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Where We Stand in Realizing the Promise of Digital Pathology

Contributed Commentary by Dr. Mike Bonham

April 9, 2021 | Pathologists and laboratory managers have long heard about the promise of digital pathology in advancing the standard of care—from driving productivity and efficiency gains to unlocking new insights with AI. Over the past several years, as pioneers have scaled their implementations, we have begun to see these promises come to fruition. Still, for many laboratories, digital pathology has remained out of reach—whether due to limited regulatory approvals or a lack of inertia to change.

This situation suddenly changed at the onset of the pandemic. Laboratories were forced to quickly adapt, as the traditional practice of pathology centered around pathologists and microscopes in physical spaces, was challenged by social distancing requirements and health concerns for an aging pathologist population. Digital pathology, which captures high-resolution images of tissue biopsies, presented a practical solution for operating remotely, made more feasible by two key regulatory developments. In March 2020, CMS issued a waiver removing time-consuming validation requirements for viewing cases from home. One month later, the FDA released emergency guidance aimed at expanding the availability of remote digital pathology devices.

A year into COVID-19, we see that it has cast an unexpected spotlight on digital pathology. It has accelerated adoption as laboratories’ ability to operate has increasingly become tied to their digital footprint. In doing so, it has also laid the foundation for laboratories to realize the benefits of the digital transformation beyond remote work, positioning them to meet future challenges and capitalize on the opportunity ahead. 

Tackling the Next Challenge

The first of these challenges is likely not too far off. After many patients delayed routine screenings and care amid the pandemic, there are worrying signs of a surge in demand for diagnostic services post-COVID. The American Cancer Society reports an estimated 80-90% decline in screenings for breast, colorectal, and cervical cancers during March and April of 2020, compared to the same time period in 2019. Those numbers have since remained down from pre-pandemic rates.

As regular screenings resume, laboratories are likely to face a flood of biopsies due to patients’ delays—along with an uptick in advanced or late-stage diagnoses—putting added pressure on pathologists to deliver fast, accurate results. Once again, digital pathology presents a solution. It can drive meaningful efficiency gains through automation and streamline collaboration with experts around the world, also helping to improve quality of care.

Overcoming Physician Burnout

Even before the pandemic, laboratories faced several challenges that were, in part, driving pathology’s digital transformation. One such pain point is the shrinking pathologist population, which according to a JAMA study, declined by 12.5% between 2007 and 2017. The same study reveals that this decline, combined with a steady rise in biopsy volume, has led to a 43% increase in workload per pathologist, not including the consequences of any influx in cancer screenings post-pandemic.

Perhaps it’s unsurprising that pathologists have been feeling the impact. Medscape’s National Physician Burnout & Suicide Report 2021 indicates 35% of pathologists surveyed felt burnout. Digital pathology has been improving the pathologist experience, as factors like quality of care and efficiency—leading to improved work-life balance—are often top of mind. More recently, pathologists have come to see that digitization can also provide worksite flexibility, further contributing to their overall satisfaction by reducing commute times and enabling them to spend more time with their families.

Importantly, the shrinking pathologist population is a trend that is not expected to reverse any time soon. This means that regardless of the spike in screenings, laboratories still need to take measures to address it. Digital pathology—increasingly enabled by artificial intelligence—is demonstrating the capacity to do so. 

Looking to The Future

Just as AI is benefitting many aspects of healthcare, it is poised to make the biggest impact on pathology since the introduction of the microscope over a century ago. And laboratories are already capitalizing on this promise. We’re increasingly seeing the development and implementation of workflow applications, which, for example sort and triage cases to help pathologists organize their day. Other applications can support tumor detection, not only improving efficiency but also helping to improve quality of care. Looking at the bigger picture, AI can unlock patterns unseen by the human eye to expand the breadth of diagnostic information available and shape our understanding of disease.

According to digital pathology’s 2020 annual report, pathologists recognize these many sources of value. Among those surveyed, 80% see quality improvements as a key benefit of AI, followed by improved accuracy and gaining new insights.

The New Normal

Much like almost every other industry, COVID-19 has forced pathology to settle into a “new normal”—one increasingly characterized by digitization and remote operations. Yet while we all remain optimistic that the global pandemic will soon come to an end, the need for accurate, timely cancer detection will always remain a top priority. As laboratories have grown to see the full range of benefits that AI-enabled digital pathology delivers, I see this momentum continuing to accelerate in the post-pandemic world. It’s safe to say that now is the time for adoption, and I, for one, am excited to see how pathology’s digital transformation unfolds.


Mike Bonham, MD, PhD, is a physician scientist with a passion for providing leadership around the convergence of fast-moving advances in artificial intelligence, digitization, and informatics that will transform healthcare. Dr. Bonham currently serves as the Chief Medical Officer at Proscia, a digital and computational pathology software company, and has previously held roles at Driver and Genomic Health. Dr. Bonham completed a pathology residency and two pathology fellowships at University of California, San Francisco. He can be reached at

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