Although healthcare providers have become accustomed to digital solutions in recent years, these solutions have only recently been introduced to dermatologists. But how much can digital pathology really do for dermatologists?

Dan Lambert, PathologyWatch CEO, recently joined Aleksandra Żuraw, DVM, PhD, host of the podcast Digital Pathology Place, to share how PathologyWatch’s quick, convenient, and comprehensive digital pathology solution is transforming the dermatology industry.

Here are some highlights from Dan and Aleksandra’s interview:

How does digital pathology empower dermatologists?

Dan: For the first time, the dermatologist is not only getting just a fax report over. They’re actually getting to see the case and see the area that the pathologist has highlighted. And now, also for the first time, a lot of our dermatologists are showing the case to the patient, showing why there’s going to be a procedure. . . . There can potentially be financial upside here, in that if the dermatologist is reading the case, it may increase the complexity of the visit. . . .

The second compelling factor for dermatologists is that because our system is integrated with their EMR, they’re typically saving, on average, about 25 hours per month, per clinic, not having to deal with organizing patient cases. And they really value that time savings. 

And then number three is simply better patient care. You’re less likely to have errors if the dermatologist can see the image and they can make sure it’s the right patient and the right case.

How do you stay ahead of the competition?

Dan: We’re deep into research on the AI front of trying to figure out how do you detect different tumors and skin conditions, and how do you make it really accurate so that it can be a true assistive device, or an assistive tool, for both dermatologists and dermatopathologists?

We’ve introduced some new staining techniques that aren’t used generally in other laboratories. We’ve also switched to fully automated equipment, and we’re not doing a lot of processes by hand that introduce variability. And that tight control of the process means true consistency. And then also a number of QA/QC processes that exist in our lab that do not exist in other laboratories, to make sure that those inputs are the best that they possibly can.

Did you have a failure that set you up for success?

Dan: We needed to be able to detect the edges of the tissue so that we can eventually do things like measurements. And so we introduced this green stain that would highlight the edge of the tissue, and it took us a couple of months of trying a bunch of different colors to try to capture this special staining. And the ink would get on other parts of the tissue, other colors would get washed out. . . . Working through some of those actual laboratory changes [was] very important. . . . We finally got a staining technique that works consistently on probably about 98% of tissue.

You won’t want to miss this intriguing interview! Click here to access the full podcast and learn more about how dermatologists can save time, improve communication, and provide a better patient experience by going digital.

At the forefront of these advancements, PathologyWatch is a full-service dermpath lab that effectively combines groundbreaking digital dermatopathology tools with the quality of customer care expected from a local provider.

Dan Lambert, PathologyWatch CEO, recently met with Dr. Maxwell Cooper of The DaVinci Hour Podcast to discuss the role of AI in current pathology workflows, the hurdles faced in the push for digital pathology, and the efficiency created by relying on these newer technologies. 

The full episode can be found here. These are a few of the highlights from the interview: 

Dr. Cooper: Tell us a little bit about PathologyWatch, like what was the impetus for starting it, and what . . . do you guys offer to dermatology practices?

Dan Lambert: We looked at this market and said, “How are we going to actually introduce the AI in a way that the market will truly adopt it?” And the more that we looked at it, it didn’t make a lot of sense to just develop the AI as a tool and then try to license it. It really needed to be a part of the laboratory, a part of the process, a part of the workflow of the physician. . . .

There are a few reasons why this process is so much better than what existed before. As you know, most [pathologists in residency] are using digital pathology to learn and study, and then they get out in the real world, and the industry is mostly microscopes and fax machines. . . . We’re replacing these very old systems with an entire end-to-end software process that takes out those fax machines, that takes out the microscopes.

A few very specific reasons why we’re growing so fast (we’re in about 70 dermatology clinics and we just started selling about two years ago): The first one is that there can be some potential financial upside for the dermatologist to view the case digitally because, even though we’re providing the primary console, if you look at the case on a secondary console, there may be potential opportunities for increased case complexity, for example.

Secondarily, it’s also just simply better patient care, but you now have both the dermatologist and the dermatopathologist or the general pathologist looking at the case. 

Other reasons: On average, we see about 25 hours of labor reduction in the dermatologist’s office because, instead of them having to deal with fax machines, we’re integrated with ModMed, EZDerm, and eClinicalWorks—all the major EMRs for our field. Going digital also enables a whole new world of being able to very easily send the case to expert consults anywhere or have your primary dermatopathologist be really anywhere in the world. And so it’s freeing up a lot of labor that otherwise would have had to be right there in the lab. I think all those pieces together make this really transformational, and that’s why we’re getting so much adoption very quickly.

Dr. Cooper: It sounds like you’ve really brought a significant amount of efficiency to what . . . previously was somewhat of an outdated process. I guess I’m wondering, as you know, physicians—and medicine at large—is resistant to change and cannot always be the best about adopting new technology or new ways of doing things. What were some of the hurdles or maybe some of the skepticism you received at first, and how did you convert those dermatologists that may have been skeptical at first to adopting your services?

Dan Lambert: Yeah, I think that’s really true. And I think those first two or three clients were so much harder than the last two or three clients. At this point, it’s very well validated, and I think everyone’s more comfortable using digital, and we don’t get as much pushback anymore. But I think early on, it was a question of “How do we know if digital is safe? How do we know that the scanner picked up all the tissue?” Actually, the scanners have really good controls in them, and we’ve fine-tuned the scanners over time to be really safe. We do use some redundant imaging to make sure that there’s not a piece of tissue that’s missing. And then also convincing the community that algorithms can really help detecting blurry spots or screening out things that happen inside the lab where the case really needs to go back and the slide needs to be redone. You know, a very common problem in pathology. . . .

[When all their conditions are aligned], they say, “Okay, you know what, I’m willing to give this a shot.” And they tend to not send all of their volume up front—they send a few samples, make sure they can see the digital, make sure that the quality of the reports is good and they’re definitive diagnoses. And then they start sending more and more; and I think that’s become a very common pattern.

I think, in general, pathologists are fairly resistant about being automated out of a job. I think that concern is in your field as well, in radiology, but we’re just not finding that. This is technology designed to assist and help go faster. Really excellent dermpaths are not going to be replaced by AI in the next few years, realistically. I think it’s an important concept to understand. Also, reimbursements are being cut; there does need to be ways to make pathology more efficient, and I think this is an answer, and the more-forward-thinking pathologists actually are really embracing this and getting involved. That’s exciting to see: that the community is moving things forward, too. . . . 

Dr. Cooper: What’s some of the positive feedback you’ve received from your clients? What have they told you [about] how this has changed their practice? How has this improved things? What are a couple of the positive comments you’ve received?

Dan Lambert: We actually have about 15 case studies—and for anyone that’s interested, we do share these case studies pretty openly. Our website is PathologyWatch.com. . . .

[One piece of feedback we’ve received] is improvement in the turnaround time because we’ve developed local laboratories in multiple locations. We’re getting really good turnaround. 

The second thing is the savings on just the time in the dermatologist’s office dealing with faxes or auto faxes—we’re eliminating a huge portion of that. We use enhanced interfaces that deliver the results directly attached to the patient record, so it’s a lot safer that way too. So you’re not putting the wrong patient record in the wrong chart. 

Also the ability to see the case—to see what the lab is seeing. That ability means that you can call up the pathologist, and you can both be looking at the case at the same time to discuss that case. In some ways, it has actually increased the amount of communication which has a lot of benefit to the patient. 

And then, overall, elimination of errors. Our labs certainly have a much lower error rate than general labs because it is software-based, and we do have patient identification controls that are better than other locations. So it’s a whole slew of benefits. . . .

I think that we can genuinely help a lot of practices move away from how it works right now.

Things are changing fast in the dermatology field. As more dermatologists turn to digital-based services, the options for expanding patient care services, accelerating turnaround times on diagnoses, facilitating interoperability among health services agencies, and streamlining workflow processes to better control overhead costs are transforming the dermatological patient experience. 

At the heart of some of those changes occurring in Utah’s pathology labs is PathologyWatch, a full-service dermpath lab that combines the dermpath expertise and cutting-edge technology of an academic center with the efficiency and customer service of a private lab.

Dan Lambert, CEO at PathologyWatch, met recently with Caitlin Hansen of Silicon Slopes to discuss the business side of running a series of digital pathology laboratories, the future of AI technology on patient care, and the vision Dan has for the future of PathologyWatch and digital dermatopathology. 

Here are some of the highlights from that interview. 

Caitlin Hansen: Can you give me a little more info about the technology?

Dan Lambert: Right now, you go into the dermatologist; then they take a biopsy, and that gets FedExed or couriered to a local lab where it’s cut into really thin slices and stained. A physician looks at that under a microscope, types up a report, and that report might be faxed somewhere. 

For us, we’re taking that process, which is very manual, and we’ve streamlined it. We make the slide digital, so that, for the first time, the dermatologist can look at that slide as part of the process, much like a radiologist would show you an X-ray. 

We’re enabling not only dermatologists but, down the road, other physicians as well to actually show you what your cancer looks like in the patient room. Also, the integration with EMR means it’s much faster for the dermatologist’s office. [This creates] a lot fewer errors, and it allows for multiple opinions on the same case, which has never been done before because it’s really just been glass slides. And so the transformation to digital across this industry is reducing costs, it’s making things faster, and it’s also drastically improving patient care.

CH: I’m curious how you feel like this is going to affect the accuracy of diagnosis as well.

DL: We see from major academic medical centers that, at the end of the day, recognizing cancer under a microscope or digital, it’s about pattern recognition, And computers, especially with deep learning, have gotten better and better at recognizing these patterns and will eventually greatly improve the diagnostic accuracy. 

It will help doctors for a long time. And then, at some point in the future, it will probably be accurate enough that we can start phasing out the human review of some of these cases. This stands to take out major costs from what is almost a $17-billion-a-year industry, which is pathology. And it’s one of the few innovations that I think can take out the true costs for a very overburdened healthcare system. . . .

CH: I’m curious about your specific focus as the CEO. . . . What does the day-to-day look like for you, and what do you put most of your focus on? 

DL: So we just raised the $25 million Series B. With that funding, now it’s going from the point where you have a product that has proven product market fit, but moving into scale means that you need a lot of really highly qualified people to build the business. I’m spending about 50 percent of my time just on straight recruiting; trying to bring in engineers. . . .

CH: You mentioned you just moved facilities. Where did you relocate to? 

DL: [We had to] move from one lab in Murray to a bigger lab in Murray. . . . It is exciting to grow. We employ about 50 people right now, and we’ll probably be at about 80 people by the end of next year, which is exciting to see the team [become] some of my close friends. It almost feels like family now. . . .

CH: What is on the horizon for you?

DL: The next phase for us is continuing development of AI. Learning to recognize cancer samples better, faster; finding those rare cases that frankly many, many physicians miss. Having gone through a couple of startups, I started this four years ago with the understanding of trying to leave something behind that’s like a true legacy or trying to make medicine truly better. It turns out that’s a hard journey. But so far it’s worked, and I’m really happy that I made that decision. . . .

CH: Are you in hospitals and clinics? How are you integrating to make sure that this technology is being used now?

DL: When we looked at the business early on, we could have gone two routes: We could have sold to hospitals, which is generally a longer sales cycle, or focus on outpatient clinics. They can make a decision usually in about a month. So we decided to go after the independent dermatology clinics that are primarily located in Utah. 

We now have five labs in different states, so we’ve scaled up quite a bit. If you go to a dermatologist here in Utah, we process the majority of skin cancer samples in the state and so your sample is probably going through our laboratories. And I’m really proud of that because I genuinely believe it’s a higher standard of care than what has existed in the past.

CH: So switching back to you being the CEO and running your company. I think that culture and motivation comes from the top down and leading by example. What is the kind of culture that you inspire your employees to abide by and how do you keep them motivated?

DL: I think in any company, you have to pick a set of values. That also means making sometimes hard decisions about what you prioritize. And I think, in this company, the culture of truth, transparency, and accuracy of the diagnostic process is more important than anything. . . .

I want our company to be the kind of place that you would send your family member samples to, and that means enforcing a really high standard of care. 

To view the full interview, click here.