Digital Pathology And Working from Home or Abroad?

[KeratinPearls]

Anyone here knows of any pathologist working at home or abroad full time signing out cases via digital pathology? I personally don’t know of any.

I wouldn’t mind living in another country signing out cases for a living just to enjoy life a little more. If not, anyone knows how much longer before something like this becomes feasible lol? I mean if I can spend a few months in Bora Bora or Hawaii, I would love it.

I enjoy traveling and experiencing other cultures. If I could do it while I still can instead of deferring it for retirement, that would be nice.

I do feel more comfortable using a regular scope to sign out cases but I think it’s because I’m so used to it.

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[caffeinegirl]

I worked from home doing digital pathology - you needed a CLIA license for your place though. Don't know if that's been changed with the COVID era. I like digital pathology better than the conventional microscope - much faster and easier to scan and annotate/mark the slide.

 

[ScubaV]

It seems that's been waived for covid, and as far as I can tell hasn't resumed:

Remote Sign-Out of Cases With Digital Pathology FAQs

In response to the COVID-19 crisis, the Digital and Computational Pathology Committee and the Informatics Committee produced FAQs to guide members who…

www.cap.org

And MSKCC wants to keep it that way:

https://www.cdc.gov/cliac/docs/april-2022/pc3_j-sirintrapun.pdf

It would certainly have it's benefits for both pathologists and patients in servicing more remote areas, but would also probably be the final nail in the coffin for any independent small-medium groups.

 

[maxxor]

i assume this would be governed under the same sorts of rules as teleradiology:

No final interpretations for government payers unless on American soil.

Private payers: YMMV, but most accept it.

 

[B***F*****]

I have the option of signing out some cases completely remotely from home. But I'm still old school and I'm much faster and feel more comfortable, at this point in time, signing out the old fashioned way by pushing glass. I think things will change more and more towards digital based workflow and as people get more comfortable doing so, there will be more stories about how people work mostly or exclusively from home and will be able to live quite some distance away from the physical lab. Just give it several years, IMO.

 

[LADoc00]

Step by Step Formula:
1. open CLIA certified lab in location with very high Medicare locality payments (Orange County, CA, Rye NY etc).
2. outsource histology and then have cases scanned at this location
3. read cases from Thailand with a sign out location of the where the slide is


Im pondering a start up that assists pathology groups in setting up an independent CLIA location as part of a "condo lab" (basically several independent CLIAs under one roof) then picks up tissue and does the histology followed by scanning slides for fee and then lets pathologists global bill.
Frozen sections and stat on-site ROSE type interpretations screw this up but barring that there is literally no reason for pathology groups to be onsite anymore.

 

[maxxor]

3. read cases from Thailand with a sign out location of the where the slide is

Is this legal? It’s not for radiology. There are billion dollar corporations who would implement this immediately if it were.

CMS specifically requires the zip code of where the professional interpretation was performed to be where your butt is physically and to be on American soil.

You could do said scheme from Hawaii / Guam.

 

[KeratinPearls]

Is this legal? It’s not for radiology. There are billion dollar corporations who would implement this immediately if it were.

CMS specifically requires the zip code of where the professional interpretation was performed to be where your butt is physically and to be on American soil.

You could do said scheme from Hawaii / Guam.

Hawaii it is then lol. Then Puerto Rico for a few months.

 

[Med Director New England]

Imo
Digital path will drive histology consolidation in larger groups with images being sent to spokes to keep paths sitting at small hospitals busy (rather than pushing paths to their home office, Hawaii, etc). Seeing some efficiency gains by allowing a single path to sit at a place that needs a path onsite and still eat cases beamed to them from the central Histo lab mothership. 2nd reads, consults also much easier in a group that is spread over large area if they have digital images.

Agree with earlier comment, digi will advantage large groups / corporate labs over small path groups.

 

[ScubaV]

I have the option of signing out some cases completely remotely from home. But I'm still old school and I'm much faster and feel more comfortable, at this point in time, signing out the old fashioned way by pushing glass. I think things will change more and more towards digital based workflow and as people get more comfortable doing so, there will be more stories about how people work mostly or exclusively from home and will be able to live quite some distance away from the physical lab. Just give it several years, IMO.

Yeah, I'm much faster with a physical slide than anytime I've used digital stuff. But I don't use a slide holder and quickly free hand around and zoom in on hotspots. Digital slides might be the same or faster for those who meticulously "lawnmower" their slides.

Imo
Digital path will drive histology consolidation in larger groups with images being sent to spokes to keep paths sitting at small hospitals busy (rather than pushing paths to their home office, Hawaii, etc). Seeing some efficiency gains by allowing a single path to sit at a place that needs a path onsite and still eat cases beamed to them from the central Histo lab mothership. 2nd reads, consults also much easier in a group that is spread over large area if they have digital images.

Agree with earlier comment, digi will advantage large groups / corporate labs over small path groups.

We've never gone past the exploratory/trial phase, but our group would probably do the opposite. We already have centralized histology and would use digital for non-frozen ROSE so that we don't have to send anyone out to the spokes as often. Then have one person cover all peripheral site ROSE digitally. No one wants to live or commute out to the spokes if they can help it.