• by Dan Angress , April 10, 2013

It’s a sad reality that, on a global basis, medical resources aren’t allocated in any kind of organized or equitable fashion. Treatments and tools that are commonplace in many societies are virtually non-existent in others. 

Telemedicine – the use of IT to provide clinical healthcare at a distance -- and my field, telepathology or digital pathology (pathology at a distance, driven by telecom and IT), seek to tap talent and technologies wherever they may be. Via the cloud, we have begun to expand the reach of every pathologist beyond his or her backyard to patients and practices the world over, whether performing diagnoses, engaging in education or embarking on research. This is visionary medicine at its best, at work to transform patient care and save lives on an unprecedented scale.

As the noted pathologist Keith Kaplan recently observed in his Digital Pathology Blog, “Much like our building materials, pool tables, clothing, toys, televisions, PCs, smartphones and a million other products … countries will export their pathology cases to the U.S. But instead of the cargo ships going back empty, they will send back pathology support and reports to guide diagnoses, treatment, management and clinical trial management. The untethering of pathologist from microscope, histology lab and laboratory information system is here -- and is now worldwide.”

Early cloud-based networks are beginning to connect pathologists in ways previously not possible. Digital consultations, social networking apps, safeguards for security and privacy, opportunities for marketing and business development – all will, in short order, become standard features of the digital pathology toolkit.

Adopting this cloud-based model of digital pathology, doctors on the ground in remote parts of the world are now able to link up with a quality pathologist partner, analyze their patients’ medical situations from different dimensions, and then effectively direct patient care. Using the network to connect doctors and hospitals with qualified, certified pathologists – many from the top medical institutions in the U.S. – represents a genuine sea change in global medical care.  

It’s crucial to understand that as we use technology to address this global imbalance in medical services, we run very little risk of emulating the IT field and actually outsourcing pathology jobs and, indeed, an entire industry. If anything, digital pathology diminishes the threat of outsourcing of pathology services because it effectively brings expertise to places where it’s needed most – without leaving home.

“One does not have to go back many years to remember folks concerned about ‘outsourcing of pathology services’ to foreign countries,” Kaplan says. “Naysayers over the years have told me that beyond cost, support requirements, lack of IT resources, speed, workflow, user interface issues, network requirements, etc., one of the major impediments to the wide-scale adoption of digital pathology has been a fear of ‘outsourcing.’ Our skills and services would be commoditized, sold on the open market to the lowest bidder and sent offshore.”

As Kaplan notes, there are a number of reasons why this has not occurred and will not occur: despite acute shortages of pathologists on some continents, the pathology community overall has the capacity to deliver. A similar lack of subspecialty expertise persists in those locales, as does a lack of quality to ensure that standards of care are being met (as would be expected of the American community, for instance). These factors are likely to become increasingly important as fee-for-service volume-based models become pay-for-performance quality/outcomes-based models of care.

“While you may be better off going to Malaysia or India for your open heart surgery or joint replacement, Western pathology is still the best in the world and this technology offers us the opportunity to provide it on a scale to places that could not previously have access to do so,” Kaplan concludes.

Ultimately, the best news is that, thanks to cloud technology and other telecommunications advances, the pathology specialty can flourish at home while it delivers enormous benefits irrespective of geography. Here, it’s about where the cases are, and where the need is greatest. We promote global telemedicine because exporting expertise in the service of vastly improved patient outcomes is the right thing to do.