Webinars
Utilizing Digital Pathology to Help Offset Today’s Laboratory Challenges
TRANSCRIPT
Michael Kalinowski: Thank you for joining today's webinar. We appreciate you being here and we're also really excited about this topic because our goal with these webinars is to pick and talk about subjects that really interest laboratorians across the country, and this one certainly checks that box.
Utilizing digital pathology to help offset today's laboratory challenges. Suren Avunjian, CEO of LigoLab will be one of the hosts, along with Westley Bernhardt, Managing Partner of OnePath Diagnostics.
Here is what we're planning to cover today.
- The importance of this collaboration between laboratory information systems and digital pathology solutions
- The reasons behind OnePath's decision to move forward with this integration
- How OnePath is using enhanced automation and AI to help with the workflow.
We also have Dr. Sheva Khalafbeigi with us. She will be doing a demonstration of a case sign-out a little bit later on, and we'll have a quick discussion about where we're headed as far as lab innovation. Then we'll also close things out with a question and answer session, so if you have questions, please just leave them during the presentation.
With that, I'll turn it over to Suren, who will take it from here.
Suren Avunjian: Thank you so much Michael and our panelists and everyone who's joining us today. Let's explore the cutting-edge integration of LigoLab and Lumea and the partnership we've built with OnePath Diagnostics.
This has been a significant leap forward in the realm of digital pathology, so let’s start by reviewing the evolution of the revolution of digital pathology from microscopes to digital platforms. The journey is remarkable. It was not easy, smooth, or quick.
It did happen rather quickly with COVID serving as one of the catalysts and a lot of us having to work remotely, and then of course the easement of and advancements of regulatory changes really drove the adoption. Four years ago, around this time, one out of 20 laboratories that came to LigoLab would even bring up the topic of digital pathology.
This was true for the 14 years that we had been involved in digital pathology before that. Today, 19 out of 20 labs that come to us ask us about digital pathology. Not only to ask us about it but also to learn more about the best practices and recommendations of hardware and laboratory software vendors that we work with.
It's been a big change. We've lived through many different waves of digital pathology, and 14 years ago, we built the very first LIS system for digital pathology integration with a little company that was known as BioImagene.
This company four years later was acquired by Ventana and now Roche for over a hundred million dollars. We were the first LIS company to integrate with them. We saw the potential of digital pathology but back then, the industry was just grappling with other significant challenges.
The cost of whole slide imagers was quite expensive. There was a lack of standardization and tools and of course, it added an extra step in the anatomic pathology lab workflow. Who wants to spend money and add extra steps? There were also concerns over image quality and fidelity, and the cost of storing these images was also a factor. There was also a lot of resistance from traditionalists.
People were skeptical about the reliability and effectiveness of digital methods compared to conventional microscopy. So a lot has changed in these 10, 14 years.
Now with imaging technology significantly improving and cloud storage and hosting costs dropping, it’s making things a bit more affordable, and now with AI tools potentially cutting turnaround times, this has become a tool to enhance laboratory operations. Of course, the regulatory approvals are also boosting the current adoption.
With AI and digital pathology together, they can stand at the forefront of laboratory technologies and what pathology groups are capable of doing. AI and machine learning are the latest buzz, right? We're hearing about it all day, every day, more and more, and we're even seeing some practical applications of it.
We can see that algorithms are analyzing images for patterns and better abnormality diagnostic markers with speed and accuracy that surpass human capabilities, so this has become a good supplementary tool for pathologists to improve their diagnostic process, helping pathologists identify classified diseases more quickly and accurately.
With this revolution of data interpretation, improving diagnostic speed and accuracy has become a reality. That impacts and improves patient care and it helps curtail the shortage of staff and pathologists, streamlines the overall process, and allows for remote participation and collaboration.
There's a lot of future potential here for continuous evolution into all aspects of the pathology lab workflow. This automation and digitalization transformation is the founding vision of why LigoLab was founded about 17 years ago, our vision was pretty clear to revolutionize the world of informatics, especially the laboratory.
This is our domain with a pioneering platform and service to embody the utmost flexibility and interoperability. This has been true since day one and it’s a core value of ours. Our mission is to help laboratories modernize with digital transformation so that they can scale and thrive faster.
We set out to create not just the solution but a transformational platform to seamlessly integrate all kinds of tools, products, and existing workflows, and help evolve the field. We do this by uniquely meeting all of the users and any organizational needs and modeling this in our system as closely as possible.
We view digital pathology and AI tools as innovative and disruptive technology, but not products. They are the tools and technologies that need to be seamlessly built into the lab workflow with informatics platforms to truly be full products that become usable. Nobody wants to log into multiple places and copy-paste things.
You want seamless integration, and this again is our ethos, right? We believe rigid laboratory information systems (LIS software) limit the efficiency of organizations and users. We want to empower users with a laboratory information system (LIS) platform that evolves with them as well. So not just made for yesterday and today, but for the future.
The LigoLab platform is designed to break down these barriers, the artificial barriers of growth and barriers of inefficiencies, facilitating streamlined communication and data exchange. This improves overall the industry, and the organization, and also significantly enhances patient care by ensuring that critical information is available and where it is needed the most.
Now into our 17th year, we're serving 250-plus laboratories nationwide spanning pathology, clinical, and molecular diagnostics, empowering them with growth and maximizing automation for them to gain the competitive advantage they need in the marketplace today.
Ethos of partnership and growth through overcoming challenges leads us to the remarkable story of our collaboration with OnePath, also known as OPDX.
So next, let’s introduce Wesley Bernhardt. We started our partnership less than a year ago. Wes is the driving force and a visionary behind OPDX. We’re excited to meet and work with folks like Wes because they help push our boundaries.
When Wes came to us, initially, I was quite hesitant with his vision and the level of depth of the integration that he wanted to make. So my first reaction, to be honest, was to push back, but he kept pushing forward with his vision.
That initial reaction turned into the collaborative effort that we see today. Kudos to Wes for his unwavering determination and the clarity of his purpose, right? That propelled us today to have this transformative endeavor, and a pivotal aspect of this collaboration was our integration and partnership with Lumea.
Both viewing and resulting capabilities have been truly embedded in the LigoLab platform. This is a one-of-a-kind integration so far and I hope this scales through to a lot more LIS systems (LIS meaning medical), not just LigoLab, but other lab information systems (LIS medical) so that we can help the overall industry work seamlessly, and have more of this open interoperability between digital pathology companies and laboratory information system vendors.
So with that, I’ll pass it off for Wes to tell us a little bit more about this integration and share his journey.
Westley Bernhardt: Thanks, Suren. I appreciate it. And that was a very nice way to say I've been a royal pain in the butt.
I get it. I know a lot of people have said that before, but thank you so much. Your vision and your partnership are what helped us to get this to happen. I appreciate your support. It was finding great partners. That was really what we needed to make all this happen in a time when we see shortages in pathologists and shortages in histotechs.
The labs are really crunched. You've got an inflationary period where costs have gone up. But remember our reimbursements haven’t. We're still challenged by that same dollar that we have that we're going to make. Medicare is not going to pay us more.
Every year we see adjustments, sometimes in our favor, sometimes not. But typically, the numbers relatively stay the same. And we have to fight and work to keep our costs down as best we can and adjust to the times. That's what we looked at OPDX when we started this process, how do we solve the problem of a shortage of pathologists?
How do we do better as a company to deliver the best subspecialist pathologists to everyone that needs them, to the patient, to that diagnosis, so that treatment can happen quicker and better with more reliability? To do that, we saw the future with digital pathology. I was fortunate enough some 20 years ago to be part of the digital transformation in radiology.
You knew when they were able to scan at the right speed, get the cost of storage down, and be able to deliver something that could replace the microscope speed-wise and quality-wise that yes, it was going to move forward because of all the benefits of having a digitized slide.
We knew once we saw that it had reached that point, that we were here for this paradigm shift in what was going to happen in pathology. From there, we had to find the right partners.
Number one, you've got to have the ability for your doctors to read quickly. We do a lot of dermatopathology, and we do a lot of GI. These doctors read high capacity and they've got to be able to move as quickly as they do on a microscope. We were very fortunate to find a partner like Lumea. They have a quality digital pathology software system. The images are fantastic.
They're just like LigoLab. They have a great team that can help to customize and automate. I think that's what's important. This field is going to be changing so fast over the next few years. It's not just about what you have now and what you buy, but what are you going to change as things continue to develop?
With partners like LigoLab and Lumea, we've been able to meet those needs and develop a system that has been quite special for our team. Bringing that together, it's challenging because everybody is used to how they've done things in the past, and how we do things now is different.
It was crucial to number one, replace that scope, and also to have our doctors work specifically and only inside of the Lumea system (the digital software). We wanted to have a lab workflow where they go in, view their slides, diagnose their case, order recut specials, and do everything else they need to.
They can see the requisition, they can see the gross, they can see the slide labels and to make it simple for them, load their macros. That took some work, but it took work on both sides. It was that integration that was crucial because we wanted to automate ICD-10 and CPT codes as much as we could so that they could work from home because again, we're dealing with a specific and finite reimbursement.
We needed to create a better quality of life so that we could still work within the confines of what we have and what we can pay our physicians to be able to still make a profit and deliver great care. So that's what we did. We brought Lumea together with LigoLab.
Everybody had differences and opinions on where we wanted to go, but eventually, it was, hey, the doctors work in Lumea and the staff works in a high throughput, and really good LIS system that allows us to automate a lot of what we do and really manage it along with interfacing and customization.
The beauty of the LigoLab system is that we can do anything on our own. We can build our interfaces. We can take advantage of the Mirth interface engine and manage those interfaces and more importantly, manage those costs. This goes back to the whole process and we're able to do that. I think that's really important. So we built that out.
We've been able to customize our pathology lab management and continue to customize it on a daily, weekly, and monthly basis. It's been fantastic, and it's all about the partnership.
It's all about finding the right people with vision and people who are flexible and can help us to continue to grow and change with what we see coming because it's going to be a crazy time over the next few years. There are going to be more LIS software vendors and more digital pathology solutions. It's going to get quicker. Storage is going to get cheaper.
Everything is going to change. Just like when cameras went to phones and technology went haywire so quickly. It's going to be similar in that respect. So everyone's going to have to pay attention to the process. I just stress to people out there, to make sure that when you work with your laboratory software vendors, you're working to get what you want, not what they want.
I think what's great about LigoLab as an LIS company is they listened to what we had to say and helped us to build what we wanted and integrate that. What we did and what this diagram shows is we built it out so that LigoLab is the face of what we do. That is our laboratory information system software (what is LIS in healthcare). So everything starts in LigoLab.
We have most of our orders come in through HL7, and we build our HL7s through the Mirth interface engine. Our team does that, so that saves us money and helps us get those projects done more quickly. Orders come in, and if it's not an HL7, then it's a manually accessioned order.
We've also used AI in some circumstances to accession. We built an AI bot that can accession the cases when they come in on a computer-generated requisition. So you've got manual accessioning by personnel as well as AI accessioning if they're manual orders, then you've got HL7 orders coming in, too. Once they come in, the gross is done and it's completed inside the LigoLab system (LIS medical).
It then goes through your typical histology processes. It's going to be processed, embedded, it's going to go to microtome, H& E staining, and then from staining, it's going right into the rack. You pull it out, it dries for a little while, and you load that same rack right into the scanner.
What we found is a lot of companies sell scanners, digital software, and so forth. For us, we bought one type of scanner. We bought a P 1000 3d HISTEC high capacity. It’s a great workhorse that works well for us. We have Lumea doing the digital pathology software and we have LigoLab as our medical LIS.
It's hard to do all of it and be great at it, so we went and looked for what we thought would be best for us, and that's what we settled on. It's worked very, very well. Once those things are scanned in, they move to our doctor inside the Lumea system.
That was an incredible integration where we had to pull together the slide label. Our team worked on that with LigoLab and Lumea to make sure that the label was printed out in LigoLab’s LIS system (lab pathology software), viewed and recognized in Lumea, and populated to the cases for our doctors to be able to read.
Once that does, it pops right up in Lumea, you've got dashboards, you've got access, and they go in and do when reading a case. They see the images, their macros are there, and they can diagnose the case, order recuts, specials, and immunos. It all flows right through.
The most important thing is we're not slowing them down. That was the key. If it slows the doctor down, they're going to be less likely to continue with the process that costs them money, time, and effort. We want to make it as fast as possible. As things continue to progress, it should only get faster.
That's how we built it. That's what we did. And our partners, Lumea and LigoLab have been fantastic. It's not that everybody has to know the answer when we start, but we're all willing to see the vision and strive to get there. I think that's what we did and what made it so special.
Suren Avunjian: I might add, or maybe suggest that you add some of the next phases of this lab workflow management and the technologies we're adding to OnePath on the grossing side and also the case distribution automation that LigoLab is also helping out with as well for pathology workloads.
Yeah, great points. It's really interesting to see how many places AI is going to be involved in the future. It's going to be everywhere. One of the unique places that we see it has huge benefits is in the gross examination. We just recently began a partnership with a company called Vistapath. Vistapath was started by a histotech. It is a camera that has AI that takes pictures of the gross examination.
When it takes a picture of that gross examination, it can measure that gross examination. So it doesn't eliminate the personnel being involved in the gross examination but assists tremendously with taking the pictures and populating everything into the laboratory information system (pathology software) before transferring it to the Lumea system.
Both the staff and the physician have access to the gross, but instead of a text description, we now have a picture and the AI has done the measurements for us. Really interesting stuff, and it only gets better as AI continues to learn
We're excited about this partnership with Vistapath. A very good company, and they're going to be a great partner. In addition to that, some of the other things that we're doing inside because it's tough in the lab business and we have shortages in pathologists, histotechs, and the costs have gone up.
There are a lot more labs demanding more of these techs, and so it's harder to find them. It's harder to find some who typically are qualified to do the type of work we need inside of a traditional pathology lab.
So you do get into a position where you have to start making some changes, not replacing personnel, but making them more efficient so they have assistance, and it's not reliant on labor hours to do it. So with our partner Sakura, we've brought in the Sakura (slide stainer) and we're currently working through the process with that. We think that has great potential. There's also some potential opportunity in automated microtomy. I think that the AI and the automation in grossing is a great start and embedding as well. We see that having a big place in the future.
Suren Avunjian: Thank you, Wes. I wanted to add also the functionality of taking into fact the insurance and specialty of a pathologist as customer preferences that could drive the workload and assignment of pathology. These examples of laboratory information systems’ functionality are going to help OnePath with this level of automation, so nobody has to sit there and think about and remember all these features and settings.
You can set up the different levels of importance, which also takes into consideration the availability of pathologists and their caseloads. So the LIS system software knows what kind of specimen is going to them, what is the weight of this specimen, and helps with load balancing for the daily and cumulative work of the pathologists.
Westley Bernhardt: That's exactly right. OnePath is a national company. We don't have any geographical limitations as to where we work. That's one of the beauties of digital pathology, even though there's a shortage in pathology, there is no reason that your patients and your clinicians can't get the best subspecialist care.
We can connect them using digital pathology, but it does have some restrictions, right? Just like you said, state licensure has to be there. Specialty has to be there. What's the type of specimen? What is their load? Who are they contracted with by the insurance companies? So all of these things are considerations.
We need to understand how to automate that distribution because once again, if the computer can do it and they can automate how those cases are assigned that makes it much quicker, the process is better, and fewer errors. We're excited about that pathology reporting software feature and it's going to be very helpful to us.
Suren Avunjian: One thing I want to highlight again about this integration is how contextual this integration is.
This is unique because it's not just an HL7 feed. You know, here's the results. Here's the report. No, it's a single sign-on LIS software solution (best LIS). There's full bidirectional capability with connectivity going back and forth as a slide is ordered in Lumea, it's automatically going into LigoLab’s pathology lab report software.
The histology department notifies them of these recuts that are needed and so on as they're handled, right? This goes back to the pathologist queue. They can see that these slides have been prepared. So, as the pathologist is building macros, LigoLab’s lab information system takes this data, generates the report, and handles the distribution of the report to the customers from whom it came.
This is what makes this integration unique and one of a kind, and we hope to inspire many more of these types of interoperabilities.
Westley Bernhardt: I'm so glad that you mentioned that because I’m trying to create a better quality of life for my physicians too. There are a couple of aspects to this.
Number one, I don't want them to feel that they have to be rushing to a lab where they need their slides right now, and then they're driving home and they want to get their work done to spend time with their family and get back. It can be a long process and it needs to be there right then.
I don't want them to also feel like they've got to be in a cockpit with two screens and sitting in a facility where that's the only place they can read. I want them to feel like they can be mobile and they can do it anywhere. The beauty of what we do with our system is my doctors are reading it and reading it well on an iPad.
They can be totally mobile. Hypothetically, they can do it on an airplane as they’re flying or anywhere. Somebody calls you and a doctor says, take a look at this case. Your iPads with you. You're sitting and watching your child's game. You can pull up a case and say, Yes, I see that.
You can discuss things on the move, giving you more flexibility. Also, it changes the way the laboratory works. Instead of having to batch process and have everything ready at a certain time, you can randomly feed everything. A doctor reads a hundred slides, then decides he or she is going to go and work out or go to a parent-teacher conference. After that, they come back and more work continues to build for them as they go through the day and they work at their pace.
All our doctors are contractors. We have a very special relationship with them. They work at the capacity that they want with us. If they want to work with full loads, if they want to work to only a certain limit, going back to the way that LigoLab’s assignments work, it can meet those requirements.
This allows us to create a better quality of life for the doctors. I think that's really, really crucial.
Suren Avunjian: Should we see how it works off of an iPad?
Westley Bernhardt: I think that's great. Let's let Dr. Khalafbeigi show that off.
Sheva Khalafbeigi: Great. It's nice to see or meet everybody watching this webinar.
My name is Dr. Khalafbeigi. I'm a contractor at OPDX. I've known Wes Bernhardt for quite some time. He is one of the most knowledgeable people in the field of laboratory medicine. I've just been so grateful to be a part of this process and the partnership we have with LigoLab (LIS software vendors) and Lumea.
I've been really happy with both LigoLab (LIS system vendors) and Lumea for numerous reasons. I think one, we discussed the flexibility and the understanding of the pathologist's needs, you know, whenever I have said, “Hey, you know, it'd be nice to have this,” they're like, “Yep, we got it. We're working on it for you.”
That's something that I love because it helps make my job much easier. The other thing I did want to add was that going digital, as Suren mentioned, was inevitable to happen and I'm glad that we as a collaborative effort between these companies, are at the forefront of that and it's changed our quality of life. Many of us pathologists have moved around so much for medical school, residency, fellowship, and maybe our first or second job.
It's been difficult to put roots down. This has really opened up endless possibilities as far as being able to sign out from literally anywhere.
Ok, let me show you guys how I sign out. I'm going to show you a test case.
This is literally from my iPad, and so here we go. Let me share my screen.
All right. So can you guys see my screen? Yes. Okay, excellent. So this is a test case, we have Wesley Bernhardt here. So let's see what Wes has got.
Westley Bernhardt: And I'm not that old. So, you know.
How I would start my day. I would go under this dashboard section. These are just two different ways that the cases are listed, but for simplicity purposes, we're just going to pull up Wes's test case here. So, the way I begin is I will click on this yellow plus sign, and right here it talks about the morphology and the clinical differential.
Then here we have our gross description. Now when we're gonna use the camera with Vistapath, the photo will pre-populate here, and I will be able to see a picture of the gross specimen, which is great. Down here you would typically click on documents and there would be the requisition form that I would be able to see.
But because this is a test case, we don't have that. So let's go back here. So in this area here, this is where you would have your slides. So we saw in the gross that it said it was completely submitted in two pieces, so one cassette. So we're only gonna have one slide. I'm going to click on that. So you see, it says one H and E.
So now we're going to pull up the slide. You may have to refresh this. Give me one second. Cause I was logged in for a while. So give me one second while I log back in.
I have not had any problems as far as internet connection goes or anything like that. As long as you have wifi you can sign into the platform.
Westley Bernhardt: Even on 5G, right? When you're doing it, if you're mobile, you get some vision power to be able to see it and move and work with it, too, right?
Sheva Khalafbeigi: Yes, exactly. Even on 5G. It's wonderful. And you can see here how quickly it pulled up the slide. So I'm using my fingers to move this slide around and I already know this is going to be an intradermal nevus. I don't want to bore anyone with the reasons why it's an intradermal nevus, but that's what it is.
You can see here at low power all three pieces of your tissue which is nice, and it's bisected like we saw in the gross description so I already know this is intradermal Nevus. So I'm gonna go up here to this triangle and I'm gonna click on it and I'm gonna put my macro for intradermal Nevus, which is IDN.
You can see all of the macros that come up that have IDN as part of their macro. I'm only going to use this one, so I'm gonna click on that. And it's going to populate intradermal nevus. Give it a second.
In a case, if your client wants a photograph, you can do that. You would just go up here and click the camera button and it would save that. If there was a case where you wanted to make an annotation, you click on the pencil and I'm just drawing with my fingers what this is, and I would press save.
If I wanted to show this to a colleague of mine, I would say, “Hey, look at the area I circled. What do you think that is?” So it makes it a lot easier. So now I'm going to go to my report and I'm going to see what the report looks like. The report preview. You see I have the final diagnosis, intradermal nevus.
Everything looks good to me, so I will click this button here, generate and approve the report. So there we go. Now the case is gone. It's signed out. If you want to see again what it looks like signed out, you can just click report preview.
And that's pretty much it. That's how I do it. It's very straightforward. If let's say I wanted to order stains on this case, I would click on slide orders and I would click on the block. We only have one block here, but you would just click the drop down and you can scroll through and see whichever one you want to pick.
Let's say I wanna get another level, I would click on that and I would click add a slide. And that would tell the lab, “Hey, I ordered a level on this case,” and it would go through. We don't need to worry about laboratory billing (lab revenue cycle management or RCM process) because that's already pre-populated according to the diagnosis. And that's pretty much it.
That's what I do daily. It's very easy to use. Very user-friendly. The images are very crisp and clear. Being able to move the image around is very easy to do. I don't feel like I'm wasting a lot of time trying to move the image around. And you know, when you're doing a lot of these, you want to be able to do a great job, do a quality job for your patient and your clients, but you also want to be able to work efficiently. And this does that very, very well.
Westley Bernhardt: Great. Thank you, doc. That was awesome.
Suren Avunjian: Yeah, I really appreciate it. I hope it was enlightening for everyone. We're getting some questions, so please start sending over some questions.
We're going to get to that shortly, but before that, I want to get some final thoughts from Wes and see where, where we could go with this.
Westley Bernhardt: Well I think it's an interesting innovation. The next few years are going to be really intense and crazy, and there's going to be a lot of people to come to the market, both on scanners, on digital pathology, on AI, and you're going to see advancements. Things are going to move quickly.
I just recommend that people really know what they are buying when they buy a system. A lot of times you say, “All right, I'm buying it. I'm putting it away.” I constantly make sure I understand what the market has out there because you never know what is going on. You never know who's going to get bought and what's going to change.
When it's moving this quickly, you want to keep yourself in the know. So I think that's important. The other thing, too, is I think the automation is going to continue. We're in a really tough business. We've got market challenges with third-party payers. Nobody wants to pay us for what we do.
If they do pay, they think that Quest and LabCorp are sufficient and they don't need any other options, so we're always fighting that battle. I feel that pain out there. I just think that we should all work together. I'm always available to talk to anyone. We as a partner out there help other labs to dip their toes in the water and understand how this stuff works and even take steps to get digital pathology without having to buy everything with it.
We also help with the staffing of doctors. So those are all areas that we reach out to do different things than we did as a traditional lab before. It is so tough out there and we can feel everyone's pain. So, we want to meet these challenges the best we can and we know how important it is to have as many laboratories out there as possible providing services. There's not enough and we need more.
Suren Avunjian: Great. Today we got a chance to see the fruits of our labor, and the journey to this point is marked by concerted efforts and shared dedication to pushing the envelope. And as Wes mentioned, these cycles are going to start getting quicker and shorter so we have to be able to keep innovating and choosing the right partnerships and the right LIS lab software that will be committed to pioneering these frontiers of digital pathology and overall lab automation and improvement of patient care as we see it.
Thank you so much for the time today, and the demonstration from our distinguished pathologist. I would now like to open it up to some questions.
Michael, if you could guide us through some of the questions that have come in?
Michael Kalinowski: I certainly can. We have a few that have come in so far. If anyone would like to join the discussion with a particular question, just use the Zoom feature at the bottom of your screen.
The first question is how can labs leverage these technologies that have been discussed during this presentation without major capital investment.
Westley Bernhardt: So it's interesting that you bring that up. When we started our new company, we dove in with both feet. We made that investment. But for a lot of people, they can be apprehensive.
How do I get into all this without spending an arm and a leg? And it can cost a lot. There are opportunities out there and this is something that we do. We allow people to rent our software and scanners and so forth so they can dip their toe in the water before they jump in with both feet.
So there are ways to try things out and test them before you have to buy so that you know you're making the right decision. I highly recommend that those of you who know you're going digital so be it. We're happy to talk to you if you ever need any advice, but there are ways to rent before you buy and if you're interested in that, please don't hesitate to reach out.
Michael Kalinowski: All right next question is how do you apply these technologies in real life? And what differences have you seen?
Westley Bernhardt: Well for us, we do it every day with every one of my doctors. They never read digitally before we started and they are all reading digitally now. And I can tell you, they don't want to go back. First, you have to get the confidence. I expected that when we started this process, I was going to be sending somewhere between 25 and 50 percent of my slides for review after they read the digital image.
But I didn't have any. I never got a request for a slide except when they had to optimize the slide. That was it. So it's totally different. Bringing your pathologists into the fold, letting them test it, and letting them be part of the decision-making process is important. So they're buying into it, and once they do that, and if everyone gives it a proper opportunity, it becomes a much easier solution.
Sheva Khalafbeigi: As you can see from the demonstration, the images are much more crisp, and clear. Ergonomically, your neck is also not in a strained position for several hours throughout the day.
You're not staring into something where you just have bright light going into your eyes, literally. That makes a big difference in your overall well-being. I truly believe that. And you know, one of the things that I love about Wes is he respects my opinion and the opinions of our pathologists.
He's open to suggestions and changes, and that helps us implement these things, in real time and real life. So I think that's been a great experience so far.
Michael Kalinowski: I think this is a pretty good related question for both Wes and Sheva. Does the innovation in OnePath make your business more attractive for pathologists?
Westley Bernhardt: I'll let Dr. Khalafbeigi respond in a second. I'll just tell you from my perspective, I get great feedback from our doctors. If you think about it, I had to hire a lot of doctors at Aurora Diagnostics and there aren't a ton of labs all over, so when you're looking for a lab job.
You know, like I mentioned, what's your quality of life as a doctor? How many times have you had a pathologist who's got a family at home? He's living where you are and his family's back in another state because he's got kids in high school. He doesn't want to move them or she's got kids in high school or whatever it may be. They don't want to uproot their family and change all of this so that they can move for their job.
This changes what we do. How many times have you hired a pathologist?
They come over, you don't like their reads, the clinician doesn't like the reads, and you realize you bought something you don't exactly want. This makes it a lot more flexible, it makes it easier. With fewer headhunter fees, you get what you want, and it's easier to exchange something if it's not exactly right and doesn't meet the needs of your clients and your practice.
It gives some flexibility, and it gives these doctors back their lives. I think that's really important because if you've got a doctor who's happy and lives a good life, they're going to make better and more diagnoses for you.
Sheva Khalafbeigi: Yeah, I have to agree with Wes on all of his points. You know, we are all humans.
We all have feelings and lives outside work. We have responsibilities, whether it's kids, a sick parent, dare I say pets, we all have things that are near and dear to us. And it's been hard to have to uproot several times. I mean, I, I've personally had to move close to five or six times.
I don't want to do that anymore. I want to live where I want to live. And I want to be close to my family. I love working from home. I, I think that's a game-changer. If your doc is happy, it's just going to create a positive environment for the growth and development of the company.
Who doesn't want to be happy and love their job, you know?
Westley Bernhardt: Let me add this for all those rural hospital-based pathology groups out there or rural hospitals who struggle so much these days. Rural hospitals are getting shut down dramatically but think about this.
With digital pathology, you can digitize frozens and you can have access as long as you're not going to require them to be on-site, which they don't need to be. Everything can be done digitally. You can have access, whereas in the past, you've got one general pathologist and consults go out every day for heme path, GI, whatever.
Now you can have access to a full slate of subspecialized pathologists to do all of your work. They may work for other hospitals too. That's going to happen, but they're going to work for you. They're going to do your cases. They're going to make it happen. And you can have the greatest pathologist reading for you and delivering care to your patients. That's pretty special.
Sheva Khalafbeigi: Yeah, it saves a lot of time rather than, “Oh, I know this colleague in this state, let me ship the slides over there, wait a day or two until the slides get there, and then have it go through my colleague's caseload of the day until they get to it.” Instead, I can immediately from wherever I am, ask my colleague, “Hey, can you please look at this?”
“I think it's this, or I'm worried about this. Do you agree? Okay.” They hop on real quick. They look at it. “Yeah, I agree.” “Okay, signed out.” There's no delay in the patient getting their results. So that's important.
Westley Bernhardt: Yesterday I had a meeting with a group that has a variety of specimens that come in. Some are dermatology, some are breast, and some are heme path. And before when they sent it, it was either a derm or general path that was reading it. And now, as I explained to them, when it comes in if it's a breast, it's going to my breast fellow. If it's a heme path, it's going to the heme path. If it's derm, it's going to the derm path.
You're going to be directed to the subspecialist right away, without delay, and you can have confidence in that diagnosis because of that. So, it's a unique time, and if everybody takes advantage of the laboratory software systems and the opportunity, it's going to be successful.
Michael Kalinowski: Next question. Do you have a preferred case viewer platform?
Westley Bernhardt: So our case view. Oh, go ahead, Doc, sorry.
Sheva Khalafbeigi: No, no, you go ahead.
Westley Bernhardt: I was just gonna say right now we view our cases in Lumea and Lumea has been a fantastic partner. Our goal in digital pathology is number one, that it replaces the microscope.
Then number two, what are the add-ons? How do I automate and eliminate some other costs? There is a cost to it, but how do I eliminate other costs? Eliminating those costs means no more admin assistant, no more transcription. We automate that entire process and use the coordination of the digital software and the LIS system to accomplish that.
Automating the coding. That's part of it too. And Suren and the team at LigoLab have been so great in helping us put that together. Both the LigoLab and Lumea teams have been fantastic in helping us create those customizations.
Sheva Khalafbeigi: I'm very happy with how their viewer is and what they've built.
Michael Kalinowski: all right, and let's go with one more and it's a rather important one. Can you talk about reimbursements? How does that work within this workflow?
Westley Bernhardt: I can and what's interesting is there are reimbursements out there. You need to check with your own Medicare max to see what they're doing. We were being reimbursed by Medicare well. There are NCCN guidelines that state one unit per type.
So if you've got a one-part biopsy, you get one T code for the 88305. If it was a five-part biopsy, you still get one. If you have one immuno, you get the one. You get one special, you get the one. It's limited to one. That's the NCCN guideline.
Recently, First Coast Services decided they're not paying it anymore so we went from being paid at 20 plus per clip, from First Coast Services to nothing. So we're gonna fight that. They added all the new T codes this year, but we continue to get reimbursements from some of the private payers. Some private payers do not pay it. They consider it already included, but some do, and some do fairly well.
It's really going to depend on who your payers are. You're going to need to check it yourself, but there is reimbursement out there. Some of it more than others. But I can tell you the dollars have been coming in on those, and I recommend you to test those to see who's paying you and who's not.
I can tell you off the top of my head that we've seen some things from United, Humana, and Cigna as well.
Suren Avunjian: Let's take one more question. I believe there's a question about images. The digital image itself. So from my understanding, OnePath did not need to do any kind of upgrades and its bandwidth. The image viewer technologies typically are built in a way where you can think of it as like Google Maps, right?
You're not downloading the entire world map all at once to the browser. As you zoom in, it's just downloading that particular section. So this type of technology and viewer allows for no limitation by the constraints of normal bandwidth.
I don't think there was a need to necessarily have massive improvements or upgrades in your bandwidth, right, Westley?
Westley Bernhardt: Yeah, we invest in our internet, but that's for many reasons, right? Number one, we want the laboratory information system (pathology lab software) to perform at its highest capacity. We don't want our people to start typing as it's getting it in.
We want that to work as quickly as possible. We want the digital movement to be as quick as possible. So we have high powered fiber internet, but it's nothing that you can't buy right off the streets anytime. So we just go through Comcast for that. We haven't had to make any changes. Lumea's system is a web-based platform.
They manage all of our storage. So it's been very, very simple.
Suren Avunjian: Keep in mind that pathologists are signing out from all over the place, right? They're not even in the library and, as Westley mentioned, they could be signing out using a 5G connection or LTE, and that should be enough to get these out.
Westley Bernhardt: That's right. The images populate well, as Dr. Khalafbeigi said, she's been all over and seen images and they populate quickly.
Suren Avunjian: Yeah, they do. Thank you.
Today we got to explore all of the newest innovations that we've put together. You know, the relentless focus of the partnership between all these companies has brought on the flexibility and the Interoperability.
I think we're not just responding to changing landscapes. Our vision is to help shape it. So I hope we have inspired some of you and we're here to answer any more questions. I believe we have another slide here. You scan that QR code. That's one way to reach out to us.
The website's also available. We have OnePath’s website that we can share as well. Wes has contacts as well with Lumea, so feel free to reach out with any questions or anything we can help with.
Westley Bernhardt: thank you so much. We appreciate your time today.
Suren Avunjian: Thank you all. Have a wonderful rest of the day.
Sheva Khalafbeigi: Thank you. Bye.