My hospital is equipping itself with digital pathology equipment

“ My hospital is getting equipped with digital pathology!” Under this title, UniHA organized a conference on March 9, 2023, bringing together Professor Catherine Guettier, head of the Department of Anatomical and Cytological Pathology at Bicêtre Hospital (AP-HP), Dr. Delphine Loussouarn, pathologist at Nantes University Hospital, Mr. Alexandre Pavy, head of the application domain within the Information Systems Department at Poitiers University Hospital, and Nelsa Louro, from the Digital User Performance Unit at Anap, the agency that has published guides on this subject.

Digital pathology is a revolution for anatomical pathology. While this medical specialty had been patiently developed since the 18th century thanks to the microscope, today it is possible to digitize all glass slides produced and analyze them on a computer screen, with the increasing use of artificial intelligence. Digitizing slides facilitates their reading and increases processing capacity. It also becomes possible to consult them remotely, whether to obtain a second diagnosis or to strengthen territorial coverage. The Covid-19 crisis accelerated this need. Because while the number of anatomical pathology analyses is constantly increasing in France, the number of pathologists is decreasing, and they must become increasingly specialized within their discipline. Thus, in 2020, digitization in anatomical pathology was not widely deployed for routine diagnosis (with the exception of the university hospitals of Rennes and Kremlin-Bicêtre).

UniHA: Supporting Ambitious Projects, Like Those of eNovA-Path and AP-HP

This is why the UniHA group, the leading cooperative purchasing network for French public hospitals, has made it its mission to support ambitious regional projects, such as those of eNovA-Path and AP-HP, as well as individual hospitals undertaking their digitization projects independently. Several hospitals have entrusted UniHA with driving their digital transformation. A team of experts was assembled to define the specifications, analyze the technical and financial proposals, conduct product testing, interview the bidders, and select the final products. “This group was composed of pathologists, IT specialists in anatomical pathology, hospital engineers, senior healthcare managers, and procurement officers from the university hospitals of Nantes, Paris (AP-HP), and Poitiers. UniHA led this project with a comprehensive, multidisciplinary ecosystem approach. IT expertise was combined with that of the anatomical pathologist and biomedical engineer. Our clients will also have the option of being supported by internal UniHA consultants,” explains Pierre Tromas, UniHA procurement officer in charge of this contract.

The leaders of the eNovA-Path project – Professor Béatrice Vergier (Bordeaux University Hospital), Drs. Aurélie Charissoux (Limoges University Hospital) and Olivier Renaud (Poitiers University Hospital) – highlight the benefits of this transformation: “It’s a revolution, a bit heartbreaking for all pathologists who love their microscopes, but it finally allows us to share our diagnoses by showing them. This evolution has become inevitable to meet medical challenges, whether diagnostic, prognostic, theranostic, or even socio-economic and demographic.” Routine digitization of slides will allow pathologists to use artificial intelligence to screen cancers, facilitate time-consuming readings of immunohistochemical stains, and also to communicate more easily and quickly with colleagues and within the national networks now necessary for optimal management of complex pathologies, to conduct teaching and research, and thus discover new prognostic criteria or treatment response indicators.

“No doctor wants to go back!” “_**

Professor Catherine Guettier, head of the Anatomical and Cytological Pathology Department at Bicêtre Hospital (AP-HP), explains how her department transitioned to fully digital pathology for its routine work: “The multi-site Pathology Department at Bicêtre Hospital (AP-HP - Paris-Saclay University) began using digital pathology in 2013 for performing extemporaneous examinations at Paul Brousse Hospital (250 examinations per year) via telepathology. This allowed the department to optimize its medical time by bringing all pathologists together at the single Bicêtre site, which housed the unique technical platform._

In 2019, building on this experience and its use of digital slides for teaching since 2007, the department transitioned to fully digital pathology for its routine work (30,000 cases per year).” This transition, which took place over an 18-month period, has been extremely beneficial for the department, and no physician wants to go back: improved pre-analytical processes for better quality digital slides, a significant saving of medical time (~15%), particularly in slide retrieval, ease of reading, and workflow monitoring, improved ergonomics, comfortable reading with a comprehensive view of the slide, fast and reliable measurements, sharing of digital slides with clinicians during staff meetings, and faster requests for expert opinions.

Towards Predictive Artificial Intelligence

Through its Digital Health and Technology division, UniHA is extending this work on digitization by preparing a market dedicated to predictive artificial intelligence. This will demonstrate the convergence between purchasing channels with the aim of structuring purchasing policy, closely aligned with innovations observed in healthcare facilities and among major suppliers.

At the Department of Anatomical and Cytological Pathology at Bicêtre Hospital (AP-HP), Professor Catherine Guettier hopes to extend this approach: “The next step, which is currently underway, is the routine implementation of diagnostic aid algorithms to save medical time and achieve faster, more precise quantification of biomarkers in tumor pathology, as well as predictive algorithms, for example, for the risk of tumor recurrence, which provide additional information to that which the pathologist’s eye can provide.” “_

Head of the ACP department at Saint-Louis Hospital, APHP Nord, Paris Cité University, and President of the College of Pathology Teachers, Professor Philippe Bertheau, concurs: “In our APHP Nord hospitals, we are currently implementing 100% digital pathology, with production scheduled for early 2024. This in-depth reorganization of our activities will allow four university hospital ACP departments to work with the same virtual slide database, enabling multiple synergies. The wave of digitization and artificial intelligence in anatomical pathology is only just beginning. Beyond the hype, in the medium and long term, we must prioritize a gradual increase in capacity, assessed by learned societies and the entire discipline, while maintaining a critical perspective on these technologies through advanced training for pathologists.”_