EXPERT OPINIONS JUST A MOUSE CLICK AWAY — THE ARMY TELEPATHOLOGY PROGRAM

http://www.wramc.amedd.army.mil/departments/pathology/telepathology/armytelepathology.htm

Keith J. Kaplan, MD
Walter Reed Army Medical Center
Washington, DC USA

Keith J. Kaplan MD
Thomas R. Bigott BS
Rod Herring
Daniel R. Butler HT(ASCP)
Bruce Williams DVM
Walter Reed Army Medical Center Departments of Pathology and Telemedicine and the Armed Forces Institute of Pathology Department of Telemedicine


Background: Telepathology is the practice of digitizing histological or macroscopic images for transmission along telecommunication pathways for diagnosis, consultation or continuing medical education. In dynamic (real-time) telepathology, the consultant examines slides remotely with a robotic microscope that allows him or her to select different fields and magnification powers. The use of real-time remote telepathology is attractive because it provides an opportunity for pathologists to obtain immediate consultation and allowing for complete control by the consulting pathologist. The Army Medical Department (AMEDD) is the ideal setting for remote telepathology with several solo-pathologists throughout the world isolated from regional medical centers.

Technology: Telepathology units consisting of standard microscopes with robotic stages controlled with standard PCs using MedMicroscopy (Trestle Corporation, Newport Beach, CA) were deployed and installed at 11 U.S. Army hospitals throughout the world and connected over the Internet to the standard PCs at the Armed Forces Institute of Pathology (AFIP) using MedMicroscopy Viewer software. At the microscope end, an automated microscope is attached to a standard PC running MedMicroscopy. Once connected to the Internet, users can log onto and control the microscope from anywhere using the MedMicroscopy Viewer. Images appear on screen in real time, and the Viewer allows full navigation of the slide, including control of objective, focus, and illumination.
An initial validation study of this technology was performed with 120 consecutive frozen sections reviewed retrospectively from across the AMEDD with 100% diagnostic concordance between the glass slide and telepathology diagnosis.

Design: Over a 1 year period, the number of consults sent to AFIP using real-time, remote telepathology was 170 compared with 43 consults sent using static image-based telepathology alone.

Results: Over a 1 year period, the number of consults sent to AFIP using real-time, remote telepathology was 170 compared with 43 consults sent using static image-based telepathology alone. 80% of cases sent using dynamic telepathology have resulted in definitive diagnoses, negating the need for slides and/or paraffin blocks, compared with only 20% historically using standard static image-based telepathology. This represents a nearly 4-fold increase in both the number of consults sent via telepathology and resulting definitive diagnoses.

Conclusion: The use of dynamic telepathology provides live, interactive expert/consultation to remote sites without access to “next door” specialists, while helping to prevent medical errors and reduce costs, while increasing access to specialty care for military personnel and their families. The use of telepathology may even enable support to remote sites without direct pathology support. This is the first time a worldwide remote telepathology program has been accomplished in the AMEDD.