The CAP has dozens of liaisons to various organizations and efforts, and periodically we publish briefs of what the liaisons hear and see in their liaison roles. Our latest, below, is from the chair and a member of the CAP Informatics Committee.
Hung S. Luu, MD, PharmD; Rajesh C. Dash, MD
May 2025—Digital pathology has revolutionized tissue-based diagnostics by allowing remote viewing of scanned slides on a display and the use of computational algorithms. However, the implementation of digital pathology has not been without growing pains, with issues arising from the proliferation of proprietary image formats from competing vendor solutions and lack of interoperability between different information systems. Diagnostic data aggregation currently requires toggling between applications that may not be synchronized to patient, specimen, or case. Clinical reporting involves manually pasting diagnostic data between information systems. Measurements, enumeration, and sophisticated analysis of images by machine learning algorithms may also require manual entry of that data.
Integrating the Healthcare Enterprise (IHE) is an international initiative of health care professionals and industry to promote the use of standards to achieve interoperability among health information technology systems. IHE promotes the coordinated use of established standards such as Health Level Seven (HL7) to address specific clinical needs. System implementation guides, called IHE Integration Profiles, are published through a well-defined process of public review and trial implementation. Finalized profiles are gathered into IHE Technical Frameworks (TFs).
IHE has proposed three IHE digital pathology profiles that work together to provide solutions to an array of use cases, including: 1) managing digital assets for primary diagnosis; 2) accessing image slides for historical review, secondary review, and consultation; 3) immunohistochemistry positive control slides; 4) sharing and cooperating on gross examination images; 5) incorporation of legacy digital images; 6) image analysis, machine learning, and in silico workflows; 7) quality control, quality assurance, and error correction workflows; 8) digital pathology in support of clinical conferences; 9) creation of a cross-image coordinate system of multiple images to allow for useful image comparisons across different digitized images; and 10) digital pathology in support of intraoperative procedures. The three profiles target different parts of the digital pathology ecosystem and include image acquisition (DPIA), ordering and workflow (DPOW), and evidence creation (DPEC). The DPEC profile includes integration with artificial intelligence algorithms. IHE takes a vendor-agnostic approach to solve the interoperability challenges by using established standards rather than relying on proprietary formats. One such standard is the profiles’ support of Digital Imaging and Communications in Medicine (DICOM).
DICOM is the international standard for the transmission, storage, retrieval, printing, processing, and display of medical imaging information. DICOM also supports encoding, storage, and exchange of image annotations with standardized ontologies such as Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT) as well as quantitative measurements derived from images. While usually associated with radiological imaging data, DICOM has been extended to support digital pathology. Digital pathology image data can be encoded with relevant patient and specimen‑related metadata as DICOM objects. DICOM is easily misunderstood as being only an open file format for storage of image pixel data. However, its metadata integration, communication, and data exchange aspects can contribute positively to the daily work of pathologists. These features, paired with their support in the new IHE profiles, promise to ease the adoption of digital pathology.
Dr. Luu is professor of pathology at UT Southwestern Medical Center and director of clinical pathology at Children’s Health, a pediatric health care system. He is chair of the CAP Informatics Committee and the CAP’s liaison to the LOINC effort. Dr. Dash is professor of pathology at Duke University Health System and vice chair for anatomic pathology and informatics. He is a member of the CAP Informatics Committee and former chair of the CAP Artificial Intelligence Committee. He is planning co-chair for the Integrating the Healthcare Enterprise, Pathology and Laboratory Medicine (IHE PaLM) domain, focused on lab data interoperability.