Editors: Raymond D. Aller, MD, & Dennis Winsten
The why and how of setting up a pathology clinic for patients
October 2024—Conducting informal pathology clinics in his office to help patients better understand their diagnosis has been standard fare for John Groth, MD. But this will change in the coming months as he finishes setting up a formal clinic, replete with the technology and tools necessary to more easily educate patients at Endeavor Health’s Evanston Hospital.
Recognizing the value of direct patient interaction, Dr. Groth, pathologist and director of pathology informatics innovation and technology at Endeavor, proposed and subsequently secured a dedicated space for a pathology clinic in the blood bank at Evanston Hospital, near Chicago. The clinic, about the size of an inpatient room, is being equipped with technology for showing patients (and often their family members) their pathology slides. Dr. Groth and other pathologists who have volunteered to staff the clinic will interpret slides for patients and explain test results.
“Endeavor Health is in the process of incorporating digital pathology into its clinical workflow,” explains Dr. Groth. “A key component of this initiative is reimagining the pathologist’s workstation. This setup not only enhances the efficiency of digital pathology but also fosters a more patient-centered approach to communication and care.”
The clinic will contain four computer displays—three displays for the pathologist to use for digital pathology and one dedicated to patient and resident use. The patient and pathologist will be able to sit and view their displays shoulder-to-shoulder. “The setup has a dual purpose,” says Dr. Groth, adding that it will also be used to further educate residents.
During an approximately one-hour long meeting with a patient, the pathologist will present that person’s digital pathology slides, using whole slide imaging software to highlight pathology of medical concern, and allow the patient to ask questions.
“Artificial intelligence software will also be used to educate patients,” Dr. Groth says. “If we tell patients, ‘This is a heat map of your cancer,’ they can visualize it better than if they simply receive a histology explanation.”
Physicians can refer patients to the pathology clinic, and the hospital will be adding the clinic as a patient service on its website menu. Patients currently telephone the pathologist to make appointments, but Dr. Groth anticipates they will be able to set up appointments through their patient portals by year’s end. He also expects the service will be expanded to a telehealth offering next year.
Onsite and virtual pathology clinics will “give patients a better understanding of their disease, helping them make decisions about treatment and lessening anxiety about their condition,” Dr. Groth says. “Digital pathology enhances the experience for patients. It’s a powerful tool.”
Dr. Groth also believes pathology clinics may increase pathologists’ level of job satisfaction as a result of their being able to directly interact with patients and can provide an additional revenue stream for pathologists and facilities. “The majority of pathologists conducting clinics do it voluntarily, in addition to their other work,” he says. “We hope to show a financial component and revenue stream that could support providing dedicated time for this endeavor.” Billing for the service is not an issue, he adds. “The same billing coding used by patient-facing clinicians for medical decision-making and time can be used.”
So, how does a hospital get a pathology clinic off the ground? Dr. Groth offers suggestions.
Identify a pathology champion. Find someone in the pathology department willing to serve as a point person and seek leadership buy-in. “If someone has a genuine interest in this, they should approach leadership to share the literature and suggest exploring the idea further,” says Dr. Groth, noting that studies have demonstrated the benefits of direct pathologist-patient discussions. “Connect with others who have published, been involved in meetings, and developed relationships around this,” he adds.
Talk to clinical colleagues. Search out clinical colleagues interested in partnering with pathology in the endeavor. Ask them to make others in their departments aware of how a pathology clinic can benefit patients and to promote the clinic to clinician colleagues who may struggle to interpret pathology reports. Ask clinicians to tell patients about the pathology service directly or through their patient portal or handouts and to make referrals.
Start with oncology. “Studies reveal that patients with cancer are interested in seeing their slides,” Dr. Groth says.
Select and staff a patient-friendly venue. Locate the clinic in a space where patients can easily make appointments and check in. Dr. Groth also suggests decorating the space with plants or other decor to make it more comfortable and less sterile. The clinic at Evanston Hospital is an ergonomic space that is fully adjustable, says Dr. Groth. Seating, tables, and monitors are height adjustable to accommodate patients, and the doorway is a flat entry wide enough for wheelchairs.
Consider all aspects of technology. “Equipment related to digital pathology or a camera setup capable of streaming an image are prerequisites,” Dr. Groth says. “You need to have the ability to digitize the slide with a camera or a whole slide image. It is critical to have HIPAA-compliant technology that is flexible and mobile, allowing us to share images anywhere within our system on a secure device.” While microscopes are traditionally used to examine specimens, Dr. Groth notes that some patients cannot peer through a microscope due to physical limitations. Furthermore, digital pathology allows for telehealth options and conducting clinics at the bedside on a tablet. “It’s important for IT to review what is applicable and appropriate,” Dr. Groth adds.
Down the road, Dr. Groth expects to add other sophisticated technologies to the pathology clinic. “Digital pathology is one tool, but multimodal imaging and artificial intelligence may enhance the experience further,” he explains. “As an example, using 3D images of the patient’s cancer—generated from pathology reports, slides, and MRI findings—pathologists will be better prepared to educate patients.”
Incorporating this technology for patients will probably take several years, Dr. Groth says. “Right now, it’s aspirational, but it’s worth doing.”
—Valerie Neff Newitt