Endeavor Health’s John Groth, M.D., on the Shift to Cloud-Based Digital Pathology

Evanston, Ill.-based Endeavor Health is leading the development of a cloud-based digital pathology platform that will allow healthcare providers to easily sharing digital files for second opinions. At Endeavor, patients will soon be able to see their pathology medical images and schedule clinical visits with a pathologist to ask questions to better understand the diagnoses they have been given. John Groth, M.D., a pathologist at Endeavor Health, recently spoke with Healthcare Innovation about the challenges of the transition to digital pathology, as well as the potential benefits. 

Nine-hospital Endeavor, which was formed by the merger of NorthShore University HealthSystem, Edward-Elmhurst Health, Northwest Community Healthcare and Swedish Hospital, is working to modernize pathology services, including incorporating AI tools, in partnership with Google Cloud. 

Healthcare Innovation: Could you could talk a little bit about some of the ways that the shift to digital pathology is starting to change the field, and what kind of broader impact it can have on the health system?

Groth: Digital pathology is a term used to describe taking a physical slide and converting it to virtual. This process has been around for decades, but the uptake has been slow. There have been regulatory, financial and technical hurdles. Now it’s really getting to that point where it’s becoming usable. When they talk about the Gartner hype cycle, we are past the trough of disillusionment. We’re not at the plateau phase, but we’re on the upswing.

HCI: Were there some file format or interoperability issues that had to be overcome? 

Groth: I just came out of a meeting on that topic. It is still a big issue. We’re like where radiology was in the early 1980s. Radiology has been digital for a long time. The difference between radiology and pathology is that in radiology, the image created is natively digital. In pathology, we’re taking an analog process and converting it. And the same thing that happened in radiology happened here. There was a variety of proprietary file formats, until someone came out and said, we have to find a way to make this interoperable. 

HCI: In radiology, they have DICOM, right? 

Groth: And in pathology, we have DICOM, too. But the reality is that no one was using it, so that’s where our journey began. I’ve been involved in digital pathology going back to 2007. But here at Endeavor it started in 2019. The two biggest use cases that pathologists saw, at least institutionally here, were access to artificial intelligence and the possibility of remote work.
The vast majority of people using digital pathology have used it for education or research. In that mindset, the interoperability issues hasn’t been as big because you’re largely working within your own institution. But we wanted an interoperable solution that works within a healthcare system, and then we want it to be scaled out from there. That was where we started in 2019, and we’re still working on it today. Our IT team was encouraging us to go to a cloud-based solution, so that’s where Google Cloud came into the relationship. 

HCI: You mentioned that one of the potential use cases could be access to AI. Can you talk about how AI could impact pathology workflow?

Groth: I think it can have an impact in a variety of ways. It can help with the quality control to ensure that the tissue that’s come through is good and make sure that the image that was created is good. The most common use that people see is that at the diagnostic level it can assist the pathologist. But it can not only help an individual pathologist, it can also help to acquire all of that data, pulling it together and aligning it with that image before a pathologist even looks at it. That effort is all very manual right now. AI also can help in all types of tissue collection and processing on that pre-analytic side. There’s a lot of information on top of just the image itself that will be greatly beneficial.

HCI: I understand that at Endeavor you are planning to provide patients access to their data and the opportunity to meet with their pathologists one on one, so they can ask questions. That seems like having direct patient interactions is a different role than most pathologists have played in the past. 

Groth: As a general rule, I think most patients are unaware of it, but actually those slides are theirs. They have the right to request them, to look at them. So the first step is about giving the patients access. Then it gets to helping them understand, right? When it comes to that, the term we are using is pathology clinics. This has gone on in pathology on a manual level for a while. Is it the common practice of pathology? No. But I’ve been fortunate to have been doing it for more than a decade. You get to show them the diagnosis, and then have a discussion. Studies have shown that patients like it. They want it, and pathologists overall are at least somewhat interested. 

HCI: Earlier you mentioned that besides AI, another early use case was remote work for the pathologist. Does that open a window to hiring somebody in Cleveland or Pittsburgh to do digital pathology in Chicago? 

Groth: 100% and this is already being discussed across the country. Ironically, pathology was an early adopter of this imaging technology, but for veterinary medicine. Veterinary medicine has been deploying digital pathology for a long time, and those pathologists live all over the world, so I think that it’s going to become more commonplace where they allow that flexibility for us. The issue that’s coming up is more on the legal side of having a physician live in another state. 

HCI: What’s the timeline for the project overall to spread out across Endeavor?

Groth: The next step for us is that no later than July 31 we will have this physically deployable, meaning that we’re going to be actually signing out cases. This year is to really dial in this environment so that we can scale it across Endeavor in the next several years. 

HCI: Do you also have to think about EHR integration and working with your IT team on on that?

Groth: Yes. DICOM is the file format and IHE is the data protocol put in place. So we will be the first to employ that, and that’s all based on connectivity to the EHRs. It’s called the Digital Pathology Protocol for IHE. Most digital pathology deployments will have some connection to an EHR, to a laboratory information system where it’s specific to that company’s product. Ours is not. Ours will be vendor-neutral, and allow for other healthcare systems to figure out an employable solution. 

When we’re building this solution, we’re not just thinking about it internally, we’re thinking about it globally. We don’t want this to be an isolated deployment that’s just good for us. We want it to be the benchmark.

HCI: If we reached out to pathology leaders at the large academic medical centers across the country, would a lot of them say they’re working on the same thing? Would a lot of them still be working in the physical slide world? 

Groth: The vast majority are in the physical slide world, but right now they are entertaining how to do this. For instance, in Chicago, everyone is at least thinking about how to do this in some way. The problem is how to integrate it at the healthcare system level. It’s just a matter of how to do it  in the right way. 

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