Overcoming Challenges in Digital Pathology: Why Do On-premises-first Hybrid Workflows Matter?

Apr 5, 2023 | Elena Doynova



Digital pathology can offer transformative benefits to medical facilities that adopt digitalization for diagnostics and treatment, allowing them to benefit from faster, more accurate, and more cost-effective results. However, outdated equipment and processes can limit their infrastructure’s ability to support technological advancements. Therefore, future-proofing their data infrastructure by introducing the cloud as part of their storage strategy is essential for medical institutions to fully leverage the potential of digital pathology and other storage-heavy systems in the coming years.

In this article, we will explore the challenges that medical facilities face in keeping their IT infrastructure up to date, and why efforts to make it more robust are critical to the success of digital pathology in particular. We will also discuss key considerations for this process and how hybrid cloud and AI can play a role in the transformation.


What is Digital Pathology?

1Digital pathology is a dynamic, image-based environment that enables the acquisition, management and interpretation of pathology information generated from a digitized glass slide.

Digital pathology is rapidly evolving to become an indispensable part of modern medicine, as it has applications in a wide variety of activities spanning from diagnostics to education and research. It allows experts to collaborate remotely without having to risk the integrity of glass slides in travel. It can also be an important step to providing adequate healthcare in areas where there are few pathologists available, mainly in developing countries.

The advantages of digital pathology are numerous from the perspective of patients, clinicians, and researchers. It allows for the use of telepathology (the transfer of digital pathology images between various locations without the need to ship and store the actual glass slides) which then facilitates the diagnostic process, getting second opinion, and collaborative work between experts. It also allows for a single glass slide to be used by pathology students all over the world in their classes.

Ultimately, digital pathology and telepathology can shorten the time between biopsy, diagnosis and treatment. This is important on a personal level for millions of patients across the globe and their healthcare providers, especially in lower-income countries that already suffer from healthcare deficiencies. On a larger scale, it is also important to students and researchers who struggle with acquiring datasets for their studies.

Unfortunately, digital pathology and telepathology have a lot of obstacles to overcome before they become standardized procedures.


Current Digital Pathology Infrastructure Challenges

The challenges in front of the global adoption of digital pathology span from the lack of standardized infrastructure to facilitate its deployment to the lack of standardized digital imaging procedures. It is important to note that for digital pathology to fulfill its potential, it will need to rely on robust standards of interoperability so that clinicians, researchers, and students can rest assured of the quality of the digital images they receive.

Local storage cannot match data growth

Unlike x-rays, CT scans, and other types of medical imaging that might be needed in digital formats, biopsy slides for just one patient can take up a lot of storage space – sometimes several gigabytes per patient. Petabytes of data can be generated by a single facility each year only by digital pathology. Once the images have been used, they are not likely to be needed again but must be retained for regulatory purposes. To put this into perspective, the annual global data generation in pathology, based on the US pathologist workforce, the number of slides viewed daily, and the US share of global cancer incidence, could reach as many as 10,000 petabytes. This means that a new approach to data transfer and storage must come into play in order to accommodate the exponential increase in storage demand over the years representing a huge obstacle on the road to digital pathology.

Current on-premises solutions in many medical facilities are already under strain which may lead to operational issues and security issues, while scaling into the cloud poses its own set of challenges. Cost is one of the main stoppers when choosing a cloud-first approach, as IT expenses can soar quickly. Although a legitimate concern, IT expenses this can be avoided easily with a technological approach that takes into consideration the needs of digital pathology by providing flexibility in the form of access to archive cloud tiers and no vendor locking of data.

Тhe annual global data generation in pathology, based on the US pathologist workforce, the number of slides viewed daily, and the US share of global cancer incidence, could reach as many as 10,000 petabytes. This represents a huge obstacle on the road to digital pathology.


Lack of standardized digital imaging processes

Routine clinical work requires a specific process for acquiring standardized digital images. This warrants that no deviations in the image will hinder clinical work. Tests have shown that when different pathologists were tasked to produce a digital image of the same region of a glass slide, using the same setup, they produced dissimilar results. This means that we are still a long way from getting rapid and stable imaging procedures.

Stable network requirements

Due to the large size of the images used in telepathology, stable connection is a must. Unfortunately, countries that will benefit the most from digital pathology are less likely to be able to provide the high speed and stability needed for the transfer of data in real time.

Compliance with local guidelines

Different countries have different codes when it comes to the storage and sharing of sensitive medical data. This may put another level of strain on medical facilities already burdened with high on-premises storage costs. Some facilities may find it more difficult to scale up into the cloud as an alternative due to regulations surrounding regional data storage.

Advances in technology are already being deployed to tackle some of these challenges. Let’s take a look at some of them.

For digital pathology to fulfill its potential, it will need to rely on robust standards of interoperability so that clinicians, researchers, and students can rest assured of the quality of the digital images they receive.


Future-proofing Infrastructure to Accommodate Digital Pathology Workflows

By future-proofing storage and network infrastructures, scalability and flexibility can be enabled, allowing medical institutions to adapt and grow as the needs of the organization and patients change. Futureproofing can also provide long-term cost savings, as it eliminates the need for constant upgrades and replacements. Medical institutions will be thus able to focus on utilizing the latest technology and capabilities of digital pathology systems (and other demanding new systems as they arise), without worrying about infrastructure limitations. Ultimately, investing in a future-proof IT infrastructure is critical to the success of digital pathology, and can enable medical institutions to realize the full potential of this transformative technology.

In the context of our discussion, future-proofing infrastructure in digital pathology comprises several action items:

  1. Creating a consistent scanning procedure
  2. Creating a long-term data storage strategy
  3. Providing fast connectivity for sharing
  4. Ensuring local compliance requirements are met

The first one is dependent on a larger discussion among experts, but the rest are subject to technical considerations that can be resolved with the help of modern solutions. Together, these action items will enable scalability, flexibility, and long-term cost savings for medical organizations. Here’s how on-prem-first hybrid cloud solutions come into the picture.

By future-proofing storage and network infrastructures, scalability and flexibility can be enabled, allowing medical institutions to adapt and grow as the needs of the organization and patients change.


On-premises-first Hybrid Cloud Workflows for Digital Pathology

An on-premises-first (OPF) hybrid cloud approach can help medical institutions solve several of the challenges they face in adopting digital pathology systems and other systems that require a substantial increase of IT resources. The OPF hybrid model is an infrastructure approach that prioritizes continuity of on-premises workflows and treats the cloud as an enhancer that can be removed without disruption, rather than a primary enabler of digital transformation.

  • Scalability

Complex storage calculations often yield results that are far from perfect – from short-term thinking due to the sheer cost of spending to underutilizing resources in the long run. Optimizing what is currently available on-premises and extending into the cloud as storage demand spikes or for specific archive uses allows medical institutions to grow as their needs grow.

In the case of digital pathology, this translates to keeping digitalized biopsy slides in use on-premises and extending into the cloud for archival purposes using lower-cost archive cloud storage tiers. If a specific slide is needed, it can be quickly rehydrated and brought down on premises or shared with fellow pathologists, researchers, or students.

  • Interoperability

Another consideration when adopting the on-prem-first hybrid cloud approach is that it can provide and keep interoperability. When extending to the cloud, vendor lock-in might prove detrimental to processes that involve the need to share data between departments and locations. To avoid that, pathologists will need to agree upon a method for the digitalization, storage and archival of images in specific formats. Then, medical facilities will need to ensure that their files do not end up locked by proprietary formats when migrated to the cloud. On-premises-first hybrid workflows can help keep data in its native DICOM format.

  • Security

Keeping vast amounts of data secure and compliant is a gargantuan task, as every system administrator at a medical facility will confirm. Outdated equipment and software, as well as human errors, pose vulnerabilities for on-premises setups. Medical institutions are not immune to ransomware attacks and the effects can be devastating – resulting not only in disrupted patient care but also the inability to restore vital information. For this purpose, a long-term hybrid strategy may offer a higher level of security. On the other hand, the expansion in data center operations now offers medical facilities the opportunity to keep data backed up within the necessary geographical region and compliant with the country’s policies.

  • Enabling AI and Machine Learning

Finally, expanding digital pathology archives can be used for research purposes, creating a new roadmap in the development of the discipline. AI and Machine Learning can provide meaningful insights for current and future research, especially if developing countries are included in data sets, as they contain a currently unexplored pool of cases due to the lack of specialists in the area. Another area where AI can help transform the field is the prediction and identification of diseases based on predictive models. On-premises-first solutions enable the processing of patient data in the cloud with easy retrieval for use in on-prem applications, offering clinicians decision support and alerting them to potential risks and outcomes.


How can Tiger Technology help?

As pioneers of the on-prem-first hybrid cloud solutions, Tiger Technology offers digital healthcare professionals and medical facility system administrators the opportunity to solve most of the described storage problems. Its flagship product, Tiger Bridge, allows for the seamless extension of existing on-prem medical workflows to the cloud with no vendor lock-in and no disruption to workflows or the patient journey. Optimizing local storage translates to increased productivity and reduced maintenance costs. Utilizing archive cloud storage tiers can long-term storage spending and allow medical facilities to seamlessly rehydrate and share digitalized slides whenever needed. All of this is done with the help of an application that feels native to users and utilizes automated policies to move infrequently accessed slides to the cloud when they are no longer needed.


In Conclusion

Digital pathology can revolutionize modern medicine by enabling faster, more accurate, and cost-effective diagnostics and treatment. However, this technology’s success relies on keeping the infrastructure that supports it up-to-date, safe, and at a reasonable cost. Future-proofing data infrastructure is essential to ensure the continued success of digital pathology as data requirements will increase exponentially with the development of the field. To this end, it is important to create a consistent scanning procedure, develop a long-term data storage policy, provide fast connectivity for sharing, and ensure local policies are met.

On-prem-first hybrid cloud workflows can play a critical role in overcoming these challenges and helping medical institutions take full advantage of digital pathology’s potential. If you are interested in learning more about how Tiger Technology enables future-proof hybrid cloud for healthcare, please visit this page.

1Digital Pathology Association: https://digitalpathologyassociation.org/about-digital-pathology