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Enabling digital pathology in the diagnostic setting: navigating through the implementation journey in an academic medical centre
  1. Chee Leong Cheng1,
  2. Rafay Azhar1,
  3. Shi Hui Adeline Sng1,
  4. Yong Quan Chua1,
  5. Jacqueline Siok Gek Hwang1,
  6. Jennifer Poi Fun Chin1,
  7. Waih Khuen Seah1,
  8. Janel Chui Ling Loke2,
  9. Roy Hang Leng Ang2,
  10. Puay Hoon Tan1
  1. 1Department of Pathology, Singapore General Hospital, Singapore, Republic of Singapore
  2. 2Integrated Health Information Systems, Singapore, Republic of Singapore
  1. Correspondence to Dr Chee Leong Cheng, Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 10, Diagnostics Tower, Singapore 169856, Republic of Singapore; cheng.chee.leong{at}


Aims As digital pathology (DP) and whole slide imaging (WSI) technology advance and mature, there is an increasing drive to incorporate DP into the diagnostic environment. However, integration of DP into the diagnostic laboratory is a non-trivial task and filled with unexpected challenges unlike standalone implementations. We share our journey of implementing DP in the diagnostic laboratory setting, highlighting seven key guiding principles that drive the progression through implementation into deployment and beyond.

Methods The DP implementation with laboratory information system integration was completed in 8 months, including validation of the solution for diagnostic use in accordance with College of American Pathologists guidelines. We also conducted prospective validation via paired delivery of glass slides and WSI to our pathologists postdeployment.

Results Common themes in our guiding principles included emphasis on workflow and being comprehensive in the approach, looking beyond pathologist user champions and expanding into an extended project team involving laboratory technicians, clerical/data room staff and archival staff. Concordance between glass slides and WSI ranged from 93% to 100% among various applications on validation. We also provided equal opportunities for every pathologist throughout the department to be competent and confident with DP through prospective validation, with overall concordance of 96% compared with glass slides, allowing appreciation of the advantages and limitations of WSI, hence enabling the use of DP as a useful diagnostic modality.

Conclusions Smooth integration of DP into the diagnostic laboratory is possible with careful planning, discipline and a systematic approach adhering to our guiding principles.


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