How pathologists are rapidly changing decades of clinical practice: Impact in Greater Manchester
Improvements to clinical practice and work-life balance are being achieved at pace by early adopters of digital pathology at the Northern Care Alliance NHS Foundation Trust. Dr Luisa Motta and Dr Lynne Jamieson give the detail on the latest impact in a Greater Manchester wide programme.
Effective new digital multidisciplinary team meetings, better work-life balance, reduced stress, and less time spent on administration and preparation.
These are just some of the benefits of digital pathology being rapidly felt by early adopters in Greater Manchester.
The region has been a pioneer in modernising and integrating diagnostics.
The Greater Manchester Diagnostics Network signed a major agreement in 2020 with medical imaging company Sectra, to bring together diagnostic imaging at scale for a population of 3 million people.
The agreement later expanded to include digital pathology, opening the potential to modernise ways of working.
Pathologists at the Northern Care Alliance NHS Foundation Trust have been the latest in Greater Manchester to put this into practice.
Piles of glass slides on a desk is not the view that pathologists want to see when they start their day, says Dr Luisa Motta, consultant histopathologist at the trust, and joint clinical lead for the digital pathology programme in Greater Manchester.
“I would often receive several trays of slides that would not always be in the right order. It generates unnecessary stress and takes the joy out of work.”
In response to this and to rising national demand faced in pathology, Dr Motta and early adopters at the trust, are now benefiting from a different approach, that is reducing stresses, delays, and labour-intensive tasks associated with physical handling and transportation of glass slides.
Embracing new ways of working
Dr Lynne Jamieson, a dermapathologist for almost 20 years, has radically changed her practice in a matter of months, learning and adopting new ways of working with minimal disruption, and significant positive impact.
“I felt that if I want to make my working life more flexible, I need to get on board with digital,” Dr Jamieson says.
“I became comfortable with digital pathology within just two months of using the Sectra platform,” she says.
“It has been transformational – not only from the personal wellbeing and work-life balance perspective, but also from caseload management.
“And that’s coming from someone who was initially sceptical about going digital. Today, I’m still finding more, and more things that I like about it.”
Dr Jamieson believes this has significantly helped with workflow efficiency.
“My list of cases would have effectively been a desk full of glass slides, not very long ago. Now, new cases appear on my list digitally, in a more manageable way,” she says.
“There has been a huge transformation in how I manage my work.
“It’s about learning what the system can do for me. I’m better able to keep track of cases.
“The ability for myself and colleagues to add comments to studies means I know where each case is up to.
“And I’m more relaxed when reporting – I can come back to a complex case when I’m best prepared, without having to necessarily travel to a particular location. I have a lot of positive things to say.”
More efficient workflow has also been the highlight for Dr Motta: “I recently had 90 active cases on a particular day and managed to go through all of them smoothly – something that normally couldn’t be achieved with a microscope and physical glass slides.”
It’s not just about improving my desk workflow, but staff morale too, Dr Motta says: “Having to look through numerous piles of slides is not the best use of anybody’s time.
“If technology can provide us with better access and better records, that also means we can have a better job satisfaction.”
A new precedent in work-life balance
Access to images from home, without the need for slides packaged and transported, is already having an impact.
Dr Jamieson praises how this transformation has positively influenced her routine: “For the first time in my career, I’ve been able to work two days a week from home.
“I can choose to start early on those days, or work later, without the stress of driving into the office.”
This helps make pathology a more attractive environment to work in, she adds: “Residents and new consultants don’t want to work like I did when I was their age. T
“hey want a better work-life balance. This represents a huge shift in a very short time. The more flexibility you can offer, the more desirable your working environment becomes.”
Fostering collaboration and communication: Digital MDTs and more
New digital ways of working mean pathologists can collaborate with multidisciplinary teams more productively.
“Before, I would use my microscopes with a camera attached to project one image at a time in online meetings, which would often require looking at paper reports – a process too convoluted,” says Dr Motta.
Now, she is able to share multiple visual images on the screen at the same time, enabling multidisciplinary colleagues to understand the case efficiently.
Time is everything when it comes to diagnosing conditions like cancer, and this is where digital pathology brings a huge benefit: “Demonstrating findings on several slides including immunohistochemical stains, at the click of a button, helps come to a conclusion quickly, which is a very relevant feature in cancer diagnosis,” says Dr Motta.
Digitising slides has also streamlined preparation for multidisciplinary meetings, she explains: “If a slide cannot be retrieved on time, then the review of the case cannot happen.
“But with digital images, it takes minutes to organise these meetings. And if I was sick or on leave, my colleagues would still have access to slides.
“The burden for laboratory and office staff is also significantly reduced, as they don’t have to manually retrieve cases in preparation for the meeting, which would often take a whole afternoon.”
Dr Jamieson agrees: “Sharing images at MDT is important,” she says.
“Being able to do that in an efficient way is beneficial to patient care. If I can illustrate to a clinician why I have said something, they can then better explain a diagnosis to a patient.
“This is so much smoother now. I can easily share images instantly, zoom in and out, and engage with people rather than the microscope.”
Enhanced cross-team collaboration has been taken to the next level thanks to the live chat function, which enables Dr Motta and Dr Jamieson to annotate images to specific clinicians when discussing cases, and receive a second opinion from a specialist colleague almost immediately.
“I can click a link in the message to the case I’m working on and add a note to my colleagues to ask about their thoughts. I’m also able to send chat messages to the scanning room, which are quickly picked up by biomedical scientists,” says Dr Jamieson.
Setting the ground for the next generation of pathologists
Traditionally, pathologists and resident doctors would examine slides with microscopes together in the same room.
Now, Dr Motta can teach online, demonstrating cases and histological findings on the screen, an approach that has been positively received by residents.
“It is a very smooth process, which doesn’t require any additional actions from the lab, such as retrieving and refiling cases. It definitely opens up new ideas and appetite to work differently.”
Residents are enthusiastic about the opportunities that digital pathology can provide. “They want to learn how to use it because it’s going to be their future career,” says Dr Jamieson.
Sharing best practice in other environments has also become more efficient: “Taking pictures for presentations, publications, and education, has become so easy,” says Dr Jamieson.
“There is no need to retrieve slides from file, make sure it is in focus, that there is no dirt on the slide, freezing screens, and editing the picture.
“Now we just search for the case and save the relevant image.”
Digital transformation may also be attractive to pathologists approaching retirement, and provide the opportunity to continue to be part of the workforce at a time that suits them: “As this gives flexibility, colleagues can still contribute, for longer. I think my retiring colleagues will be enthusiastic to embrace it,” says Dr Jamieson.
All about people
As wider adoption begins to take place and cross-site collaboration becomes possible, a conversation on entirely new ways people can work is opening.
Dr Jamieson is eager to share learnings: “Once more people are on board with digital pathology, it would be beneficial to create surgeries where colleagues can share what they’ve learned,” says Dr Jamieson.
In the end, it’s all about people – building the next generation of pathologists who are both successful in their roles and satisfied in their careers, says Dr Motta.
“If we can use technology to help us work more efficiently and improve job satisfaction, I think we should embrace it and maximise its impact.”
