October 2025—Glass or digital, onsite or remote—and what the rules are for the latter. That’s what Compass Group lab leaders talked about with CAP TODAY publisher Bob McGonnagle when they met online on Sept. 2. Here’s a glimpse into their digital pathology journeys.
The Compass Group is an organization of not-for-profit IDN system laboratory leaders who collaborate to identify and share best practices and strategies.
Wally Henricks, Cleveland Clinic has many referred and second opinion cases for which digital pathology seems to be a natural fit. Can you tell us where your group is at with its digital pathology work and remote sign-out?
Walter Henricks, MD, vice chair, Department of Pathology and Laboratory Medicine, and laboratory director, Cleveland Clinic: We have performed consultations using digital pathology, nationally and internationally, for about nine to 10 years. We recently went live on using digital pathology for remote reading of gastrointestinal biopsies across our system, and we plan to expand on this. We’ve been doing scanner validation, including adding a different scanning platform to our environment. We’ve been deliberate about our validation, and we’ve also put emphasis on supporting our pathologists’ training, et cetera.
Our goal by the end of the year is to have nearly all GI biopsies read via digital pathology, and that’s from various locations, our other campuses, residences, and so forth. That’s going well. Hidden costs have always been important—the time it takes to validate, train, and build up good workflow and quality indicators, like the re-scan rate. We’re watching how many times pathologists want to look at the glass and how often we have to distribute the glass slides for a particular case and how we handle that logistically.
Emilie Morphew, how much digital pathology have you done to date?
Emilie Morphew, MD, vice president of medical affairs, Alverno Laboratories, Hammond, Ind.: I started in 2019. Philips came out with its digital pathology system; it was the only one that was FDA approved. We got 10 or 12 scanners and started almost from day one. Alverno was the second, I believe, in the country. I was one of the first pathologists at Alverno services to do the digital reads and was hooked from the moment I started working with it.
Is everyone signing out and are you signing out remotely?
Dr. Morphew (Alverno): We’re doing the histology for 30 hospitals, and the vast majority are on the digital platform. A couple of people insist on getting glass. We have moved to a single courier run for delivering glass slides, so everyone gets their digital pathology in the morning and the glass slides don’t show up until 1 or 2 PM. If someone is reluctant to do the digital, they’ll see increases in turnaround time. Our cytology is not digitized and certain things like hematology, lymph node biopsies, et cetera, you just don’t want to read digitally.
We don’t do remote sign-out. Everyone comes in. There are requirements for the computer screen you use. It has to be a high-resolution screen, and those are very expensive. I’m not sure regulatory-wise where things stand now.
Dr. Henricks (Cleveland Clinic): The Centers for Medicare and Medicaid Services issued a memo in May 2023 on CLIA post-public health emergency guidance [https://www.cms.gov/files/document/qso-23-15-clia.pdf]. It outlined nine criteria for laboratories to meet if they choose to allow staff to remotely review digital laboratory data, digital results, and digital images. Certain conditions have to be met, among them that the lab director of the primary, home site CLIA number is responsible for all testing performed under its CLIA certificate, including testing and reporting performed remotely; the primary lab’s test report indicates the remote site location where testing is performed; and the lab may use a coding system rather than the remote site address [personnel residence, for example] on the final report. We’ve been setting that up, including the equipment, but also attesting that the specs at home meet our minimum specs and there’s VPN access, et cetera.
Adam Baldwin, what are the current conditions at Henry Ford of people reading pathology remotely?
Adam K. Baldwin, MS HCAD, MLS(ASCP), system vice president, pathology and laboratory medicine, Henry Ford Health, Detroit: During the early stages of the COVID-19 pandemic, I was at a different institution where we launched digital pathology with urgency and purpose following a multimillion-dollar strategic investment. At that time, in 2019, the primary financial driver was reducing logistical costs, which made the deployment both innovative and economically compelling.
Today, in a completely different market, the landscape has shifted. Digital pathology is no longer a strategic differentiator—it’s a baseline expectation. We’ve received substantial funding to complete what’s already underway. The infrastructure is in place: We have digital pathology and algorithms. Yet despite having the tools, we’re not operating at full capacity. Remote sign-out, for example, remains aspirational. Everyone is still on campus.
I’m a strong advocate for remote sign-out. The technology is ready, but the workload is immense. This isn’t an excuse; it’s a reality. We’re constantly making decisions about where to focus our efforts—clinical throughput or validation. Both are essential, but resource constraints force us to prioritize.
Let’s hear from your colleague Dhananjay Chitale.
Dhananjay Chitale, MD, MBA, vice chair, anatomic pathology, and division head, molecular pathology and genomic medicine, Henry Ford Health: We have been using digital pathology for nearly six years, initially driven by resource constraints rather than strategic investment. At the time, we lacked the capital, which has only recently been approved. Our whole slide imaging platform was primarily used to digitize immunohistochemistry, allowing peripheral hospital colleagues to access IHC results before physical slides were transferred from the core lab.
A secondary goal was tumor board deployment, which remains incomplete due to bandwidth and logistical challenges as the system continues to expand across hospitals. Currently, WSI is planned selectively for high-volume areas such as breast, GI, GU, and gynecology.
Our ultimate goal is to implement primary sign-out via digital pathology—it’s simply the future of how we do business. With capital constraints resolved, the team is energized. Our system VP Adam Baldwin is setting up the scanner landing area, and Dr. Mark Tuthill from pathology informatics is preparing his part. The entire value stream is actively being aligned as we speak.
Gaurav Sharma, can you comment on digitization at Henry Ford?
Gaurav Sharma, MD, system vice chair of clinical pathology, division head of regional laboratories, and medical director of the outreach laboratory, Henry Ford Health: Digitization, with or without digital sign-out, is the future because unless you have digitization as a technology, you cannot build further. You cannot build the information superhighway. You will get left behind. This is going to rocket up in the coming years. Everything that is related to an AI algorithm requires digitization.
Eric Carbonneau, where are you at TriCore in terms of deploying digital pathology and artificial intelligence on a working basis?
Eric Carbonneau, MS, MLS(ASCP), chief operating officer, TriCore, Albuquerque: We have three separate pathology groups. One is 100 percent digital with using AI for immunohistochemistry as a quality check. Our other two groups are using digital pathology for some IHC delivery. We are in the process of implementing Halo from Indica Labs, which is a new company in the space. We’re hoping to have that up first quarter of 2026. We’re pushing forward with dermatopathology so some of our dermatopathologists can do remote sign-out.
Because we have hospitals throughout the state, we’re looking to beat the courier delivery times. Therefore, we do all our rush cases digitally. Our goal is to transition to 100 percent digital.
Jordan Olson, where is HNL Lab with digital pathology?
Jordan Olson, MD, chief medical officer, chair of pathology, and medical director, HNL Lab Medicine, Allentown, Pa.: HNL Lab Medicine has been digital for about a year, scanning 100 percent of our slides. Four months ago we stopped sending glass slides to our pathologists unless they request it. Glass slides are sent in less than one percent of cases. If anyone has questions, we’re happy to send the glass, but our pathologists rarely need it.
Working from home has been a huge recruiting boost and helps with retention. If a surgical pathologist has high quality and acceptable turnaround times, they can spend a day to two days a week signing out cases at home. When people sign with us, they’ve said it’s because we’re being flexible, we have the digital platforms, we’re expanding, and we’ve made these investments. At this point digital pathology is the cost of doing business. We’ve been extremely happy with it.
The concerns about remote sign-out were addressed in full within your system?
Dr. Olson (HNL Lab Medicine): Yes. We brought it to our compliance folks. They looked at the memos from CMS to make sure we were going to be covered and doing things the right way. You have to be thoughtful about these requirements. I do worry that if the CMS rules change, that’s going to drastically change our structure in terms of work from home, but we’ll keep on top of it.
It must be a big advantage when you’re recruiting. The competition is intense.
Dr. Olson (HNL Lab Medicine): It’s very intense. We want the best people to be working at HNL and to be able to offer the type of flexibility that drives people to us. When we first installed, we worried people were going to leave the organization because of digital pathology. That didn’t happen. We kept all the people who were here and we’ve had people want to join us because of digital pathology.
Chris Scanlan, where is BayCare with digital pathology?
Christopher Scanlan, director of laboratory administration, BayCare Health System, Clearwater, Fla.: We recently upgraded and validated a tissue staining system in our pathology lab. We’re also investing in scanners and monitors that will help launch our digital journey.
Having digital capabilities is a significant advantage when you’re recruiting new residents. The promise of the AI modules, especially in oncology, is significant. We are looking forward to the ability to quickly send slides for consult digitally, bringing even more efficiency to our clinical care.
What does it mean to say a laboratory is 100 percent digital? Does it mean there is no glass slide delivery at all?
Dr. Olson (HNL Lab Medicine): We don’t send any glass to our pathologists unless they request it, whether it’s IHC, H&E, special stains. Nothing goes out.
Dr. Henricks (Cleveland Clinic): Our definition is the same as Dr. Olson’s. In addition to the benefits Dr. Olson mentioned, digital pathology helps us manage office space.
Adam Baldwin (Henry Ford): My definition of 100 percent digital is the same, but I notice that every time I share my definition, I learn it means something different to everyone else. I subscribe to this definition all the way. And unless you’re doing that, I don’t know that you’re doing digital pathology, but then again, we’re saying we’re doing digital pathology.
I am interested and encouraged when I see how much M&A there is in the digital pathology space. Most of us have felt there were too many vendors, many of which were struggling, but we’ve seen major deals. Pramana was acquired by Evident, and Tempus AI acquired Paige, and that’s usually a healthy thing. Stan Schofield, can you comment on the healthiness of doing deals in this space?
Stan Schofield, VP and managing principal of the Compass Group (formerly of NorDx/MaineHealth): It’s just starting to warm up. We’re going to see new names and new combinations of names going forward. Mergers and acquisitions in diagnostics and pharma are going to heat up. Venture capital money is readily available for those with a winning combination. When you talk about digital pathology, cancer medicine, companion diagnostics, those are all positive financial opportunities from a business perspective. There’s going to be a lot of activity to build scope and scale among all the companies.