Conference Coverage

Veterans Health Administration cancer centers are lacking registered dieticians (RDs), and patients are more likely to be diagnosed with malnutrition when they are on staff, according to a new study.

The average number of full-time RDs across 13 cancer centers was just 1 per 1,065 patients, advanced practice oncology dietitian Katherine Petersen, MS, RDN, CSO, of the Phoenix VA Health Care System, reported at the AVAHO annual meeting.

However, patients treated by RDs were more likely to be diagnosed with malnutrition (odds ratio [OR], 2.9, 95% CI, 1.6-5.1). And patients were more likely to maintain weight if their clinic had a higher ratio of RDs to oncologists (OR, 1.6 for each 10% increase in ratio, 95% CI, 2.0-127.5).

Petersen told Federal Practitioner that dieticians came up with the idea for the study after attending AVAHO meetings. “A lot of the questions we were getting from physicians and other providers were: How do we get dietitians in our clinic?”

There is currently no standard staffing model for dieticians in oncology centers, Petersen said, and they are not reimbursed through Medicare or Medicaid. “We thought, ‘What do we add to the cancer center by having adequate staffing levels and seeing cancer patients?’ We designed a study to try and get to the heart of that.”

Petersen and her team focused on malnutrition. Nutrition impairment impacts an estimated 40% to 80% of patients with gastrointestinal, head and neck, pancreas, and colorectal cancer at diagnosis, she said.

Petersen discussed the published evidence that outlines how physicians recognize malnutrition at a lower rate than RDs. Dietary counseling from an RD is linked to better nutritional outcomes, physical function, and quality of life.

The study authors examined 2016 and 2017 VA registry data and reviewed charts of 681 veterans treated by 207 oncologists. Oncology clinics had a mean of 0.5 full-time equivalent (FTE) RD. The mean ratio of full-time RDs to oncologists was 1 per 48.5 and ranged from 1 per 4 to 1 per 850.

“It's almost like somebody randomly assigned [RDs] to cancer centers, and it has nothing to do with how many patients are seen in that particular center,” Petersen said. “Some clinics only have .1 or .2 FTEs assigned, and that may be a larger cancer center where they have maybe 85 cancer oncology providers, which includes surgical, medical, and radiation oncology and trainees.”

Why would a clinic have a .1 FTE RD, which suggests someone may be working 4 hours a week? In this kind of situation, an RD may cover a variety of areas and only work in cancer care when they receive a referral, Petersen said.

“That is just vastly underserving veterans,” she said. “You're missing so many veterans whom you could help with preventative care if you're only getting patients referred based on consults.”

As for the findings regarding higher RD staffing and higher detection of malnutrition, the study text notes “there was not a ‘high enough’ level of RD staffing at which we stopped seeing this trend. This is probably because – at least at the time of this study – no VA cancer center was adequately staffed for nutrition.”

Petersen hopes the findings will convince VA cancer center leadership to boost better patient outcomes by prioritizing the hiring of RDs.

Katherine Petersen, MS, RDN, CSO has no disclosures.

Veterans Health Administration cancer centers are lacking registered dieticians (RDs), and patients are more likely to be diagnosed with malnutrition when they are on staff, according to a new study.

The average number of full-time RDs across 13 cancer centers was just 1 per 1,065 patients, advanced practice oncology dietitian Katherine Petersen, MS, RDN, CSO, of the Phoenix VA Health Care System, reported at the AVAHO annual meeting.

However, patients treated by RDs were more likely to be diagnosed with malnutrition (odds ratio [OR], 2.9, 95% CI, 1.6-5.1). And patients were more likely to maintain weight if their clinic had a higher ratio of RDs to oncologists (OR, 1.6 for each 10% increase in ratio, 95% CI, 2.0-127.5).

Petersen told Federal Practitioner that dieticians came up with the idea for the study after attending AVAHO meetings. “A lot of the questions we were getting from physicians and other providers were: How do we get dietitians in our clinic?”

There is currently no standard staffing model for dieticians in oncology centers, Petersen said, and they are not reimbursed through Medicare or Medicaid. “We thought, ‘What do we add to the cancer center by having adequate staffing levels and seeing cancer patients?’ We designed a study to try and get to the heart of that.”

Petersen and her team focused on malnutrition. Nutrition impairment impacts an estimated 40% to 80% of patients with gastrointestinal, head and neck, pancreas, and colorectal cancer at diagnosis, she said.

Petersen discussed the published evidence that outlines how physicians recognize malnutrition at a lower rate than RDs. Dietary counseling from an RD is linked to better nutritional outcomes, physical function, and quality of life.

The study authors examined 2016 and 2017 VA registry data and reviewed charts of 681 veterans treated by 207 oncologists. Oncology clinics had a mean of 0.5 full-time equivalent (FTE) RD. The mean ratio of full-time RDs to oncologists was 1 per 48.5 and ranged from 1 per 4 to 1 per 850.

“It's almost like somebody randomly assigned [RDs] to cancer centers, and it has nothing to do with how many patients are seen in that particular center,” Petersen said. “Some clinics only have .1 or .2 FTEs assigned, and that may be a larger cancer center where they have maybe 85 cancer oncology providers, which includes surgical, medical, and radiation oncology and trainees.”

Why would a clinic have a .1 FTE RD, which suggests someone may be working 4 hours a week? In this kind of situation, an RD may cover a variety of areas and only work in cancer care when they receive a referral, Petersen said.

“That is just vastly underserving veterans,” she said. “You're missing so many veterans whom you could help with preventative care if you're only getting patients referred based on consults.”

As for the findings regarding higher RD staffing and higher detection of malnutrition, the study text notes “there was not a ‘high enough’ level of RD staffing at which we stopped seeing this trend. This is probably because – at least at the time of this study – no VA cancer center was adequately staffed for nutrition.”

Petersen hopes the findings will convince VA cancer center leadership to boost better patient outcomes by prioritizing the hiring of RDs.

Katherine Petersen, MS, RDN, CSO has no disclosures.

Veterans Health Administration cancer centers are lacking registered dieticians (RDs), and patients are more likely to be diagnosed with malnutrition when they are on staff, according to a new study.

The average number of full-time RDs across 13 cancer centers was just 1 per 1,065 patients, advanced practice oncology dietitian Katherine Petersen, MS, RDN, CSO, of the Phoenix VA Health Care System, reported at the AVAHO annual meeting.

However, patients treated by RDs were more likely to be diagnosed with malnutrition (odds ratio [OR], 2.9, 95% CI, 1.6-5.1). And patients were more likely to maintain weight if their clinic had a higher ratio of RDs to oncologists (OR, 1.6 for each 10% increase in ratio, 95% CI, 2.0-127.5).

Petersen told Federal Practitioner that dieticians came up with the idea for the study after attending AVAHO meetings. “A lot of the questions we were getting from physicians and other providers were: How do we get dietitians in our clinic?”

There is currently no standard staffing model for dieticians in oncology centers, Petersen said, and they are not reimbursed through Medicare or Medicaid. “We thought, ‘What do we add to the cancer center by having adequate staffing levels and seeing cancer patients?’ We designed a study to try and get to the heart of that.”

Petersen and her team focused on malnutrition. Nutrition impairment impacts an estimated 40% to 80% of patients with gastrointestinal, head and neck, pancreas, and colorectal cancer at diagnosis, she said.

Petersen discussed the published evidence that outlines how physicians recognize malnutrition at a lower rate than RDs. Dietary counseling from an RD is linked to better nutritional outcomes, physical function, and quality of life.

The study authors examined 2016 and 2017 VA registry data and reviewed charts of 681 veterans treated by 207 oncologists. Oncology clinics had a mean of 0.5 full-time equivalent (FTE) RD. The mean ratio of full-time RDs to oncologists was 1 per 48.5 and ranged from 1 per 4 to 1 per 850.

“It's almost like somebody randomly assigned [RDs] to cancer centers, and it has nothing to do with how many patients are seen in that particular center,” Petersen said. “Some clinics only have .1 or .2 FTEs assigned, and that may be a larger cancer center where they have maybe 85 cancer oncology providers, which includes surgical, medical, and radiation oncology and trainees.”

Why would a clinic have a .1 FTE RD, which suggests someone may be working 4 hours a week? In this kind of situation, an RD may cover a variety of areas and only work in cancer care when they receive a referral, Petersen said.

“That is just vastly underserving veterans,” she said. “You're missing so many veterans whom you could help with preventative care if you're only getting patients referred based on consults.”

As for the findings regarding higher RD staffing and higher detection of malnutrition, the study text notes “there was not a ‘high enough’ level of RD staffing at which we stopped seeing this trend. This is probably because – at least at the time of this study – no VA cancer center was adequately staffed for nutrition.”

Petersen hopes the findings will convince VA cancer center leadership to boost better patient outcomes by prioritizing the hiring of RDs.

Katherine Petersen, MS, RDN, CSO has no disclosures.

The US Department of Veterans Affairs (VA) now has a permanent pharmacogenomics service that provides genetic tests to give clinicians insight into the best medication options for their patients.

The tests, which have no extra cost, are available to all veterans, said pharmacist Jill S. Bates, PharmD, MS, executive director of the VA National Pharmacogenomics Program, who spoke in an interview and a presentation at the annual meeting of the Association of VA Hematology/Oncology.

Genetic testing is “a tool that can help optimize care that we provide for veterans,” she said. “Pharmacogenomics is additional information to help the clinician make a decision. We know that most veterans—greater than 90%—carry a variant in a pharmacogenomics gene that is actionable.”

The genetic tests can provide insight into the optimal medication for multiple conditions such as mental illness, gastrointestinal disorders, cancer, pain, and heart disease. According to a 2019 analysis of over 6 years of data, more than half of the VA patient population used medications whose efficacy may have been affected by detectable genetic variants.

For instance, Bates said tests can let clinicians know whether patients are susceptible to statin-associated muscle adverse effects if they take simvastatin, the cholesterol medication. An estimated 25.6% of the VA population has this variant.

Elsewhere on the cardiac front, an estimated 58.3% of the VA population has a genetic variant that increases sensitivity to the blood thinner warfarin.

Testing could help psychiatrists determine whether certain medications should not be prescribed—or should be prescribed at lower doses—in patients who’ve had adverse reactions to antidepressants, Bates said.

In cancer, Bates said, genetic testing can identify patients who have a genetic variant that boosts toxicity from fluoropyrimidine chemotherapy treatments, which include capecitabine, floxuridine, and fluorouracil. Meanwhile, an estimated 0.9% will have no reaction or limited reaction to capecitabine and fluorouracil, and 4.8% will have hypersensitivity to carbamazepine and oxcarbazepine. 

Tests can also identify a genetic variant that can lead to poor metabolism of the chemotherapy drug irinotecan, which is used to treat colon cancer. “In those patients, you’d want to reduce the dose by 20%,” Bates said. In other cases, alternate drugs may be the best strategy to address genetic variations.

Prior to 2019, clinicians had to order pharmacogenomic tests outside of the VA system, according to Bates. That year, a donation from Sanford Health brought VA pharmacogenomics to 40 pilot sites. Since then, more than 88,000 tests have been performed.

The VA has now made its pharmacogenomic program permanent, Bates said. As of early September, testing was available at 139 VA sites and is coming soon to 4 more. It’s not available at another 23 sites that are scattered across the country.

A tool in the VA electronic health record now reminds clinicians about the availability of genetic testing and allows them to order tests. However, testing isn’t available for patients who have had liver transplants or certain bone marrow transplants.

The VA is working on developing decision-making tools to help clinicians determine when the tests are appropriate, Bates said. It typically takes 2 to 3 weeks to get results, she said, adding that external laboratories provide results. “We eventually would like to bring in all pharmacogenomics testing to be conducted within the VA enterprise.”

Bates reported that she had no disclosures.

The US Department of Veterans Affairs (VA) now has a permanent pharmacogenomics service that provides genetic tests to give clinicians insight into the best medication options for their patients.

The tests, which have no extra cost, are available to all veterans, said pharmacist Jill S. Bates, PharmD, MS, executive director of the VA National Pharmacogenomics Program, who spoke in an interview and a presentation at the annual meeting of the Association of VA Hematology/Oncology.

Genetic testing is “a tool that can help optimize care that we provide for veterans,” she said. “Pharmacogenomics is additional information to help the clinician make a decision. We know that most veterans—greater than 90%—carry a variant in a pharmacogenomics gene that is actionable.”

The genetic tests can provide insight into the optimal medication for multiple conditions such as mental illness, gastrointestinal disorders, cancer, pain, and heart disease. According to a 2019 analysis of over 6 years of data, more than half of the VA patient population used medications whose efficacy may have been affected by detectable genetic variants.

For instance, Bates said tests can let clinicians know whether patients are susceptible to statin-associated muscle adverse effects if they take simvastatin, the cholesterol medication. An estimated 25.6% of the VA population has this variant.

Elsewhere on the cardiac front, an estimated 58.3% of the VA population has a genetic variant that increases sensitivity to the blood thinner warfarin.

Testing could help psychiatrists determine whether certain medications should not be prescribed—or should be prescribed at lower doses—in patients who’ve had adverse reactions to antidepressants, Bates said.

In cancer, Bates said, genetic testing can identify patients who have a genetic variant that boosts toxicity from fluoropyrimidine chemotherapy treatments, which include capecitabine, floxuridine, and fluorouracil. Meanwhile, an estimated 0.9% will have no reaction or limited reaction to capecitabine and fluorouracil, and 4.8% will have hypersensitivity to carbamazepine and oxcarbazepine. 

Tests can also identify a genetic variant that can lead to poor metabolism of the chemotherapy drug irinotecan, which is used to treat colon cancer. “In those patients, you’d want to reduce the dose by 20%,” Bates said. In other cases, alternate drugs may be the best strategy to address genetic variations.

Prior to 2019, clinicians had to order pharmacogenomic tests outside of the VA system, according to Bates. That year, a donation from Sanford Health brought VA pharmacogenomics to 40 pilot sites. Since then, more than 88,000 tests have been performed.

The VA has now made its pharmacogenomic program permanent, Bates said. As of early September, testing was available at 139 VA sites and is coming soon to 4 more. It’s not available at another 23 sites that are scattered across the country.

A tool in the VA electronic health record now reminds clinicians about the availability of genetic testing and allows them to order tests. However, testing isn’t available for patients who have had liver transplants or certain bone marrow transplants.

The VA is working on developing decision-making tools to help clinicians determine when the tests are appropriate, Bates said. It typically takes 2 to 3 weeks to get results, she said, adding that external laboratories provide results. “We eventually would like to bring in all pharmacogenomics testing to be conducted within the VA enterprise.”

Bates reported that she had no disclosures.

The US Department of Veterans Affairs (VA) now has a permanent pharmacogenomics service that provides genetic tests to give clinicians insight into the best medication options for their patients.

The tests, which have no extra cost, are available to all veterans, said pharmacist Jill S. Bates, PharmD, MS, executive director of the VA National Pharmacogenomics Program, who spoke in an interview and a presentation at the annual meeting of the Association of VA Hematology/Oncology.

Genetic testing is “a tool that can help optimize care that we provide for veterans,” she said. “Pharmacogenomics is additional information to help the clinician make a decision. We know that most veterans—greater than 90%—carry a variant in a pharmacogenomics gene that is actionable.”

The genetic tests can provide insight into the optimal medication for multiple conditions such as mental illness, gastrointestinal disorders, cancer, pain, and heart disease. According to a 2019 analysis of over 6 years of data, more than half of the VA patient population used medications whose efficacy may have been affected by detectable genetic variants.

For instance, Bates said tests can let clinicians know whether patients are susceptible to statin-associated muscle adverse effects if they take simvastatin, the cholesterol medication. An estimated 25.6% of the VA population has this variant.

Elsewhere on the cardiac front, an estimated 58.3% of the VA population has a genetic variant that increases sensitivity to the blood thinner warfarin.

Testing could help psychiatrists determine whether certain medications should not be prescribed—or should be prescribed at lower doses—in patients who’ve had adverse reactions to antidepressants, Bates said.

In cancer, Bates said, genetic testing can identify patients who have a genetic variant that boosts toxicity from fluoropyrimidine chemotherapy treatments, which include capecitabine, floxuridine, and fluorouracil. Meanwhile, an estimated 0.9% will have no reaction or limited reaction to capecitabine and fluorouracil, and 4.8% will have hypersensitivity to carbamazepine and oxcarbazepine. 

Tests can also identify a genetic variant that can lead to poor metabolism of the chemotherapy drug irinotecan, which is used to treat colon cancer. “In those patients, you’d want to reduce the dose by 20%,” Bates said. In other cases, alternate drugs may be the best strategy to address genetic variations.

Prior to 2019, clinicians had to order pharmacogenomic tests outside of the VA system, according to Bates. That year, a donation from Sanford Health brought VA pharmacogenomics to 40 pilot sites. Since then, more than 88,000 tests have been performed.

The VA has now made its pharmacogenomic program permanent, Bates said. As of early September, testing was available at 139 VA sites and is coming soon to 4 more. It’s not available at another 23 sites that are scattered across the country.

A tool in the VA electronic health record now reminds clinicians about the availability of genetic testing and allows them to order tests. However, testing isn’t available for patients who have had liver transplants or certain bone marrow transplants.

The VA is working on developing decision-making tools to help clinicians determine when the tests are appropriate, Bates said. It typically takes 2 to 3 weeks to get results, she said, adding that external laboratories provide results. “We eventually would like to bring in all pharmacogenomics testing to be conducted within the VA enterprise.”

Bates reported that she had no disclosures.

Recognizing the increasing importance of digital pathology and its potential impact to transform federal health care, government, military, and university digital pathology specialists convened in May 2023 to share expertise to advance the use of digital pathology in federal health care. 

The seminar was hosted by the University of Pittsburgh and led by Ronald Poropatich, MD, Director of the Center for Military Medicine Research, Health Sciences, and Professor of Medicine at the University of Pittsburgh Medical Center, and Douglas Hartman, MD, Vice Chair of Pathology Informatics, Associate Director of the Center for AI Innovation in Medical Imaging, and Professor of Pathology at the University of Pittsburgh/University of Pittsburgh Medical Center (UPMC).

Invitees included senior federal government pathologists, laboratory scientists, IT leaders, and stakeholders from the VA, DoD, HHS (NIH, CDC, IHS, FDA) and other federal agencies. The speakers for the conference were CDR Roger Boodoo, MD, Chief of Innovation, Defense Health Agency; Ryan Collins, MD, Pathologist, Williamsport Pathology Association; Pat Flanders, Chief Information Officer, J6, Defense Health Agency; Matthew Hanna, MD, Director, Digital Pathology Informatics, Memorial Sloan Kettering Cancer Center; Stephanie Harmon, PhD, Staff Scientist, NIH NCI, Imaging/Data Scientist in Molecular Imaging; Douglas Hartman, MD, Vice Chair of Pathology Informatics, University of Pittsburgh; Stephen Hewitt, MD, PhD, Head, Experimental Pathology Laboratory, NIH NCI, Center for Cancer Research; Jason Hipp, MD, PhD, Chief Digital Innovation Officer, Mayo Collaborate Services,  Mayo Clinic; Brian Lein, MD, Assistant Director, Healthcare Administration, Defense Health Agency; Col Mark Lyman, MD, Pathology Consultant to the US Air Force Surgeon General; COL Joel Moncur, MD, Director, Joint Pathology Center; Ronald Poropatich, MD, Director of the Center for Military Medicine Research, Health Sciences; Professor of Medicine, University of Pittsburgh; David Shulkin, MD, Ninth U.S. Secretary of Veterans Affairs; Eliot Siegel, MD, Chief of Radiology and Nuclear Medicine, Veterans Affairs Maryland Healthcare System; Professor and Vice Chair, University of Maryland School of Medicine; CDR Jenny Smith, DO, Pathologist, US Naval Medical Center Portsmouth; Shandong Wu, PhD, Associate Professor, Departments of Radiology, Biomedical Informatics, and Bioengineering, Director of Center for Artificial Intelligence Innovation in Medical Imaging, University of Pittsburgh; LCDR Victoria Mahar MD, Pathologist, US Army. 

Throughout the 1.5-day meeting, topics such as the integration of systems, the value of single vendor solutions vs multiple vendors, and the interconnectedness of radiology and pathology in health care were discussed. The speakers addressed the challenges of adopting digital pathology, including workflow improvement, quality control, and the generalizability of algorithms. The importance of collaboration, leadership, data analytics, compliance with clinical practice guidelines, and research and development efforts were stressed. The increasingly important role of artificial intelligence (AI) in digital pathology, its applications, and its benefits were also highlighted. Continuing education credits were offered to participants. 

Overall, the meeting provided valuable insights into the advancements, challenges, and potential of digital pathology, AI, and technology integration in the federal health care ecosystem. However, this cannot be achieved without leadership from and close collaboration between key industry, academic, and government stakeholders.

Uses of Digital Pathology

Digital pathology refers to the practice of digitizing glass slides containing tissue samples and using digital imaging technology to analyze and interpret them. It involves capturing high-resolution images of microscopic slides and storing them in a digital format. These digitized images can be accessed and analyzed using computer-based tools and software.

While traditional pathology involves examining tissue samples under a microscope to make diagnoses and provide insights into diseases and conditions, digital pathology uses digital scanners that capture all relevant tissue on the glass slide at high magnification. This process generates a high-fidelity digital representation of the tissue sample that can be navigated akin to how glass slides are reviewed on a brightfield microscope in current practice (eg, panning, zooming, etc). Microscopic review of patient specimens in pathology allows for identifying patterns and markers that may not be easily detectable with manual examination alone. 

The digitized slides can be stored in a database or a slide management system, allowing pathologists and other healthcare professionals to access and review them remotely, thus creating the potential to improve collaboration among pathologists, facilitate second opinions, and enable easier access to archived slides for research purposes. 

Potential Benefits

Digital pathology also opens the door to advanced image analysis techniques, such as computer-aided diagnosis, machine learning, and AI algorithms, with the potential for the following outcomes and benefits:

• Improved accuracy AI algorithms can analyze large volumes of digital pathology data with great precision, reducing the chances of human error and subjective interpretation. This can lead to more accurate and consistent diagnoses, especially in challenging cases where subtle patterns or features may be difficult to detect.
• Automated detection and classification AI algorithms can be trained to detect and classify specific features or abnormalities in digital pathology images. For example, AI models can identify cancerous cells, tissue patterns associated with different diseases, or specific biomarkers. This can assist pathologists in diagnosing diseases more accurately and efficiently.
• Quantitative analysis AI can analyze large quantities of digital pathology data and extract quantitative measurements. For instance, it can calculate the percentage of tumor cells in a sample, assess the density of immune cells, or measure the extent of tissue damage. These objective measurements can aid in prognosis prediction and treatment planning.
• Image segmentation AI algorithms can segment digital pathology images into different regions or structures, such as nuclei, cytoplasm, or blood vessels. This segmentation allows for precise analysis and extraction of features for further study. It can also facilitate the identification of specific cell types or tissue components.
• Image enhancement AI techniques can enhance the quality of digital pathology images by improving clarity and reducing noise or artifacts. This can help pathologists visualize and interpret slides more effectively, especially in challenging cases with low-quality or complex images.
• Decision support systems AI-powered decision support systems can assist pathologists by providing recommendations or second opinions based on the analysis of digital pathology data. These systems can offer insights, suggest potential diagnoses, or provide relevant research references, augmenting the pathologist’s expertise and improving diagnostic accuracy.
• Collaboration and second opinions Digital pathology, combined with AI, facilitates remote access to digitized slides, enabling pathologists to seek second opinions or collaborate with experts from around the world. This can enhance the quality of diagnoses by leveraging the collective expertise of pathologists and fostering knowledge sharing.
• Education and training AI algorithms can be utilized in virtual microscopy platforms to create interactive and educational experiences. Pathology residents and students can learn from annotated cases, receive real-time feedback, and develop their skills in a digital environment.
• Research and discovery AI can assist in identifying patterns, correlations, and novel biomarkers in digital pathology data. By analyzing large datasets, AI algorithms can help uncover new insights, contribute to research advancements, and aid in the development of personalized medicine approaches.
• Predictive modeling AI can analyze vast amounts of digital pathology data, patient records, and outcomes to develop predictive models. These models can estimate disease progression, treatment response, or patient survival rates based on various factors. They can contribute to personalized medicine by assisting in treatment decisions and prognosis assessment.

It is important to note that while AI has shown promising results, it is not intended to replace human pathologists but to augment their capabilities. Overall, the combination of AI technology with the expertise of pathologists can lead to improved diagnosis, better patient care, and more efficient workflows in digital pathology.
 

Recognizing the increasing importance of digital pathology and its potential impact to transform federal health care, government, military, and university digital pathology specialists convened in May 2023 to share expertise to advance the use of digital pathology in federal health care. 

The seminar was hosted by the University of Pittsburgh and led by Ronald Poropatich, MD, Director of the Center for Military Medicine Research, Health Sciences, and Professor of Medicine at the University of Pittsburgh Medical Center, and Douglas Hartman, MD, Vice Chair of Pathology Informatics, Associate Director of the Center for AI Innovation in Medical Imaging, and Professor of Pathology at the University of Pittsburgh/University of Pittsburgh Medical Center (UPMC).

Invitees included senior federal government pathologists, laboratory scientists, IT leaders, and stakeholders from the VA, DoD, HHS (NIH, CDC, IHS, FDA) and other federal agencies. The speakers for the conference were CDR Roger Boodoo, MD, Chief of Innovation, Defense Health Agency; Ryan Collins, MD, Pathologist, Williamsport Pathology Association; Pat Flanders, Chief Information Officer, J6, Defense Health Agency; Matthew Hanna, MD, Director, Digital Pathology Informatics, Memorial Sloan Kettering Cancer Center; Stephanie Harmon, PhD, Staff Scientist, NIH NCI, Imaging/Data Scientist in Molecular Imaging; Douglas Hartman, MD, Vice Chair of Pathology Informatics, University of Pittsburgh; Stephen Hewitt, MD, PhD, Head, Experimental Pathology Laboratory, NIH NCI, Center for Cancer Research; Jason Hipp, MD, PhD, Chief Digital Innovation Officer, Mayo Collaborate Services,  Mayo Clinic; Brian Lein, MD, Assistant Director, Healthcare Administration, Defense Health Agency; Col Mark Lyman, MD, Pathology Consultant to the US Air Force Surgeon General; COL Joel Moncur, MD, Director, Joint Pathology Center; Ronald Poropatich, MD, Director of the Center for Military Medicine Research, Health Sciences; Professor of Medicine, University of Pittsburgh; David Shulkin, MD, Ninth U.S. Secretary of Veterans Affairs; Eliot Siegel, MD, Chief of Radiology and Nuclear Medicine, Veterans Affairs Maryland Healthcare System; Professor and Vice Chair, University of Maryland School of Medicine; CDR Jenny Smith, DO, Pathologist, US Naval Medical Center Portsmouth; Shandong Wu, PhD, Associate Professor, Departments of Radiology, Biomedical Informatics, and Bioengineering, Director of Center for Artificial Intelligence Innovation in Medical Imaging, University of Pittsburgh; LCDR Victoria Mahar MD, Pathologist, US Army. 

Throughout the 1.5-day meeting, topics such as the integration of systems, the value of single vendor solutions vs multiple vendors, and the interconnectedness of radiology and pathology in health care were discussed. The speakers addressed the challenges of adopting digital pathology, including workflow improvement, quality control, and the generalizability of algorithms. The importance of collaboration, leadership, data analytics, compliance with clinical practice guidelines, and research and development efforts were stressed. The increasingly important role of artificial intelligence (AI) in digital pathology, its applications, and its benefits were also highlighted. Continuing education credits were offered to participants. 

Overall, the meeting provided valuable insights into the advancements, challenges, and potential of digital pathology, AI, and technology integration in the federal health care ecosystem. However, this cannot be achieved without leadership from and close collaboration between key industry, academic, and government stakeholders.

Uses of Digital Pathology

Digital pathology refers to the practice of digitizing glass slides containing tissue samples and using digital imaging technology to analyze and interpret them. It involves capturing high-resolution images of microscopic slides and storing them in a digital format. These digitized images can be accessed and analyzed using computer-based tools and software.

While traditional pathology involves examining tissue samples under a microscope to make diagnoses and provide insights into diseases and conditions, digital pathology uses digital scanners that capture all relevant tissue on the glass slide at high magnification. This process generates a high-fidelity digital representation of the tissue sample that can be navigated akin to how glass slides are reviewed on a brightfield microscope in current practice (eg, panning, zooming, etc). Microscopic review of patient specimens in pathology allows for identifying patterns and markers that may not be easily detectable with manual examination alone. 

The digitized slides can be stored in a database or a slide management system, allowing pathologists and other healthcare professionals to access and review them remotely, thus creating the potential to improve collaboration among pathologists, facilitate second opinions, and enable easier access to archived slides for research purposes. 

Potential Benefits

Digital pathology also opens the door to advanced image analysis techniques, such as computer-aided diagnosis, machine learning, and AI algorithms, with the potential for the following outcomes and benefits:

• Improved accuracy AI algorithms can analyze large volumes of digital pathology data with great precision, reducing the chances of human error and subjective interpretation. This can lead to more accurate and consistent diagnoses, especially in challenging cases where subtle patterns or features may be difficult to detect.
• Automated detection and classification AI algorithms can be trained to detect and classify specific features or abnormalities in digital pathology images. For example, AI models can identify cancerous cells, tissue patterns associated with different diseases, or specific biomarkers. This can assist pathologists in diagnosing diseases more accurately and efficiently.
• Quantitative analysis AI can analyze large quantities of digital pathology data and extract quantitative measurements. For instance, it can calculate the percentage of tumor cells in a sample, assess the density of immune cells, or measure the extent of tissue damage. These objective measurements can aid in prognosis prediction and treatment planning.
• Image segmentation AI algorithms can segment digital pathology images into different regions or structures, such as nuclei, cytoplasm, or blood vessels. This segmentation allows for precise analysis and extraction of features for further study. It can also facilitate the identification of specific cell types or tissue components.
• Image enhancement AI techniques can enhance the quality of digital pathology images by improving clarity and reducing noise or artifacts. This can help pathologists visualize and interpret slides more effectively, especially in challenging cases with low-quality or complex images.
• Decision support systems AI-powered decision support systems can assist pathologists by providing recommendations or second opinions based on the analysis of digital pathology data. These systems can offer insights, suggest potential diagnoses, or provide relevant research references, augmenting the pathologist’s expertise and improving diagnostic accuracy.
• Collaboration and second opinions Digital pathology, combined with AI, facilitates remote access to digitized slides, enabling pathologists to seek second opinions or collaborate with experts from around the world. This can enhance the quality of diagnoses by leveraging the collective expertise of pathologists and fostering knowledge sharing.
• Education and training AI algorithms can be utilized in virtual microscopy platforms to create interactive and educational experiences. Pathology residents and students can learn from annotated cases, receive real-time feedback, and develop their skills in a digital environment.
• Research and discovery AI can assist in identifying patterns, correlations, and novel biomarkers in digital pathology data. By analyzing large datasets, AI algorithms can help uncover new insights, contribute to research advancements, and aid in the development of personalized medicine approaches.
• Predictive modeling AI can analyze vast amounts of digital pathology data, patient records, and outcomes to develop predictive models. These models can estimate disease progression, treatment response, or patient survival rates based on various factors. They can contribute to personalized medicine by assisting in treatment decisions and prognosis assessment.

It is important to note that while AI has shown promising results, it is not intended to replace human pathologists but to augment their capabilities. Overall, the combination of AI technology with the expertise of pathologists can lead to improved diagnosis, better patient care, and more efficient workflows in digital pathology.
 

Recognizing the increasing importance of digital pathology and its potential impact to transform federal health care, government, military, and university digital pathology specialists convened in May 2023 to share expertise to advance the use of digital pathology in federal health care. 

The seminar was hosted by the University of Pittsburgh and led by Ronald Poropatich, MD, Director of the Center for Military Medicine Research, Health Sciences, and Professor of Medicine at the University of Pittsburgh Medical Center, and Douglas Hartman, MD, Vice Chair of Pathology Informatics, Associate Director of the Center for AI Innovation in Medical Imaging, and Professor of Pathology at the University of Pittsburgh/University of Pittsburgh Medical Center (UPMC).

Invitees included senior federal government pathologists, laboratory scientists, IT leaders, and stakeholders from the VA, DoD, HHS (NIH, CDC, IHS, FDA) and other federal agencies. The speakers for the conference were CDR Roger Boodoo, MD, Chief of Innovation, Defense Health Agency; Ryan Collins, MD, Pathologist, Williamsport Pathology Association; Pat Flanders, Chief Information Officer, J6, Defense Health Agency; Matthew Hanna, MD, Director, Digital Pathology Informatics, Memorial Sloan Kettering Cancer Center; Stephanie Harmon, PhD, Staff Scientist, NIH NCI, Imaging/Data Scientist in Molecular Imaging; Douglas Hartman, MD, Vice Chair of Pathology Informatics, University of Pittsburgh; Stephen Hewitt, MD, PhD, Head, Experimental Pathology Laboratory, NIH NCI, Center for Cancer Research; Jason Hipp, MD, PhD, Chief Digital Innovation Officer, Mayo Collaborate Services,  Mayo Clinic; Brian Lein, MD, Assistant Director, Healthcare Administration, Defense Health Agency; Col Mark Lyman, MD, Pathology Consultant to the US Air Force Surgeon General; COL Joel Moncur, MD, Director, Joint Pathology Center; Ronald Poropatich, MD, Director of the Center for Military Medicine Research, Health Sciences; Professor of Medicine, University of Pittsburgh; David Shulkin, MD, Ninth U.S. Secretary of Veterans Affairs; Eliot Siegel, MD, Chief of Radiology and Nuclear Medicine, Veterans Affairs Maryland Healthcare System; Professor and Vice Chair, University of Maryland School of Medicine; CDR Jenny Smith, DO, Pathologist, US Naval Medical Center Portsmouth; Shandong Wu, PhD, Associate Professor, Departments of Radiology, Biomedical Informatics, and Bioengineering, Director of Center for Artificial Intelligence Innovation in Medical Imaging, University of Pittsburgh; LCDR Victoria Mahar MD, Pathologist, US Army. 

Throughout the 1.5-day meeting, topics such as the integration of systems, the value of single vendor solutions vs multiple vendors, and the interconnectedness of radiology and pathology in health care were discussed. The speakers addressed the challenges of adopting digital pathology, including workflow improvement, quality control, and the generalizability of algorithms. The importance of collaboration, leadership, data analytics, compliance with clinical practice guidelines, and research and development efforts were stressed. The increasingly important role of artificial intelligence (AI) in digital pathology, its applications, and its benefits were also highlighted. Continuing education credits were offered to participants. 

Overall, the meeting provided valuable insights into the advancements, challenges, and potential of digital pathology, AI, and technology integration in the federal health care ecosystem. However, this cannot be achieved without leadership from and close collaboration between key industry, academic, and government stakeholders.

Uses of Digital Pathology

Digital pathology refers to the practice of digitizing glass slides containing tissue samples and using digital imaging technology to analyze and interpret them. It involves capturing high-resolution images of microscopic slides and storing them in a digital format. These digitized images can be accessed and analyzed using computer-based tools and software.

While traditional pathology involves examining tissue samples under a microscope to make diagnoses and provide insights into diseases and conditions, digital pathology uses digital scanners that capture all relevant tissue on the glass slide at high magnification. This process generates a high-fidelity digital representation of the tissue sample that can be navigated akin to how glass slides are reviewed on a brightfield microscope in current practice (eg, panning, zooming, etc). Microscopic review of patient specimens in pathology allows for identifying patterns and markers that may not be easily detectable with manual examination alone. 

The digitized slides can be stored in a database or a slide management system, allowing pathologists and other healthcare professionals to access and review them remotely, thus creating the potential to improve collaboration among pathologists, facilitate second opinions, and enable easier access to archived slides for research purposes. 

Potential Benefits

Digital pathology also opens the door to advanced image analysis techniques, such as computer-aided diagnosis, machine learning, and AI algorithms, with the potential for the following outcomes and benefits:

• Improved accuracy AI algorithms can analyze large volumes of digital pathology data with great precision, reducing the chances of human error and subjective interpretation. This can lead to more accurate and consistent diagnoses, especially in challenging cases where subtle patterns or features may be difficult to detect.
• Automated detection and classification AI algorithms can be trained to detect and classify specific features or abnormalities in digital pathology images. For example, AI models can identify cancerous cells, tissue patterns associated with different diseases, or specific biomarkers. This can assist pathologists in diagnosing diseases more accurately and efficiently.
• Quantitative analysis AI can analyze large quantities of digital pathology data and extract quantitative measurements. For instance, it can calculate the percentage of tumor cells in a sample, assess the density of immune cells, or measure the extent of tissue damage. These objective measurements can aid in prognosis prediction and treatment planning.
• Image segmentation AI algorithms can segment digital pathology images into different regions or structures, such as nuclei, cytoplasm, or blood vessels. This segmentation allows for precise analysis and extraction of features for further study. It can also facilitate the identification of specific cell types or tissue components.
• Image enhancement AI techniques can enhance the quality of digital pathology images by improving clarity and reducing noise or artifacts. This can help pathologists visualize and interpret slides more effectively, especially in challenging cases with low-quality or complex images.
• Decision support systems AI-powered decision support systems can assist pathologists by providing recommendations or second opinions based on the analysis of digital pathology data. These systems can offer insights, suggest potential diagnoses, or provide relevant research references, augmenting the pathologist’s expertise and improving diagnostic accuracy.
• Collaboration and second opinions Digital pathology, combined with AI, facilitates remote access to digitized slides, enabling pathologists to seek second opinions or collaborate with experts from around the world. This can enhance the quality of diagnoses by leveraging the collective expertise of pathologists and fostering knowledge sharing.
• Education and training AI algorithms can be utilized in virtual microscopy platforms to create interactive and educational experiences. Pathology residents and students can learn from annotated cases, receive real-time feedback, and develop their skills in a digital environment.
• Research and discovery AI can assist in identifying patterns, correlations, and novel biomarkers in digital pathology data. By analyzing large datasets, AI algorithms can help uncover new insights, contribute to research advancements, and aid in the development of personalized medicine approaches.
• Predictive modeling AI can analyze vast amounts of digital pathology data, patient records, and outcomes to develop predictive models. These models can estimate disease progression, treatment response, or patient survival rates based on various factors. They can contribute to personalized medicine by assisting in treatment decisions and prognosis assessment.

It is important to note that while AI has shown promising results, it is not intended to replace human pathologists but to augment their capabilities. Overall, the combination of AI technology with the expertise of pathologists can lead to improved diagnosis, better patient care, and more efficient workflows in digital pathology.
 

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