Interpreting pathology cases using digital pathology from under-developed nations by North American and European (NAE) pathologists has been a Holy Grail of digital pathology. It is widely believed that the developing world has an unmet need in cancer diagnosis and treatment. The White House Office of Science and Technology Policy (OSTP) in October 2015 held a conference to strategize on meeting this need (6). Patients from developing countries would benefit from their pathology slides being digitized locally, stored in the cloud and then reviewed by pathologists from the developed world. It is estimated that 70% of the world's pathologists reside in the USA. To emphasis the scope of the problem, Dr. Dan Miller, a pathologist with Partners for Health said "It will take 700 years to train enough pathologists to serve Africa properly." In parts of Africa, there are fewer than one pathologist per million people.
There are international projects to enable Digital pathology slides from overseas to be interpreted by NAE pathologists. One model is the Academic to Academic consultation. In this model, an overseas academic pathology department or large laboratory has a partnership with a US or European academic pathology department to review selected cases. Examples of this model are: University of California Los Angeles (1), University of Pittsburg Medical Center (2), and Massachusetts General Hospital (3). Recently, The Cleveland Clinic published on their “epathology” collaboration with Abu Dhabi (4).
A variation of this model would be multiple overseas pathology departments contracting with a single NAE academic pathology department. The next iteration of this model is for multiple overseas pathology departments to upload whole slide images to a central cloud based distribution site that is available to a distributed network of subspecialist NAE pathologists. PathCentral was on example of this model but unfortunately it is no longer in business. Some of the impediments to these distributed pathology networks were the lack of low cost digital scanners overseas, lack of local sales and marketing teams, and the lack of Branding. Patients in India and especially in China are very brand name conscious. They want either a world renown expert or a world renown academic pathology department to review their slides.
Now imagine a company like Uber that provides digital pathology consultations for patients overseas. Uberpathology has sales and marketing teams for each country or region. Uberpathology makes the arrangements with local laboratories. Uberpathology places and services the low cost scanners and handles the informatics, including slide access, security and storage in the Cloud. Uberpathology contracts with individual pathologists in North America and Europe. The pathologists are independent contractors, not employees of Uberpathology. The pathologists are part of the "gig" economy. Uberpathology has a whole slide image viewer and case workflow product. When a case has been scanned and uploaded into Uberpathology's platform, the workflow software sends a text message to a subspecialist pathologist about the case, just like Uber. If the pathologist accepts, the case is made available in the pathologist's worklist. If the pathologist does not accept, the next pathologist is notified. The pathologist, using voice recognition, dictates his interpretation into the workflow product. Uberpathology distributes the result back to the originating laboratory or requesting oncologist. In order to ensure confidence, Uberpathology will credential and appraise (Focused Practitioner Performance Evaluation, FPPE) each independent pathologist. Uberpathology ensures each pathologist has acceptable bandwidth, an acceptable monitor and is competent and validated to perform digital pathology. Uberpathology conducts a robust peer review program which is facilitated by the images being digital. Uberpathology, thus become the brand that is trusted worldwide.