment. I want to help my specialty get it right 100 percent of the time. 

This ultimately translates to providing optimized care and spending more time with patients, where we feel the most joy and connection in our jobs. This is what drives me.

My favorite part of being a dermatologist is the relationship I develop with my patients. You learn to trust each other. It’s a unique relationship as you help them make decisions for their care.

As a dermatologist, what are the rewards of working at PathologyWatch? 

I feel fortunate to be a part of this fantastic team and to be surrounded by intelligent, kind, hard-working individuals, each using his or her expertise toward a common goal. I am learning so much about all these different aspects of medicine and business and computer science. It’s exciting to see what the combination of technological advances and human intelligence can do for medicine, which before was just science fiction. I also love interacting with other dermatologists, helping them find what works for them and improves their practice, which I hope leads to more success and joy in their work lives.

What do you do when you are not working? 

I live with my husband and four children in southern Utah. My family spends a lot of time boating and playing outdoors.

 

*PathologyWatch dermatopathologists use an independently validated digital software platform. The systems referenced are not FDA approved for use in primary digital diagnosis. Digital images may be made available to referring dermatology providers upon request through a digital display. Displays used are FOR EDUCATION AND RESEARCH USE ONLY, NOT FOR USE IN DIAGNOSTIC PROCEDURES. When referring providers or other providers choose to perform primary interpretation on any specimen, the corresponding glass slides are mailed for diagnostic purposes. For more information, please contact [email protected].

From Microscope to Monitor: 3 Ways Digital Pathology Is Improving Dermatology Practices

Is your dermatology practice ready for digital pathology? Most physicians feel the need to create a more efficient patient care process, but many don’t realize the far-reaching advantages of using a digital pathology workflow. 

According to a 2018 survey of US Healthcare Consumers and Physicians, up to 69 percent of physicians, including dermatologists, are interested in increasing the use of digital tools to improve patient care, among other purposes. Due to recent advances in digital pathology, there is an alternative for dermatology clinics that typically rely on microscopy and glass slides: the online access of digital slides and reads from academic-level dermatopathologists. Companies like PathologyWatch, which offers whole-slide imaging to dermatologists, are helping digital pathology quicken its pace to the forefront of dermatology patient care. 

As complications like COVID-19 force healthcare providers to consider alternative options to traditional office visits, dermatologists must find a way to abide by HIPAA guidelines while remaining profitable. Experts agree that a digital system can be cost neutral and even save money for medical practices. 

Three critical factors contribute to a successful dermatology practice: efficiency, accessibility, and customer satisfaction. Each of these can improve with the adoption of a digital pathology platform.

1. Digital pathology is the solution for a more efficient and profitable pathology process. 

According to experts, current trends in the traditional pathology model were already facing transformation. Based on data collected by DARK Daily, between 2007 and 2017, the pathologist workforce reduced its numbers by almost 18 percent, while the pathologist’s diagnostic workload rose by 41.7 percent. 

Such imbalance is a formula for potential disaster as technicians scramble to meet lab work demands while using manual processes to prepare slides, mail specimens, collect and organize test results, and input data for each patient’s specimen slide. 

Those who work in labs recognize that a digital pathology system may help to reduce errors and create efficiency, even while the workload increases. Fortunately, adopting a digital workflow and imaging system reduces the risk of mistakes while inputting data, eliminates redundancy in handling slides, and speeds up the process for issuing test results. Laboratories that provide digital images of the glass slides can also result in 24/7 access to slides by clinicians.

2. Digitized slides enable collaboration among specialists. 

With whole-slide images digitally cataloged, doctors can easily access a patient’s specimen themselves and securely share it anywhere and anytime with fellow pathologists. Such collaborative practices heighten the quality of care at all participating facilities rather than limiting expertise to one or two locations. “We place a lot of value in consulting, case sharing, and communicating in our practice so that each hospital receives the benefit of our combined knowledge and experience,” says Nicolas G. Cacciabeve, MD, a managing member at Advanced Pathology Associates. 

Cacciabeve adds that incorporating whole-slide imaging into their practice workflow has led to an improvement in the way they do things. “It drives efficiency and improves access to expertise,” he says. 

The ability to extend patient care to those who often face challenges accessing specialized care is an exciting feature of digital technology. For healthcare professionals, providing treatment to the most vulnerable communities, particularly those in rural communities, is a constant challenge. 

According to the Office of Disease Prevention and Health Promotion, almost 25 percent of Americans living in rural areas do not have a primary care provider (PCP) or health center where they can receive regular medical services. And with skin cancer ranking as the most common form of cancer in the US, people living in rural, agricultural areas could particularly benefit from access to dermatopathologists, who can examine a digitalized specimen and work with a local physician to design a treatment plan. Such services wouldn’t be possible without digital pathology technology.

3. Improve customer confidence with a digital platform.

The expanded access and collaboration available with the adoption of digital pathology also results in equivalent or improved patient outcomes. Zoltan Laszik, MD, PhD, professor of clinical pathology at the University of California San Francisco School of Medicine, directed a team to collect results between 30 pathologists and 800 test slides distributed among three hospitals. “There was not a single case that was misdiagnosed because of the digital technology, and the benefits were immediate from hospital to hospital,” Laszik says. By improving access to expertise and facilitating collaboration, Laszik and Cacciabeve see digital pathology as a vehicle to increase the speed and accuracy of diagnosis while innovating the modern standard of patient care. 

While digital technology isn’t new, the possibilities digital pathology creates for the dermatopathology field to streamline lab processes, expand patient access to specialized care, and improve customer satisfaction are exciting and work together to ultimately help physicians take better care of their patients.

 

*PathologyWatch dermatopathologists use an independently validated digital software platform. The systems referenced are not FDA approved for use in primary digital diagnosis. Digital images may be made available to referring dermatology providers upon request through a digital display. Displays used are FOR EDUCATION AND RESEARCH USE ONLY, NOT FOR USE IN DIAGNOSTIC PROCEDURES. When referring providers or other providers choose to perform primary interpretation on any specimen, the corresponding glass slides are mailed for diagnostic purposes. For more information, please contact [email protected].

Meet Greg Osmond, MD, Chief Medical Officer and Co-Founder of PathologyWatch 

For over 15 years, Greg Osmond has been studying the growing field of dermatopathology and accompanying forms of cancer. He is a board-certified pathologist and dermatopathologist and an expert on cutaneous disease. 

During his residency at Duke University, Greg participated in the Health Policy Law and Ethics concentration track, where he focused on novel business models surrounding the implementation of digital pathology with an emphasis on dermatology. Following his residency, he completed a fellowship in dermatopathology in the combined Harvard program, rotating between Beth Israel Deaconess, Brigham & Women’s, and Massachusetts General Hospitals. 

While Pathology Watch currently focuses its laboratory services to dermatologists within the United States, Greg is looking forward to expanding the capabilities and accessibility of specialized diagnoses and treatment through the use of digital pathology and supervised artificial intelligence in underdeveloped settings.

We sat down with Greg to learn more about his connection with digital pathology as well as his vision for PathologyWatch and its influence on the dermatology field. 

At what point in your education did you realize you wanted to pursue a career in dermatopathology?

I spent my third year of medical school at Duke in dermatology clinics and performing melanoma research. As part of those endeavors, I worked extensively with the staff dermatopathologists and discovered that I enjoyed my time at the microscope more than my time in clinic, though I have always enjoyed both.

What is the most rewarding aspect of working in dermatopathology?

I find the most satisfaction when I take a deep dive into unusual cases in order to come up with the best answer and most helpful results to the clinician and patient. Sometimes, answers aren’t clear-cut on the pathology slides, and more involved correlation with clinical findings and the literature are needed to issue a report that is helpful. Generating a concise but clinically helpful report in these instances is the most rewarding.

What made you want to develop PathologyWatch

I have been privileged to train under, work in, and consult with some of the best hospital systems and pathology departments in the country. However, within each center, there is a noticeable disconnect between the technology being used in other industries and systems commonly employed in the healthcare settings. At the same time, health systems and providers are also looking for ways to enhance efficiencies in providing care while simultaneously noticeably improving quality. We have created PathologyWatch to solve these issues simultaneously within anatomic pathology using cutting-edge digital technologies as the foundation. 

What is it about your experience and/or background that helps you bring something unique to PathologyWatch?

I think my strongest asset for PathologyWatch has been to help gather outstanding people to work with. I would say that goes for my co-founders Dan and Michael as well. We’ve gathered excellent, dedicated people with incredible skill sets that are focused on the problem, but also have a high level of integrity and character; these are people that I genuinely enjoy interacting with.

When it comes to serving dermatologists, what matters most to you?

I believe the best way to serve dermatologists is to set up and optimize our systems and services so they are focused on the patient experience. Patients come first at PathologyWatch, and we develop our systems to be optimally efficient for them. The beautiful thing is that what improves care for patients also seems to serve dermatologists best. This includes

  1. the quality of the diagnosis and report format,
  2. optimal interfacing to minimize patient errors and get results to the provider in their EMR faster,
  3. enhancing the dermatologist’s ability to easily correlate pathology with clinical findings via immediate 24/7 access to diagnostic slides that have been digitized,
  4. 24/48-hour turnaround time on routine specimens, as well as on cases when additional consultation may be needed,
  5. having dermpaths available to view digital slides with dermatologists as needed,
  6. having comprehensive insurance coverage, and
  7. reasonable cash pay prices.

Focusing on what we would want if we were the patient has been the guiding principle for us. Patients get a better answer when derms work with digital tech. This also includes the underdeveloped world. When you learn that 45 percent of the world doesn’t currently have access to diagnostics, largely due to the cost of care, you want to do something to change that. Optimally developed algorithms working in tandem with an expert pathology service model will hopefully not only improve the quality of care but also allow for the cost of care to drop to an affordable price point for all patients, both domestically and internationally. That’s our goal. 

What’s an interesting fun fact about Greg Osmond? 

I lived in rural Honduras for a few years during college. I enjoy music production and downhill skiing, so living in Utah has been great. But I spend most of my free time exploring the red rocks of Southern Utah with my wife and five kids. We had twins a few years ago, and that definitely keeps us busy.

*PathologyWatch dermatopathologists use an independently validated digital software platform. The systems referenced are not FDA approved for use in primary digital diagnosis. Digital images may be made available to referring dermatology providers upon request through a digital display. Displays used are FOR EDUCATION AND RESEARCH USE ONLY, NOT FOR USE IN DIAGNOSTIC PROCEDURES. When referring providers or other providers choose to perform primary interpretation on any specimen, the corresponding glass slides are mailed for diagnostic purposes. For more information, please contact [email protected].

How to Vet a Qualified Dermatopathology Group

You have invested valuable time and resources to ensure your dermatology clinic offers patients a professional and confidence-earning experience. As such, it’s vital to ensure your practice aligns with a qualified dermatopathology group to provide the highest level of service and help secure long-term patient loyalty.

Developing a solid reputation in your community and throughout the healthcare industry requires dedication and paying close attention to the details. Focusing that same energy into vetting the training, experience, and reporting and communication skills of dermatopathology groups will help you align with a professional group that strengthens your practice.

Appropriate Training
Verifying a dermatopathologist is certified from an accredited institution is the first and most crucial checkbox in your evaluation. In the US, there are only 53 fellowship training programs for dermatopathology. Completing one of these competitive, board-certified programs confirms a dermatopathologist is trained in all aspects of laboratory and diagnostic dermatopathology. 

Certification also indicates the dermatopathologist worked with a variety and high quantity of skin specimens in training. As a result, the individual should have the ability to diagnose a variety of dermatological conditions with confidence.

While certification is a sign of proper training, it does not always signify that the dermatopathologist was exposed to world-class facilities and the latest in pathology technology. Many programs embrace the cutting-edge convenience and efficiency of digital pathology, which PathologyWatch makes available in the private sector. However, just as certification is a sign of proper training, it’s equally essential that dermatopathologists don’t let their board certification lapse, as 7 percent of practicing pathologists are not board-certified.

Measurable Experience
Once a dermatopathologist receives certification, it’s important to note where and how long she or he has practiced. While nearly 25 percent of dermatopathologists pursue careers in academia, the majority turn to the private sector to work in hospitals and pathology laboratories. 

With a workload that can increase 5 to 10 percent annually, pathologists working in busy labs have experience reviewing a large number of skin biopsies that feature a broad assortment of conditions. On the other hand, an individual working at a smaller hospital may have limited experience when it comes to variety or volume. 

Clear Reporting and Communication
It is also vital to determine if the dermatopathology group you are considering can communicate clearly and with scientific accuracy. While errors occur in only 1 percent of pathology reporting, that’s still enough to impact patient care and introduce legal repercussions.

Instead of long reports that don’t provide direct answers, consider dermatopathologists who convey what they know with self-assurance. In cases where they don’t feel 100 percent sure about a diagnosis, it’s equally important to know they will seek second opinions.

A valuable dermatopathology partner will be available to communicate whenever you have questions about a diagnosis. In addition to accessibility, make sure the dermatopathologist is comfortable talking about correlating diagnosis with clinical features and using correct medical terms. 

The safety and satisfaction of your patients are in your hands. Seeking a qualified dermatopathology group with the right training, experience, and communication skills will help you provide the quality of care that your dermatology clinic deserves.

 

*PathologyWatch dermatopathologists use an independently validated digital software platform. The systems referenced are not FDA approved for use in primary digital diagnosis. Digital images may be made available to referring dermatology providers upon request through a digital display. Displays used are FOR EDUCATION AND RESEARCH USE ONLY, NOT FOR USE IN DIAGNOSTIC PROCEDURES. When referring providers or other providers choose to perform primary interpretation on any specimen, the corresponding glass slides are mailed for diagnostic purposes. For more information, please contact [email protected].

What Makes a Reliable Dermatopathology Partner?

Running a successful dermatology clinic means providing your patients with efficient and accurate care. For the almost three-quarters of the 13,847 American dermatologists practicing in offices of five or fewer physicians, having a reliable dermatopathology partner is paramount to the life of the business.

While there are many to choose from, it’s essential to understand that not all labs are alike. By knowing what to look for when it comes to diagnostic expertise, technical quality, accurate reporting, open communication, and cost-effectiveness, you can be sure to align your clinic with a qualified and reliable dermatopathology partner that can bolster the clinical quality of your practice.

Expertise in Pathology Diagnosis
Your dermatopathology partner is a virtual extension of your practice, which means your reputation is staked on how well they do their job. For example, the mother of a dermatopathologist had her local dermatologist run a biopsy on an atypical mole and dermatofibroma. The clinic sent the specimen to a busy laboratory for diagnosis. Due to poorly trained technicians and a subpar dermatopathology read, the lab returned an inaccurate, more malignant diagnosis, which recommended an unnecessary excision with significant morbidity.

What are the warning signs to help you avoid working with a lab that produces these kinds of results? Academically, a dermatopathologist must complete four years of medical school, plus a residency and fellowship, to acquire the proficiency to make accurate diagnoses. Don’t be shy about requesting credentials, paying close attention to reputable institutions and US board-certified accreditation in dermatopathology before making your selection.

High Technical Quality
Returning to the example from before, when the dermatologist requested to review her mother’s slides, she found the immunohistochemical stains in poor quality. A red chromogen overstained the cells and made the lesion appear more worrisome than it was.

It isn’t easy to make quality reads if the specimens don’t meet industry standards. As a practicing dermatologist, you’ve worked years to earn the trust of your patients. In return, 67 percent of patients report to trust or strongly trust their physicians. All the more reason to demand that your dermatopathology partner meet the same level of quality you strive for.

During your selection process, vet the lab to make sure it meets current laboratory accreditation standards. Nearly 70 percent of people choose their providers based on positive online reviews. You’re no different, so do your homework and see what existing and former clients have to say.

Useful Dermatopathology Reports
The report that accompanied the mother’s diagnosis was missing a key component: the microscopic description. Also, the diagnosis did not correlate with the clinical findings. It took two weeks for the dermatopathologist daughter to receive the glass slides, wasting precious time.

A dermatologist requires accurate and organized information to provide patients with timely and factual results. In a 2020 study, 184 patients were presented with reports indicating a benign diagnosis. However, over 92 percent of participants were somewhat or very worried after reviewing the information based on a lack of understanding. The same misunderstanding can exist when a pathology report fails to report essential information, such as a definitive diagnosis with clinical correlation, or a microscopic description.

When considering all of the ingredients that go into a quality dermatopathology report, ease of access rises to the top. The quickest—and easiest—way to receive and manage reports is by having them sent directly into your EMR, which is another modern convenience of digital pathology. Using a digital pathology services provider like PathologyWatch results in rapid deployment of a high-quality report directly to your EMR.

Clear Communication
A reliable dermatopathology partner will effectively transmit vital data to your clinic. In a study of melanocytic lesions, 79 percent of pathologists claimed they offered collaborative suggestions to colleagues to improve patient care. In that same spirit, seek a lab that goes out of their way to ensure you’re able to provide patients with the attention to detail they deserve.

Communication from the lab should be understandable, utilizing industry-standard medical vocabulary. Dermpath labs should correlate the diagnosis with clinical findings and allow you to see the images or slides the dermatopathologist used to make the diagnosis at any time. At PathologyWatch, we give clinicians immediate, 24-7 digital access to the corresponding pathology slides.*

Cost-Effectiveness
In a final look at our example case, the dermatopathologist’s mother received a bill directly from the laboratory for over $500. As it turned out, the clinic had sent her slides to a lab that was outside of her insurance network. If it were not for investigating the fact that her state has laws against surprise billing, she would have never known to contact her insurance company to get this invoice reduced to $25.

Aligning with a lab that offers efficient billing practices will help your clinic to maintain cost-effectiveness. With annual overbilling exceeding $40 billion, it’s critical to select a partner that provides varied and robust insurance contracts in the networks for the majority of your patients.

It’s not uncommon for patients to be direct-billed or even overbilled if they are out of network. Remember that patients will associate any confusion or burdens of cost from the lab as a direct reflection of your dermatology practice. Use caution to select a lab that is in-network with key insurance providers and has reasonable self-pay rates.

Your dermatopathology lab partner is a key part of your practice and an important contributor to the patient experience. By ensuring expertise in diagnosis, technical quality, detailed reports, clear communication, and efficient billing by your dermatopathology lab partner, you and your patients will have a significantly improved experience in working with your laboratory.

 

*PathologyWatch dermatopathologists use an independently validated digital software platform. The systems referenced are not FDA approved for use in primary digital diagnosis. Digital images may be made available to referring dermatology providers upon request through a digital display. Displays used are FOR EDUCATION AND RESEARCH USE ONLY, NOT FOR USE IN DIAGNOSTIC PROCEDURES. When referring providers or other providers choose to perform primary interpretation on any specimen, the corresponding glass slides are mailed for diagnostic purposes. For more information, please contact [email protected].

Comparing the Accuracy of Digital Pathology Images and Traditional Glass Slides

Whole-slide imaging is a qualified alternative to traditional microscopy. With approximately 1,000 pathology labs around the world converting to digital pathology systems, the accuracy of digital pathology images compared to glass slides is no longer an obstacle.

Modern dermatologists are turning to whole-slide imaging to take advantage of remote access, portability, ease of sharing, virtual archiving, and user-friendly tools. By examining the concordance with glass slides, technology training, and intraobserver variability, we will demonstrate why clinics should embrace laboratories that have undergone a digital transformation.

Digital slides are reliable and accessible.

Ensuring every patient receives the highest quality of care means dermatologists require complete trust in the results of their reads. By providing pathologists with up to 98 percent accuracy, digital pathology is a proficient, high-tech additive to optical microscopes.

Surprisingly, less than 5 percent of global pathology sites use digitalized workflows to handle all of their primary diagnoses. Misconceptions about the barriers to entry—including cost, labor, software, and memory—prevent dermatologists from moving to whole-slide imaging. However, partners like PathologyWatch remove these barriers because they can, in the context of providing tissue processing and/or interpretation, carry the burden of cost and provide the necessary hardware, implementation, labor to digitize, and software maintenance to make it simple for clinics to access electronic records. 

The only remaining hurdle is familiarity, which is essential to building confidence in any new form of technology. In a study from the Department of Pathology, University of Pittsburgh Medical Center, pathologists who received proper training interpreted digital imaging with 16 percent greater accuracy than those without training. 

Digital pathology provides significant clinical benefits.

Incorporating whole-slide imaging into your practice means providing patients with industry-leading, state-of-the-art processes. “When patients come to my office I can show them the whole slide image on the computer screen, point out things of significance, and tell them what they mean,” says Sylvia Asa, MD, PhD. “Sitting with patients and reviewing their pathology is a critical element that brings us to the patient and makes patients understand the importance of what we do. And that has always been a big challenge for pathology.” 

The 99.3 percent diagnostic equivalency to glass slides shown with digital pathology has occurred on systems where staff and pathologists have undergone adequate training and assessment, highlighting the importance of appropriate training and experience.

Equally important is the responsibility for every pathologist working in digital imaging to feel comfortable with the process and ensure regulatory compliance. 

Intraobserver variability is a chance for collaboration. 

Because glass slides and digital pathology images are equivalent, a challenging read on a digital device will result in the same challenges when analyzed through a microscope. This means that if a case is diagnostically ambiguous on glass, you’ll find the same inconclusive results using whole-slide imaging. For this reason, it is expected that the same dermatologists or pathologists will render a different diagnosis on a certain percentage of cases depending on the day or modality on which they are viewed. 

However, digital imaging offers dermatologists an advantage when it comes to challenging reads. Unlike glass slides, specimens on a digital image viewer can be simultaneously viewed and annotated by colleagues around the world at a moment’s notice. With the demand for pathologists in the US expected to increase 16 percent by 2030, adapting to the efficiency and collaborative offerings of digital imaging can keep your practice up to speed with a higher workload. 

Aligning with a laboratory like PathologyWatch will help your dermatology practice access the performance and productivity of whole-slide imaging. By understanding the concordance between digital pathology images and traditional microscopy, the value of appropriate training, and intraobserver variability in analog and digital reads, you have the assurance that digital pathology is right for your practice.

 

*PathologyWatch dermatopathologists use an independently validated digital software platform. The systems referenced are not FDA approved for use in primary digital diagnosis. Digital images may be made available to referring dermatology providers upon request through a digital display. Displays used are FOR EDUCATION AND RESEARCH USE ONLY, NOT FOR USE IN DIAGNOSTIC PROCEDURES. When referring providers or other providers choose to perform primary interpretation on any specimen, the corresponding glass slides are mailed for diagnostic purposes. For more information, please contact [email protected].