A national digital pathology system

A national digital pathology system across Denmark has helped to significantly improve efficiency and raise levels of patient safety. It has used advanced computer software systems and created a countrywide database to optimise the assessment of patients’ specimens.

The development and success of the system will be highlighted at the Digital Pathology Conference in London (3-4 December) where Professor Ben Vainer will lead the session ‘How Digitisation Can Improve Pathology Service – The Danish Experience’. Vainer, a consultant in the Pathology Department at Rigshospitalet, University of Copenhagen, will focus on the Danish civil registry database and other national databases connected to this, and the use of the same LIS in all pathology departments in the entire country with access to the national pathology database of all pathology reports in Denmark since at least 1998. He will also discuss the important links between LIS and patient medical records in hospitals and in private practice (e.g. general practitioners), and how computerisation of the entire laboratory flow, from ordering the pathology service to specimen presentation to the ordering physician, has helped ensure patient safety and eliminate time-consuming manual steps. Vainer: ‘Pathology departments in Denmark have, through close collaboration, been able to build a national pathology system, where each individual pathology department serves as a sort of “branch office”.’ ‘All steps of the specimens are followed through the pathology department, which gives a good global view of the departmental activities and the possibility to trace individual specimens. For the managers this also provides good measures of operational objectives.’ The “users” – ordering physicians – are provided with a clear overview of their patients’ specimens during the assessment process, and patients have full access to reports on their own tissue, he added. Digitisation of laboratory processes and the link to the pathology LIS, plus national pathology database, opens up the opportunity for image automation, including digital image analysis and transfer of whole slide images, in cases where a second opinion is needed without compromising either patient safety or the international data acts. Vainer believes other countries can learn several points from this system: ‘In large pathology labs the large number of specimens is often a hindrance to efficient handling and ensuring patient safety without time-consuming steps. Such steps can be turned digital, releasing valuable staff resources. However, most important is that digitisation opens up for the implementation of new imaging techniques, which are necessary to provide each patient with the correct assessment of diagnosis and biomarker expression profile.’ The system is fully implemented, with automated image analysis and the option for second opinions using whole slide images currently being tested. There are also a number of patient benefits from the Danish system. Vainer: ‘The risk of specimen mix-ups are minimised, and application of national pathology databases linked to national person-identification databases ensures that the pathologist always has access to previous tests performed on the patient. This increases the quality of the pathology assessment and hence the final diagnosis.’ Denmark’s next step is to introduce new digitisation procedures such as automated image analysis and substitution of conventional light microscopies with whole slide images, including possibilities to perform a second opinion without the delays when using shipment of glass slides by postal services. Vainer: ‘Automated image analysis will further increase the pathology assessment quality by eliminating subjective readings of biomarker expression, for example, in addition to elimination of the risk of patient case mix-up.’