Vol. 20 • Issue 6 • Page 40
A dermatologist removes a small skin tumor and prepares a frozen tissue slide for the pathologist to view. “Are my margins free of tumor?” he asks. “Yes,” the pathologist replies. Or “No, take more.”
Once, intra-operative pathology consultations like these occurred only when both parties were on different floors of the same building. Now pathology consultations can happen digitally, in real time, across hundreds or thousands of miles, all while the patient lies on the operating table.
Telepathology is carving its niche in direct patient care. For small, rural hospitals with active surgical suites that cannot afford to hire staff pathologists, telepathology offers a potentially ideal solution.
“The overarching reason for telepathology is to improve the quality and safety of patient care,” says L. Berle Stratton, MD, director of Cytology at Northwest Pathology, in Bellingham, WA.
Secondarily, telepathology can enhance the services of critical access hospitals such as Ketchikan General Hospital (KGH) in Alaska, with whom Dr. Stratton’s lab has an exclusive contract.
How It Works
When a surgeon at KGH wants to submit tissue for pathology review during a procedure, a histotechnologist at Ketchikan freezes the sample, prepares the slide and scans it. Meanwhile, in Bellingham, Dr. Stratton logs into an online site and reviews the image.
Click to view larger graphic.
Dr. Stratton can change focus, illumination, magnification and field of view using the special online interface to examine the frozen tissue slide. Then he calls the surgeon directly in KGH’s operating room to discuss his findings.
“In Ketchikan, we have two pieces of equipment,” Dr. Stratton explains. “One is the slide scanner with accompanying software, firmware and hardware. The software allows us to review a whole slide image in a way that simulates a microscopic examination. And we can take snapshots of our field of view as a digital file for conferences, consults and other uses.
“The second piece of equipment essential for telepathology is a live video that allows us to review a gross specimen before it is cut and a slide is prepared. So the pathologist can dictate to the technologist in Ketchikan how to dissect the gross specimen to get the microscopic specimen they want to review.”
Flight, Hotel Costs
Prior to telepathology, when a surgeon at KGH scheduled a frozen section, Dr. Stratton or one of his associates would receive a phone call one to four weeks in advance.
“We would fly up to Ketchikan and stay overnight for a 30-minute procedure,” he says. “Then we would fly back home. It took two days of the pathologist’s time. The hospital would bear the cost of room and board, plus the flight-although this was still much cheaper than paying a full-time staff pathologist. But the downside was limited accessibility of intra-operative consults.”
Now, he adds, “a pathologist is available to consult with a surgeon at Ketchikan 10 hours a day, 50 hours a week.”
As a result, KGH retains more surgeries locally, a financial advantage to the hospital. Plus, patients don’t have to travel and their surgeries are expedited.
Be advised, though: Reimbursement from frozen sections will not pay for telepathology technology or the required personnel. Therefore, critical access hospitals that use their ORs only sparingly needn’t invest in it.
“However, for critical access hospitals that do surgical procedures in sufficient volume, telepathology reduces travel and hotel expenses for the pathologist and increases revenue because the hospital retains more procedures locally,” Dr. Stratton says. “Hospital administrators love those two things. In the big picture, it pays for itself.”
Michael Gibbons is an editor at ADVANCE.