Anne Paxton
January 2025—Pathology informatics leaders at the University of Michigan are moving in steps to a fully digital practice as they put in place an innovative workflow for primary diagnosis.
Fresh off their August launch of the new workflow program within their remodeled histology lab, informatics directors in the pathology department say Michigan Medicine is the first in the U.S. to have radiology and pathology operating in the same shared picture archiving and communication system, or PACS, and to implement the well-established DICOM standard for pathology workflow.
“The unknowns that legitimately existed maybe five or 10 years ago”—whether storage and computation are adequate and whether the images are of adequate quality—“those have been answered,” says Ulysses G. J. Balis, MD, associate chief medical information officer and director of the Michigan Medicine Division of Pathology Informatics.
The expense will always need to be addressed, he admits. “This will cost money. That’s probably the biggest barrier right now. But the technology or the knowledge that it works—those are not the barriers anymore.”
The pathology department’s transformation was intended to be part of the move to its current offsite facility six years ago, though at the time they didn’t know when it would happen. “We knew at some point this building would be going to pure digital workflow,” and all the anatomic pathology spaces were designed for it, says Dr. Balis, who is the A. James French professor of pathology informatics and director of the computational pathology lab section.
He explains the physical reconfiguration of Michigan’s sign-out rooms. “The microscope used to literally be front and center in our sign-out spaces. The pathologist was seated centrally, with learners huddled nearby at adjacent microscope binocular heads. For this new workflow, we wanted to keep the microscope convenient but off to the side, so we had to change the configuration of our multiheaded scopes. While the microscope is still at the front and within arm’s reach, what is now front and center is the diagnostic-grade monitor, where most diagnoses are now made.” In addition, they have subordinate monitors throughout the room so fellows and residents can also see the cases conveniently.