“Errors in pathology testing can cost patients their lives. The pathology slide is information that the patient cannot verify as their own. If the wrong slide is sent to a higher-level hospital, the diagnosis will be completely wrong, and the patient's treatment course will be greatly affected."

Dr. Jang Kee-taek, president of the Korean Society of Pathologists (KSP) and a professor of pathology at Samsung Medical Center, made this statement, highlighting the potential errors that can occur in the pathology slide delivery process and emphasizing that digitizing it is the most effective way to ensure patient safety.

In practice, the patient must carry pathology slides, and there are risks associated with this process, such as the potential for someone else's slides to be handed over.

It is not a clerical error but a diagnostic error, which can lead to serious medical errors, including changes in surgical plans, unnecessary surgery, or delayed surgery.

Manual pathology examination has limitations, requiring digital transformation

The Korean Society of Pathologists emphasizes the adoption of a digital pathology system to solve the problem of errors and diagnostic delays that can occur during the pathology specimen referral process. “By switching from scanned slides to digital files that can be transferred between hospitals, we can save time and money and eliminate errors that occur during physical transportation,” Jang said.

Pathology diagnosis is manual, mainly, with a low rate of automation in the examination process. Pathology slides, in particular, undergo numerous steps, from receiving to paraffin blocking, slide sectioning, staining, pathologist reading, and report writing. Any error in any of these steps can skew the entire diagnosis.

The accuracy of pathology tests directly affects critical medical decisions, including the diagnosis of cancer. Therefore, systematizing the testing process and digitizing the information is not just a matter of efficiency, but a matter of patient safety, according to Jang.

Requiring patients to transport slides shifts the burden onto them

Thousands of pathology slides are shipped to hospitals across the country every month. The Department of Pathology at Samsung Medical Center alone receives about 2,000 external slides every month, mostly from patients who have been referred for cancer diagnosis and surgery.

During this transfer process, patients or their guardians have to pick up and carry the slides themselves, which is time-consuming, costly, and administratively burdensome. With a digital pathology system in place, this physical burden can be reduced, and patient safety can be enhanced. Patients, especially those in rural areas who must travel long distances, often have to stay in the hospital for more than a day or visit multiple hospitals to have a single slide delivered.

This inefficiency not only creates a time and financial burden for patients and their caregivers but also carries the risk of unexpected incidents, such as damaged slides. Digital transformation is a fundamental approach to addressing these issues at the system level.

Digital system lacks insurance coverage, making adoption a ‘distant reality’

The problem is the cost of building and operating a digital pathology system. The initial investment in slide scanners, storage servers, and dedicated PACS (picture archiving and communication system) infrastructure can run into hundreds of millions of won, which is currently not reflected in health insurance reimbursement.

"Digital pathology is not just a matter of technology but of institutional support. In Japan, the government fostered the development of pathology scanner technology and distributed them to hospitals nationwide. However, we are still stuck in a rut," Jang said.

Pointing out this reality, Jang emphasized that it is challenging to spread digital pathology nationwide without the government’s policy support. This is because a digital pathology system is not just a matter of installing equipment but requires a complex infrastructure that includes long-term operation, maintenance, and education systems.

Safety mechanisms of KSP are also shaky due to the contract inspection structure

Jang also explained that digital pathology systems are not just automation but a key means of reducing the diagnostic burden on pathologists and increasing their efficiency. Approximately 30 pathologists graduate each year, but by 2024, the number of new graduates is expected to decrease significantly due to the government-doctor conflict. On the other hand, the demand for pathology specimens continues to increase due to population aging and the promotion of health screenings.

“Under these circumstances, the number of tests that a single pathologist has to handle is bound to increase, increasing the likelihood of diagnostic errors. This is not just fatigue accumulation but a serious threat to patient safety,” Jang pointed out.

The KSP aims to protect patient safety by setting a cap on the relative value units (RVUs) of pathologists' workloads, in addition to managing degrees to limit overworked diagnosticians. However, field clinicians say that these systems are difficult to function in the context of a contracted testing structure and intensifying unit price competition.

Broad effects of pathology digital transformation from sharing to archiving

Radiology departments digitize image data through PACS (Picture Archiving and Communication System), thereby ending the era of patients carrying films from one hospital to another. With the ability to deliver test results via USB or CD and more efficient coordination between hospitals, the accessibility and utilization of imaging tests have improved dramatically.

However, pathology still relies on glass slides. It requires patients or their caregivers to transport the slides needed for diagnosis from one hospital to another. This process is more than just cumbersome; it also carries the risk of errors, including damaged slides or miscommunication.

“Digitizing slides reduces these risks and allows for faster information sharing between hospitals, improving the efficiency and accuracy of diagnosis,” Jang said.

Especially in the diagnosis of cancer, where complex treatment plans must be developed, it is essential to compare slides with historical data or to collaborate with pathology departments at other hospitals. With a digital pathology system, this can be done in real time, ensuring continuity of care for patients, he noted.

"Digital slides are scanned as high-resolution images that can be viewed directly through a PACS-like system, compared to historical material, or reviewed by multiple providers simultaneously. It's all just a few clicks away," Jang explained.

The system also helps reduce the diagnostic burden on pathologists. When slides are accessible in real-time, repeat diagnoses and re-reads are much easier and can go some way toward alleviating the pathology labor shortage.

Storage efficiency is also a big advantage of digital pathology. Currently, pathology slides must be physically stored for more than five years, and some large hospitals have tens of thousands of slides stacked in underground warehouses.

“If you want to find a specific slide, you have to go to the warehouse and manually search for it, but if it's digitized, it's instantly searchable and viewable, and space is no longer an issue,” Jang said.

Just as radiology has transformed the entire healthcare system through digital transformation, pathology needs to follow suit. It's no longer a matter of convenience, but a necessity to improve patient safety and quality of care, he noted.

Making the ‘patient-centered’ system is key to change

The KSP has consistently proposed to the government and related organizations the need for the introduction of digital pathology systems and the recognition of health insurance reimbursement.

It is difficult to convince policymakers by simply arguing that hospitals will be more convenient or that costs will be reduced,” Jang said. “We must show how digital pathology can benefit patients.”

“When the PACS was introduced to radiology, we won public consensus by emphasizing the inefficiencies and burdens of patients carrying film. Pathology needs to be approached in a similar vein -- not simply by making the system more advanced or more convenient for medical workers but by demonstrating the benefits in terms of patient safety, time, and money.”

To this end, the KSP is strengthening the activities of its Digital Pathology Research Society and recently partnered with the industry to create the Digital Pathology Industry Association. The association is a public-private partnership that brings together pathologists, industry representatives, and healthcare policy experts to discuss policy proposals, technical standards, and reimbursement system improvements aimed at promoting digital pathology.

“It is time to recognize that digital pathology is not a problem of a specific hospital or society, but of the entire medical community and patients as a whole,” Jang said. “The three pillars of policy, awareness, and system must work together to ensure that advances in medical technology lead to direct benefits for patients.”

The KSP is conducting a study to demonstrate the cost-effectiveness of digital pathology adoption by quantifying various metrics, including patient transportation costs, appointment waiting times, and staff time spent on slide transfers. These data will provide substantial evidence for future policy decisions. They will be used to convince external stakeholders such as civil society organizations and parliament.

Transformation for patient safety can no longer be delayed

Jang emphasized that the digital pathology system is not just a change in the pathology department, but can also be an opportunity to transform the structure and philosophy of healthcare as a whole.

In terms of diagnostic efficiency at the point of care, a sustainable working environment for medical staff, and integrated management of patient information, digital pathology can be a means of mid- to long-term innovation.

“A slide is not just a specimen but a clue for decision-making that directly affects a patient's life, and it is our responsibility to create a system that can handle that clue more safely, quickly, and without error," he said.

Through the Digital Pathology Research Society and the Digital Pathology Industry Association, the Korean Society of Pathology will continue its efforts to drive change in the medical field and lay the foundation for digital transformation. The digitization of slides is not just a matter of technological advancement, but a trend of the times and a new standard that will determine the credibility of medical institutions, according to Jang.

"Digital pathology is no longer an option but a necessity. We are at a turning point to protect the lives and safety of patients," he emphasized.