Difference between revisions of "Journal:DigiPatICS: Digital pathology transformation of the Catalan Health Institute network of eight hospitals - Planning, implementation, and preliminary results"
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==Introduction== | ==Introduction== | ||
The Catalan Health Institute (Institut Català de la Salut or ICS) is the largest provider for the Catalan Health Service, the insurer of universal health coverage in Catalonia. It is the company with the most employees in Catalonia and the largest public company in Spain, with almost 39,000 professionals who provide services to almost six million people throughout the territory. [1] The ICS manages 283 primary care teams, three large high-tech tertiary [[hospital]]s (Vall d’Hebron, Bellvitge, and Germans Trias), four regional reference hospitals (Arnau de Vilanova in Lleida, Joan XXIII in Tarragona, Josep Trueta in Girona, and Verge de la Cinta in Tortosa), and a regional hospital (Viladecans) (Figure 1). The ICS accounts for seven percent of the Catalonian government budget, accounting for over 40 million primary visits and over 100,000 surgical interventions yearly. | |||
[[File:Fig1 Temprana-Salvado Diagnostics22 12-4.png|900px]] | |||
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| style="background-color:white; padding-left:10px; padding-right:10px;"|<blockquote>'''Figure 1.''' Map of Catalonia and the eight ICS hospitals.</blockquote> | |||
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Some [[Laboratory|laboratories]] are beginning to successfully deploy [[digital pathology]] solutions for routine diagnosis, which we believe will be a growing trend in the next few years. [2,3,4,5,6,7,8,9,10] In Catalonia, the DigiPatICS project plans to accomplish a complete digital pathology transformation of primary [[Histopathology|histopathological]] diagnosis for over 168 [[Pathology|pathologists]]. Many groups have reported equivalency between digital pathology and conventional pathology. [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] | |||
With the DigiPatICS project, we aim to increase patient safety and quality of care, improving diagnosis and the efficiency of processes in [[anatomical pathology]] departments of the ICS through digital pathology and [[artificial intelligence]] (AI) tools. [28] With digital pathology, we aim for a network of eight hospitals to work as one in terms of case sharing and teaching, putting all our patients on equal footing. This transversal digital transformation will have an impact on the care of patients treated by all medical and surgical specialists. | |||
First, we created a network between ICS centers. This helped us increase the reproducibility and quality of diagnoses, as well as offered greater equity and safety to patients. In turn, this network approach facilitated remote diagnosis, case sharing, sub-specialization, and teaching for pathologists. In addition, we aimed for better working conditions, impacting the optimization of workflows, productivity, and, finally, turnaround times. We also intended to improve ergonomics and postural health, as well as to facilitate morphometric tools and the quantification of diagnostic and prognostic biomarkers to involve the optimization of time and a higher quality in diagnosis. | |||
From a more technical point of view, the aim was to achieve a central digital repository of images on the network, thereby reducing the burden of slide file management and integrating medical imaging with SIMDCAT, a digital medical imaging system used in Catalonia. It was also intended as a subproject to establish bidirectional communications with other locations, such as operating rooms. | |||
The project included the development of AI tools with [[machine learning]] (ML) and deep learning, taking advantage of the availability of whole slide images (WSIs) that were obtained after digitization. The objectives were to recognize tissue patterns, select tumor areas, and quantify them, among others. Hopefully, this use of AI tools will contribute to improving the quality of diagnosis and the efficiency of processes. | |||
==Materials and methods== | |||
DigiPatICS was created as a European Regional Development Fund (ERDF) project, with European funds for the optimization of anatomopathological diagnosis in a network of public ICS hospitals in Catalonia through digitalization and AI tools. | |||
Subsequently, a market consultation was carried out, and, finally, it was tendered with the file code CSE/CC00/1101202869/20/AMUP [29]. | |||
===Planning, scope, and tender process=== | |||
A definition of needs was first carried out. We firmly believe meticulous planning is essential, taking into account all functional and technological requisites. Failing to detail such requirements can end in the failure of a digitization project, resulting in expensive scanners installed in pathology laboratories that are barely used. It is also important to highlight that going digital is not about acquiring pathology scanners; we focused our project on the purchase of a service with a shared risk with the bidder to achieve our objectives. Since this transformation was meant to be a one-way street with no possibility of going back to microscopes, all planning needed to include sufficient contingencies to avoid any kind of downtime for pathologists, as well as to ensure they benefit from the potential added value. | |||
The purpose of the DigiPatICS project was to increase patient safety and quality of care, improving diagnosis and the efficiency of processes in pathological anatomy departments of the ICS using digital pathology and AI tools. | |||
In defining the scope, several questions arose: | |||
* Do we want to save the whole slide images (WSIs) forever? Who will store them? | |||
* Is our [[laboratory information system]] (LIS) ready? | |||
* Do we want to (or have to) address pre-analytics? | |||
* Do we want to address dark-field microscopy (e.g., direct fluorescence, FISH)? | |||
* Do we want to digitize the macroscopic images? | |||
* Do we need to update the hospital network? | |||
* Do we need to update our pathologists’ workstations? | |||
* Do we want to share cases with the outside world? | |||
* Is teaching important? | |||
* Do we want AI algorithms? | |||
* Do we want to do telepathology? | |||
* What do we do with [[Cytopathology|cytology]]? | |||
* Do we have money for everything? | |||
Revision as of 22:09, 8 April 2022
| Full article title | DigiPatICS: Digital pathology transformation of the Catalan Health Institute network of eight hospitals - Planning, implementation, and preliminary results |
|---|---|
| Journal | Diagnostics |
| Author(s) | Temprana-Salvado, Jordi; López-García, Pablo; Vives, Josep C.; de Haro, Lluís; Ballesta, Eudald; Abusleme, Matias R.; Arrufat, Miquel; Marques, Ferran; Casas, Josep R.; Gallego, Carlos; Pons, Laura; Mate, José L.; Fernández, Pedro L.; López-Bonet, Eugeni; Bosch, Ramon; Martínez, Salomé; Ramón y Cajal, Santiago; Matias-Guiu, Xavier |
| Author affiliation(s) | Institut Català de la Salut, Centre de Telecomunicacions i Tecnologies de la Informació, Vall d’Hebron University Hospital, TIC Salut Social, Technical University of Catalonia, Germans Trias i Pujol University Hospital, Doctor Josep Trueta Hospital of Girona, Verge de la Cinta Hospital of Tortosa, Joan XXIII University Hospital of Tarragona, Arnau de Vilanova University Hospital, Bellvitge University Hospital |
| Primary contact | Email: jtemprana at vhebron dot net |
| Editors | Eloy, Catarina |
| Year published | 2022 |
| Volume and issue | 12(4) |
| Article # | 852 |
| DOI | 10.3390/diagnostics12040852 |
| ISSN | 2075-4418 |
| Distribution license | Creative Commons Attribution 4.0 International |
| Website | https://www.mdpi.com/2075-4418/12/4/852/html |
| Download | https://www.mdpi.com/2075-4418/12/4/852/pdf (PDF) |
 |
This article should be considered a work in progress and incomplete. Consider this article incomplete until this notice is removed. |
Abstract
Complete digital pathology transformation for primary histopathological diagnosis is a challenging yet rewarding endeavor. Its advantages are clear with more efficient workflows, but there are many technical and functional difficulties to be faced. The Catalan Health Institute (Institut Català de la Salut or ICS) has started its DigiPatICS project, aiming to deploy digital pathology in an integrative, holistic, and comprehensive way within a network of eight hospitals, over 168 pathologists, and over one million slides each year. We describe the bidding process and the careful planning that was required, followed by swift implementation in stages. The purpose of the DigiPatICS project is to increase patient safety and quality of care, improving diagnosis and the efficiency of processes in the pathological anatomy departments of the ICS through process improvement, digital pathology, and artificial intelligence (AI) tools.
Keywords: digital pathology, computational pathology, artificial intelligence, deep learning, implementation, workflow, primary diagnosis, LIS, telepathology, network
Introduction
The Catalan Health Institute (Institut Català de la Salut or ICS) is the largest provider for the Catalan Health Service, the insurer of universal health coverage in Catalonia. It is the company with the most employees in Catalonia and the largest public company in Spain, with almost 39,000 professionals who provide services to almost six million people throughout the territory. [1] The ICS manages 283 primary care teams, three large high-tech tertiary hospitals (Vall d’Hebron, Bellvitge, and Germans Trias), four regional reference hospitals (Arnau de Vilanova in Lleida, Joan XXIII in Tarragona, Josep Trueta in Girona, and Verge de la Cinta in Tortosa), and a regional hospital (Viladecans) (Figure 1). The ICS accounts for seven percent of the Catalonian government budget, accounting for over 40 million primary visits and over 100,000 surgical interventions yearly.
|
Some laboratories are beginning to successfully deploy digital pathology solutions for routine diagnosis, which we believe will be a growing trend in the next few years. [2,3,4,5,6,7,8,9,10] In Catalonia, the DigiPatICS project plans to accomplish a complete digital pathology transformation of primary histopathological diagnosis for over 168 pathologists. Many groups have reported equivalency between digital pathology and conventional pathology. [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]
With the DigiPatICS project, we aim to increase patient safety and quality of care, improving diagnosis and the efficiency of processes in anatomical pathology departments of the ICS through digital pathology and artificial intelligence (AI) tools. [28] With digital pathology, we aim for a network of eight hospitals to work as one in terms of case sharing and teaching, putting all our patients on equal footing. This transversal digital transformation will have an impact on the care of patients treated by all medical and surgical specialists.
First, we created a network between ICS centers. This helped us increase the reproducibility and quality of diagnoses, as well as offered greater equity and safety to patients. In turn, this network approach facilitated remote diagnosis, case sharing, sub-specialization, and teaching for pathologists. In addition, we aimed for better working conditions, impacting the optimization of workflows, productivity, and, finally, turnaround times. We also intended to improve ergonomics and postural health, as well as to facilitate morphometric tools and the quantification of diagnostic and prognostic biomarkers to involve the optimization of time and a higher quality in diagnosis.
From a more technical point of view, the aim was to achieve a central digital repository of images on the network, thereby reducing the burden of slide file management and integrating medical imaging with SIMDCAT, a digital medical imaging system used in Catalonia. It was also intended as a subproject to establish bidirectional communications with other locations, such as operating rooms.
The project included the development of AI tools with machine learning (ML) and deep learning, taking advantage of the availability of whole slide images (WSIs) that were obtained after digitization. The objectives were to recognize tissue patterns, select tumor areas, and quantify them, among others. Hopefully, this use of AI tools will contribute to improving the quality of diagnosis and the efficiency of processes.
Materials and methods
DigiPatICS was created as a European Regional Development Fund (ERDF) project, with European funds for the optimization of anatomopathological diagnosis in a network of public ICS hospitals in Catalonia through digitalization and AI tools.
Subsequently, a market consultation was carried out, and, finally, it was tendered with the file code CSE/CC00/1101202869/20/AMUP [29].
Planning, scope, and tender process
A definition of needs was first carried out. We firmly believe meticulous planning is essential, taking into account all functional and technological requisites. Failing to detail such requirements can end in the failure of a digitization project, resulting in expensive scanners installed in pathology laboratories that are barely used. It is also important to highlight that going digital is not about acquiring pathology scanners; we focused our project on the purchase of a service with a shared risk with the bidder to achieve our objectives. Since this transformation was meant to be a one-way street with no possibility of going back to microscopes, all planning needed to include sufficient contingencies to avoid any kind of downtime for pathologists, as well as to ensure they benefit from the potential added value.
The purpose of the DigiPatICS project was to increase patient safety and quality of care, improving diagnosis and the efficiency of processes in pathological anatomy departments of the ICS using digital pathology and AI tools.
In defining the scope, several questions arose:
- Do we want to save the whole slide images (WSIs) forever? Who will store them?
- Is our laboratory information system (LIS) ready?
- Do we want to (or have to) address pre-analytics?
- Do we want to address dark-field microscopy (e.g., direct fluorescence, FISH)?
- Do we want to digitize the macroscopic images?
- Do we need to update the hospital network?
- Do we need to update our pathologists’ workstations?
- Do we want to share cases with the outside world?
- Is teaching important?
- Do we want AI algorithms?
- Do we want to do telepathology?
- What do we do with cytology?
- Do we have money for everything?
References
Notes
This presentation is faithful to the original, with only a few minor changes to presentation, though grammar and word usage was substantially updated for improved readability. In some cases important information was missing from the references, and that information was added.
