Digital pathology rollouts race for proof of concept at national level

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The U.K.'s National Pathology Imaging Co-operative (NPIC) at Leeds Teaching Hospitals NHS Trust will scale up the infrastructure of its national digital pathology research platform to incorporate a national secure data environment, or SDE.

NPIC said the effort will facilitate the curation of large-scale research datasets and support clinical trials of new U.K.-created therapies for cancer. 

"This could unleash a raft of new medical tech products onto the global market, including more flexible medical scanners and an AI tool to help spot lung cancer sooner," the U.K. government said October 6. Five hubs are planned across the U.K., from Glasgow to Bristol, to support the development of new health technologies.

Notably, these hubs will work in "intimate partnership" with the private sector, the U.K. government said, with experts at University College London (UCL) developing scanners to improve cancer surgery and delivering their research together with both large medtech multinationals and British start-ups, for example.

Alex Wright, PhD.

Led by Alex Wright, PhD, SDE will "scale up NPIC’s existing research infrastructure to upgrade its capability and resilience, link to additional sites, and demonstrate the ability to create research cohorts of digital pathology images in collaboration with the regional SDEs," NPIC said October 9.

National platform

U.K. government funding will also allow NPIC to go a step further -- to develop a proof-of-concept national platform for digital pathology research data. Moreover, NPIC, together with the NHS England Data for Research and Development program, will accelerate national research in artificial intelligence (AI) model development and evaluation with exemplar projects linked with regional SDEs, according to NPIC.

For those not familiar, NPIC was founded in 2019 as the Northern Pathology Imaging Co-operative. More recently, NPIC said it planned to deliver and install digital slide scanners in three NHS "improvement networks," encompassing 15 NHS sites over the next two years, that serve people across Yorkshire and northeastern England. Two further national networks are also being rolled out to support specialist pediatric tumor and sarcoma pathology services, NPIC said. 

NPIC will also work with Spotlight Pathology Ltd., funded by Innovate UK’s Advancing Precision Medicine award, to create an AI digital diagnostics platform to streamline the diagnosis of blood cancers. 

Cooperative models 

In total, three government initiatives that have been activated and funded in the U.K. will scale up the country's national clinical and AI research capabilities, according to NPIC. More than 2.4 million pathology images will be created and stored each year allowing for research and collaboration opportunities. It amounts to three petabytes of pathology image data per year, covering all specialties and stains. 

"The NHS is globally unique in holding data for the entire population," said NHS England's National Director of Transformation Vin Diwakar of the pathology data network. "This makes the test result information we hold particularly valuable for AI training as we know that it represents the population properly. 

"The information will remain under the control of the NHS at all times and will only allow secure access to approved researchers who are conducting analysis which improves health and care," Diwakar also said. 

Connected laboratories

In other news, toward larger, connected laboratory medicine networks, Magentus (formerly Citadel Health) will serve as information technology supplier for a single digital pathology system across pathology services in the Cheshire and Merseyside Pathology Network laboratories. The company won an 11.5-million-pound ($14.9 million) contract to provide the laboratory information management system (LIMS). 

Four clinical workstreams run in the Cheshire and Merseyside Pathology Network, covering blood sciences, microbiology, cellular pathology, and point-of-care testing. The aim is for regional collaboration in a networked service model by 2025, for the purpose of "driving out unwarranted variation in pathology services and achieving critical mass to support specialist diagnostics so that patients have equal access to key tests and services are sustainable." 

According to Magentus, the new IT system will replace aged systems and connect five pathology laboratories:

  1. Countess of Chester Hospital NHS Foundation Trust
  2. Wirral University Teaching Hospital NHS Foundation Trust
  3. Warrington and Halton Teaching Hospitals NHS Foundation Trust
  4. Mersey and West Lancashire Teaching Hospitals NHS Trust
  5. Liverpool Clinical Laboratories, part of Liverpool University Hospitals NHS Foundation Trust

“This is significant engagement for Magentus, aligned with the NHS Long Term Plan’s vision of improving clinical efficiency and safety while ensuring equitable access to diagnostics," Magentus Group's new CEO Rachael Powell said in the related announcement. 

Pressing on 

Elsewhere, Australia's progress toward a national rollout of digital pathology is also drawing on Magentus for the potential of its interoperable eRequests product. The company said approximately 90% of Australia's pathology laboratories, including newly signed Australian Clinical Labs, are using eRequests.

Adding Australian Clinical Labs follows implementing the product at Sonic Healthcare, and also at Healius, two of Australia's largest private pathology providers. 

"Australian Clinical Labs plays an important part in Australia’s pathology landscape and this adoption of eRequests is a significant step towards improving patient, specialist, and lab workforce experiences,” said Michele Blanshard, CEO of Magentus’s Practice Management division, in connection with the announcement. 

Share or else 

This might come as unwelcome news in Australia. For the past 10 years, the country has not kept pace with international best practices to create consistent health information capture and exchange standards, its Minister for Health and Aged Care Mark Butler said in an October 17 speech at Victorian Healthcare Week 2024.

"All states and territories are now sharing pathology and diagnostic imaging reports to My Health Record, with most uploading more than 75% of all tests and scans, and most on track to share 100% of them in coming months," Butler said.

With private pathology and radiology clinics already uploading over 10 million pathology and nearly one million diagnostic imaging reports monthly, Butler said he plans to introduce legislation in Australia in November that will mandate “sharing by default” for all tests and scans, in near real time.  

"The 'sharing by default' framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan," Butler continued, adding that under the legislation, providers that do not have modern cloud-based systems in place to enable this sharing could even be sent to jail. 

In Australia, the Clinical Reference Group will provide strategic and clinical advice to ensure implementation of diagnostic imaging and report sharing is aligned with consumer needs and preferences, and healthcare provider clinical workflows, Butler added. The country's vision for digital health over the next 10 years was unveiled in a new plan released in December. It was billed as a $20 billion long-term investment. 

7 years in 

It has been just over seven years since the first Royal Philips digital pathology pilots on a large, multiregional scale, when the Intellisite Pathology Solution debuted in 2017 at Queen Elizabeth University Hospital in Glasgow, Scotland; and Royal Infirmary and Western General Hospitals in Edinburgh. 

NHS England led the way by committing to consolidating pathology services across England as part of a larger pathology network transformation program. 

Data and experience produced by various organizations may be beneficial for those at various stages of digital transformation; however, the NHS is still trying to get the basics right in terms of nationwide development and access to high-quality digital reporting, according to authors of an October 28 report in the journal Diagnostic Histopathology

"Due to the limited number of digital pathology experts with the correct skill mix, and the complex infrastructure needed for AI, a supraregional or national approach may be needed to ensure high quality and consistent support for all laboratories," wrote Dr. Benjamin Moxley-Wyles, a national medical director's clinical fellow at the NHS and pathology adviser for the National Cancer Programme’s Cancer Vaccine Launchpad, and Dr. Richard Colling, a senior research fellow at the University of Oxford and consultant pathologist. 

Moreover, "for a national approach to be successful, increased standardization of digital workflows across all networks would be required," they wrote.

Seven years may mark a significant milestone for digital pathology. Read "Artificial intelligence and digital pathology: where are we now and what are the implementation barriers?" here.

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