PathologyWatch CEO Dan Lambert Discusses the Future of Digital Pathology on The DaVinci Hour Podcast

Digital-based services are transforming the dermatology industry, allowing clinics and patients alike to experience streamlined turnaround times and greater interoperability between healthcare providers.

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.

Dan Lambert, CEO at PathologyWatch, Chats with Silicon Slopes Host on the Impact of Digital Pathology

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.

Is Melanoma “Overdiagnosed?”

By Darren Whittemore, DO

As one of the most feared types of cancer, melanoma accounts for about 1 percent of skin cancers while contributing to over 7,000 deaths in the United States every year. And those numbers are steadily increasing, with annual incidences rising up to 4–6 percent over the last several decades.

In the age of improved preventative measures, early detection, digital technologies, and better treatments, why are cases of melanoma continuing to rise? Is it our propensity for skin cancer? Or could it be the diagnosis? Are patients receiving the most accurate and reliable information possible? Some voices in the dermatopathology industry believe the pursuit of a “definitive” diagnosis—bolstered with advancements in digital pathology—sometimes leads to biopsies that are collected and tested too soon and ultimately come back with a negative result for malignancy. 

However, others believe it is better to risk overdiagnosis than to miss cases before it is too late. As the industry-wide debate persists concerning melanoma diagnostic processes, let’s discuss points that support both sides of the argument. 

Yes: There are indicators of melanoma overdiagnosis.

“From an epidemiologic perspective, the sharp rise in the incidence of melanoma in the face of stable mortality for the past 40 years [signifies] the epidemiologic signature of overdiagnosis,” says Jason B. Lee, MD, in an article for the American Academy Dermatology Association

Lee echoed some of the concerns expressed by H. Gilbert Welch and his team’s research, which postulates that “the rapid rise in the incidence of melanoma is not due to a true rise in incidence, but it is the byproduct of increased scrutiny, which they refer to as the epidemic of inspection, surveillance, and biopsy of pigmented skin lesions.” 

Welch’s team asserts that the rapid rise in the incidence of melanoma is due to the increasing skin cancer screening activities, low threshold to biopsy, and low threshold to diagnose melanoma by dermatopathologists fueled by heightened public awareness of melanoma, financial incentive, and fear of missing melanoma that has resulted in what they refer to as the “cycle of melanoma overdiagnosis.” 

No: Testing for early detection—even if tests don’t result in malignancy—is good.

Opponents of this overdiagnosing argument—particularly Sancy A. Leachman, MD, PhD, and John D. Gray, an endowed chair in melanoma research—caution against rejecting new technologies for fear of diagnoses not resulting in malignant melanoma:

They suggest that we revert to not biopsying lesions less than 6 mm, rather than making an effort to better understand the biology (and clinical signs) that makes some 2 mm lesions deadly. Shouldn’t our call-to-action be to improve, rather than to decrease, our diagnostic scrutiny? Wouldn’t it be better to utilize the COVID “experiment of nature” to evaluate the true (data-based) impact of decreased melanoma screening, rather than keep all screening programs closed? . . . Should the SPOT Skin Cancer™ screening program be halted completely, as they suggest, or should we purposefully stratify risk and screen those with highest need?

The drive toward innovations in digital pathology and AI technology continues to improve the accuracy of tissue testing. Advances in digital pathology transform our view of the early stages of cellular behaviors. 

But how are we best utilizing this information? At PathologyWatch, we combine state-of-the-art technology and clinical decision-making to deliver optimal patient care with accurate diagnosis. Our clinical team carries extensive experience in identifying and predicting the cellular behaviors of chronic conditions and skin cancers. One of the advantages of having access to this expertise is that dermatologists can collaborate with our clinical team to discuss those factors should there be concerns about early detection. 

Call us to discuss the innovations in digital pathology that can help your practice diagnose with confidence.

5 Ways Technology Elevates the SHARE Model Approach

With emerging technologies promoting self-service portals to access medical information and other self-care practices, it seems the healthcare industry hopes to empower people to take control of their healthcare decisions and care. But that doesn’t necessarily mean patients must take the trip down the treatment lane alone. 

“So much of our lives are now assisted virtually, and on-demand, that going to the doctor when we’re sick feels like stepping back in time,” says Katelyn Smalley, adding that digital health is a welcome addition to healthcare. However, she also emphasizes the need for balance between technology and building an honest personal relationship with your healthcare provider. 

In the dermatological field, technology is a strategic tool for reducing turnaround times for test results, controlling overhead costs for clinics, and expanding access to care. It also reinforces the SHARE approach to decision-making in clinical encounters. 

If you’ve incorporated the SHARE model approach to bolster the patient experience with shared medical decisions, today’s digital technology is a natural fit for encouraging participation, assessing the diagnosis, and discussing the most preferred options. Here’s why: 

SEEK your patient’s participation.

Emerging patient-centered technologies broaden patient involvement in their treatment plans, and it reflects in how patients communicate with their healthcare provider. For instance, recent studies found that over half (51 percent) of consumers are likely to tell their doctors that they disagree with them. 

The onset of the 21st Century Cures Act and EMR technology equipped with custom self-service portals provide patients with essential information about their medical history. Access to this data drives patient involvement and prepares them for an in-depth discussion about their diagnosis and how to move forward. Essentially, the doctor needn’t lead the patient into a discussion about their diagnosis; the patient is already engaged.

HELP your patient explore and compare treatment options.

To make informed decisions about treatment options, seeing is believing. When patients can see the actual diagnosis while discussing their condition with a doctor, it bolsters better doctor-patient communication. 

When offered, 75 percent of patients will engage in a consultation geared to demystify the diagnostic process and provide information that empowers the patient. Partnering with a full-service digital dermatopathology lab like PathologyWatch enables 24/7 access to patient slides to add a new level of clarity to the discussion. 

ASSESS your patient’s values and preferences.

In some cases, particularly those associated with malignancy, reaching out to a specialist via remote consultation may also bolster the patient’s confidence in their doctor and encourage collaboration in treatment preferences. 

With digital slide imaging as part of the patient/provider consultation, your patient can express concerns, ask questions, and consider options while they see and hear from both doctors sharing encouraging and qualified support while addressing the patient’s preferences. 

REACH a decision with your patient.

A study out of the University of Washington School of Medicine found that almost all of us (90 percent) want to know the whole truth about the diagnosis of a serious illness. When you’ve created a comfortable, trusting environment to discuss a patient’s condition, it makes it easier for them to ask more questions about the risks of treatment options based on the digital slides of their lab results. 

EVALUATE your patient’s decision.

Many health conditions don’t have a clear best treatment option, so finding the right answer often requires the doctor and patient to work together. “Shared decision-making allows patients to engage in a deliberative, communicative process with their clinicians and be active participants in their care,” says Angie Fagerlin, chair of the department of population health sciences at the University of Utah and president of the Society for Medical Decision Making, explained.

Experts agree that engaging in shared medical decisions leads to better patient outcomes, more effective treatments, and lower costs. And patients who engage in health care decisions with their doctor “are less likely to regret the choices they make and more likely to stick to the treatment regimens they select,” adds Laura Landro of the Wall Street Journal.

Using the SHARE model for medical decision-making remains a strategic way to engage with patients about their care. Adding digital technology reinforces that relationship by providing patients with a broader perspective of their care and treatment options.

Digital Technology Benefits Patients AND the Rural Clinics That Treat Them—Here’s How

Since the pandemic’s onset, we’ve learned a lot about the impact of digital technologies like telehealth services and remote patient care models. These services have been pivotal for ensuring the nearly 78 million people who live in rural communities across the US have access to a healthcare provider.

But telecommunications and digital pathology capabilities within rural clinics also benefit primary healthcare providers by elevating the quality of patient care they can provide with no heavy investment in lab equipment or additional staff. 

With a digital pathology workflow, your patient’s lab results are sent electronically directly to each patient’s EMR. Plus, a digital image of your patient’s results makes it possible to collaborate with expert dermatopathologists from all over the country to utilize their expertise for the best care options possible.

Let’s talk about the current state of healthcare in rural communities and how the need for alternatives in delivering patient care, including specialized care, is in sync with digital technology capabilities. Then, we’ll explore how transitioning to digital technology doesn’t require more overhead costs. Instead, it empowers your rural clinics to expand accessibility and be more effective with existing staff. Here’s how. 

Understanding the Doctor-to-Rural-Patient Ratio

First, let’s understand what doctors in rural communities face. The National Rural Health Association says the ratio of doctors to the population in the rural communities they serve averages around 39.8 physicians per 100,000 people. This is compared to 53.3 physicians per 100,000 in urban areas. Access to specialized care is even lower, with only around 30 specialists serving 100,000 people in rural areas. These facts underline how critical it is for technology to bridge the gap between modernized healthcare and America’s rural regions. 

Comparing General Clinical Care to Specialized Care

In many cases, rural clinics staff medical school residents who can provide effective general care. On any given day, these busy rural clinics respond to various patient care needs ranging from setting bone fractures and running a lab test for a bladder infection to vaccinating an infant. 

But what about chronic skin conditions? An NIH study found that rural communities in Texas, for instance, experience higher incidences of cancer than urban areas, particularly melanoma, which accounts for over 7,000 deaths each year. And in Utah—which holds the rather dubious honor of reporting the highest incidences of melanoma and mortality rates in the US (80 percent higher than the national average)—96 percent of its land is rural or frontier. 

“Patients from rural and frontier counties may have different pathways of care to a melanoma diagnosis,” explains Tawnya L. Bowles and her research team. “Rural patients may not have proximity to a diagnosing provider and the specialty of the diagnosing provider may be different compared with urban patients. Furthermore, patient and tumor characteristics may also be influenced by rural residence.”

With early detection playing such a huge role in successfully treating chronic skin diseases, how can rural clinics best deliver optimal care without increasing overhead costs? Simple: Bring the dermpath lab and their team of specialists to the clinic. And that’s where digital technology comes into play.

Digital Technology: A Modernized Tool for Accessible Specialized Care

In any pathology case, tissue samples of the affected area must be collected, then processed in a pathology lab. Digital dermpath specialists add an additional process of digitizing slides in a scanner, which allows for improved access to whole-slide images for both the requesting physician and the dermpath lab, typically resulting in a shorter diagnostic turnaround time.

But here’s where rural clinics benefit from this technology: Since the process is virtual, slides can be instantly shared with specialists anywhere in the world. Some dermpath labs—including PathologyWatch—also have specialists in other fields on staff, allowing them to have even more immediate access to virtual slides after they’ve been digitized without needing to send glass for a consultation.

A dermatopathologist’s understanding of skin diseases includes knowing which ones can indicate something else, such as systemic diseases found in other parts of the body that may present dermatologically. Through digital dermatopathology, dermpaths can conveniently review and share slides with specialists familiar with these indicators and include those specialists’ findings as part of their report. 

Enhanced Patient Care

Understanding the correlation between dermatopathology findings and disease with readily available access to specialists can ultimately result in improved patient care. Once a diagnosis has been established, a primary care physician can take a swift and appropriate course of action. With digital technology, doctors can treat patients anywhere without requiring more full-time staff or expensive lab equipment. 

Compared to traditional pathology practices, digital pathology provides a strategic resource in qualitative analysis and reduces errors through the conversion of slides into digital imagery.

With an extensive network of specialists in multiple fields, digital dermpath labs can generate more detailed reports based on additional findings through collaboration achieved by sharing these high-resolution digital slides with specialists. That means a rural clinic in Hurricane, UT, can feel confident that they are providing the same caliber of specialized care for their patients as those treated in larger cities. 

Digital pathology can transform your rural clinics by offering patient care services that weren’t possible a decade ago. With digital technology as the foundation of your care delivery process, your staff will provide the most innovative dermatological care available, partnered with a personalized and caring patient experience. 

Contact us today for a free demo if you’re interested in learning more about how PathologyWatch, our team of dermatopathologists, and our network of dermatopathologists can help you.

Is Telepathology the Right Solution for Your Practice?

Though the term telepathology may conjure images of psychic abilities, the reality is much more simple. Initially conceptualized in 1986 by Dr. Ronald S. Weinstein, the field has grown substantially, though widespread use has not yet been fully realized, both here in the United States and abroad.

Curious if telepathology is the right solution for your practice? We’ll examine just what telepathology is—including the different methodologies it can encompass—and how it can improve patient care, research, and diagnoses, to help you decide for yourself.

What is Telepathology?

Simply put, telepathology is the practice of pathology done remotely. This is primarily achieved through the sharing of digital slides with pathologists over the internet, though we’ll examine other methods later on. Using a digital slide system, samples are digitized at a high resolution, making them easier to examine at various magnification levels. This makes them ideal for telepathology, as pathologists are able to manipulate and study samples in ways that cannot be achieved through other methods.

Though the use of telepathology was increased due to the COVID-19 pandemic, a 2020 report found that prior to that in the United States, fewer than 20 percent of laboratories were utilizing the benefits of telepathology for secondary diagnosis, and fewer than one percent were using it for a primary diagnosis. The reasons for this could range from a cost-prohibitive standpoint to difficulties with EMR integration and more. PathologyWatch has addressed these concerns, providing infrastructure implementation with complete EMR integration along with improved read quality, resulting in reductions in associated overhead costs.

Additional Types of Telepathology

Along with the aforementioned digital slide method, there are two other common methods of telepathology. One is a real-time system, which falls under the umbrella of telemedicine. Through this approach, pathologists are able to remotely control a microscope, which allows them the ability to adjust and view results from their location. A live video feed of the microscopy is fed back to the pathologists over a secure network, and a communication system allows them to speak with the individual placing the slides on the microscope at the lab or medical office. This approach does allow for pathologists to examine samples in real time, but unlike the digital slide method, they are unable to access slides 24/7.

The second is an image-based system, which is similar to the digital slide method, though much less advanced. In effect, an image of a slide is captured and shared remotely with a pathologist, who is able to then access the file and make a determination based on what they see. Unlike the digital slide approach, these images are not saved at the same high-resolution quality, meaning they cannot be magnified or manipulated in a similar way.

Benefits of Using Telepathology

The biggest benefit of telepathology is the response time. When samples are able to be instantly shared with pathologists anywhere in the world—especially through a streamlined system—it allows for an expedited response, typically resulting in a faster diagnosis. This is especially true when fully interpreted pathology reports can be uploaded directly into a patient’s EMR.

In the same vein, telepathology allows for better collaboration among medical professionals. By partnering with a digital dermpath lab like PathologyWatch, clinics can experience improved clinical correlation by including more than one pathologist to examine a sample to compare interpretations or sending a sample to a specialist if the slide indicates something indicative of a systemic illness. 

Additionally, evaluations made using telepathology tend to have a higher quality. When using the digital slide method, pathologists can examine a whole-slide image more easily and compare it to other slides for confirmation. Because of the design of the digital slide software, the margin for error is also greatly reduced.

So is telepathology the right solution for your practice? Advancements in technology have led to more widespread use, and according to Industry Research, the global telepathology market size was more than $500 million in 2019 and is expected to reach $985 million by 2026. If you are interested in telepathology—or more specifically, digital dermatopathology—contact PathologyWatch to learn more about how our approach has revolutionized the industry for our dermatology clients.