Newsbytes

Editors: Raymond D. Aller, MD, & Dennis Winsten

A peek at the particulars of new digital pathology calculator

April 2024—Transitioning to digital pathology can seem complex and costly. And for some, but not all, laboratories, cost in particular can be a barrier to adoption. So how do you determine which camp your lab falls into? You calculate, according to Orly Ardon, PhD, director of digital pathology operations at Memorial Sloan Kettering Cancer Center.

For the past two years, Dr. Ardon and colleague Matthew Hanna, MD, have spearheaded a Digital Pathology Association working group tasked with helping laboratories tabulate the costs and potential savings of digital pathology. The working group formed in 2021, but the process of exploring the multiple financial factors that impact digital pathology began in earnest early last year. The result of that effort is a comprehensive online calculator, available to DPA members on the organization’s website, that laboratories can use to calculate a potential return on investment for digital pathology.

The idea for the project came about when Dr. Ardon and her colleagues noticed how few publications take a holistic look at the financial implications of adopting digital pathology. “There is this misconception that digital pathology is very expensive and will never show any return on investment, so it will be hard to justify,” Dr. Ardon says. She hopes the automated tool will dispel that perception.

The categories the calculator uses to assess digital pathology ROI were determined by Dr. Ardon and Dr. Hanna, director of digital pathology informatics at Memorial Sloan Kettering, based on an evaluation of the costs their institution has incurred and the expenses it has avoided by implementing digital pathology. The calculator exclusively evaluates tangible financial costs and savings and does not attempt to quantify related intangible advantages, such as patient satisfaction, Dr. Ardon says.

Because Memorial Sloan Kettering’s digital pathology experiences as a research institution do not apply to all laboratories, the calculator also has a flexible design that laboratories can tailor to their own business models, Dr. Ardon says. Laboratory personnel can skip specific questions (or even entire sections of questions) that don’t apply to their lab’s operations to customize the ROI calculation.

Dr. Ardon compares the calculator to the numerous mortgage calculators available online and hopes that it will be used in a similar manner. Just as prospective home buyers enter different home prices and downpayment amounts in a calculator to find a mortgage that suits their needs, laboratories could use the DPA’s calculator to test different digital pathology investment scenarios. For example, if a laboratory is considering adopting digital pathology for only one portion of its operations, such as for biopsies only, it could use the calculator to test the viability of that strategy, she says.

The calculator accepts up to five years’ worth of data to account for how costs change over time. Five years was chosen in part because many institutions depreciate equipment over a five-year period, Dr. Ardon says. However, users have the option of inputting data from a shorter time span.

The calculator addresses the following areas.

Clinical operations. This screen collects information on the size of a laboratory’s operation, including details such as how many glass slides are generated per year, how many days per week and shifts per day the laboratory operates, the average pathologist salary, and the number of pathologists using digital technology.

Other clinical services. On this screen, laboratories enter data about frozen sections or rapid on-site evaluation procedures that would be affected by transitioning to digital pathology. Laboratories that do not perform these procedures can skip this section.

Consults. Laboratories that send or receive consult slides can enter data about consult volumes and the workflow involved in processing them. Digital pathology can help laboratories avoid the costs associated with the lengthy workflows that are a part of glass slide consults, Dr. Ardon says.

Case assembly and delivery. By providing data for estimating courier costs, lab technician time spent assembling and collating glass slides, and average lab technician salaries, laboratories can track some of the fundamental savings that digital pathology can provide.

Scanner. Dr. Ardon estimates that a quality high-throughput scanner can cost as much as $500,000. In this section of the calculator, laboratories can input the cost of their current scanner, salaries for scanner operators, scan time per glass slide, and estimated glass slide throughput per hour if they want to assess their existing investment, or they can input projected costs for purchasing and operating a scanner. This information can also be used to predict when additional scanners will be needed in the future.

Viewer/case-management system. This section is designed to capture the total costs of the digital pathology viewer and case-management system the lab is using or would like to purchase, including licensing fees, installation or integration fees, and annual maintenance costs.

Pathologist workstation. The cost of pathologist workstation monitors can vary greatly depending on whether the monitors are medical grade and based on such factors as resolution and screen size, Dr. Ardon says. This section captures current or anticipated pathologist workstation monitor costs and associated workstation upgrade costs.

Quality control. At Memorial Sloan Kettering, a quality control technician reviews scanned digital slides to evaluate whether they are blurry and have captured all of the tissue. In the future, Dr. Ardon says, the lab plans to automate this process. Not all labs have a defined process for digital scan quality control, but those that do can input the related costs on this screen.

Information technology architecture. Digital pathology can require a larger IT architecture investment than many other technology changes in the laboratory, Dr. Ardon says. This section helps laboratories calculate the cost of LIS integration, service contracts, and the additional IT support required for digital pathology operations.

Storage. The storage section has an asterisk because complex decisions about digital slide storage should be made separately, using designated data storage calculators, Dr. Ardon says. In this section, labs can enter the cost structure for their chosen digital slide storage solution, as well as the glass slide storage expenses that can be avoided by using digital pathology.

Archive and retrieval. This section helps calculate the savings generated by digital pathology due to labs avoiding the courier fees, administrative time, and other costs associated with archiving and retrieving glass slides.

Education and conferencing. This section estimates the costs that laboratories can avoid by not having to manually select, prepare, or transport glass slides for conferences or other educational purposes.

Case review and collaboration. Labs can use this section to calculate the savings digital pathology produces by eliminating the need to transport glass slides to diagnostic management team meetings or other internal review meetings.

Legal. Institutions that have incurred legal expenses related to missing, lost, or damaged glass slides can enter those costs, as well as costs associated with preparing and reviewing medicolegal cases, into this section.

Commercialization. Institutions that expect to generate revenue by using digital images for sponsored research or other ventures can record the projected revenue on this screen.

AMA CPT reimbursement (current and anticipated). The last two sections track Current Procedural Terminology code reimbursements related to digital pathology. This topic is divided into two sections: one for the computer-assisted IHC quantification CPT code that has been used for reimbursement, and one for the new add-on digital pathology category III CPT codes for primary diagnosis that began being tracked on January 1.

As users enter information into the calculator, separate panes on the right side of the screen keep a running tally of digital pathology costs and savings so users can see how each entry affects the overall calculation. The time required to fill out the calculator will vary depending on the amount of information users choose to input and the amount of time it takes them to find that information, Dr. Ardon says.

The calculator does not yet have a mechanism for saving or downloading information that has been input—every time users open the calculator, they have to re-enter information anew. This was done because the DPA working group did not want the liability of holding other laboratories’ data. However, the team will consider adding a mechanism for saving data in future versions, Dr. Ardon says.