Did you know up to 70 per cent of patient decisions are based on results of laboratory tests? Kingston Health Sciences Centre’s (KHSC) digital pathology initiative for the hematology laboratory has been live since May 2021 and armed with funding from Ontario Health for their “Digital Morphology Tests of Change Proposal”, Dr. David Good and his colleagues in the Department of Pathology and Molecular Medicine are increasing positive patient outcomes regularly.
Dr. Good is an associate professor at Queen’s and the Service Chief for Hematopathology at KHSC. He’s been in Kingston for 11 years and for the past two years, Dr. Good and his team have been using digital pathology to help guide patient care in Kingston and the surrounding areas. “The digital perspective of this involves the complete blood count or CBC. When a patient has a CBC, the blood is run through an analyzer to perform most of the counts. Traditionally, if abnormalities are found that require a blood film to be reviewed, a medical laboratory technologist (MLT) reviews the film using a microscope and manually counts and categorizes the white blood cells. Now, the system takes that slide that’s been stained and runs it through a scanner that will identify the white blood cells, take photos and through its own internal software, try to categorize what type of cells the white blood cells are. It’s essentially automating the work of the MLT,” Dr. Good describes. The MLT’s role is now instead of primarily using the microscope, they are reviewing cells on a screen and determining if the software categorized everything properly. “The scanning system is excellent for normal cells. Where it sometimes has trouble is with malignant cells and that is where the MLT’s skills come into place. The benefits of the system are a faster turnaround as it’s always scanning in the background. While the MLT is looking at one scan, the machine can be scanning the next one – it’s a continuous process. We can now get faster results to outpatients, to the Emergency Department and to inpatients in the ICU. The system is improving care that’s happening.”
Dr. Good says he has already seen a vast improvement in the turnaround time to give physician colleagues accurate results. “Everything is digital now. I can make a rapid assessment and report and make the appropriate phone call. Acute issues needing an urgent diagnosis that happen after hours can now be solved by me or one of my colleagues on call logging in through a VPN, accessing that same slide, making a rapid morphological assessment and conveying that information to the treating physician,” Dr. Good explains.
With the funding received from the Ontario Health grant, these digital pathology connections are now being set up in laboratories in Brockville, Napanee and Perth and Smiths Falls this year. Dr. Good recalls a situation in one of the regional hospital laboratories where the use of digital pathology potentially saved one life in particular: “We got a tube of blood from that hospital for a reticulocyte count, a test they aren’t able to perform there. Because it had to be run on our analyzer to get that count, it went through our scanning system and our MLT recognized there was something wrong and called me right away. This turned out to be acute promyelocytic leukemia, a rare type of acute leukemia that can be rapidly fatal if it is not identified and treated promptly. This was a young patient who had been in and out of various hospitals for about a week and no one had identified the cause of her symptoms,” he describes. “As soon as I saw these abnormal cells digitally from home, I was on the phone to the Emergency Department at the regional hospital and had the patient directed to KHSC. Within a matter of hours, the patient was receiving treatment. Thankfully, that patient is alive and disease-free a year and a half later.”
Dr. Good wants people to know even though they are not directly interacting with patients, his colleagues in the Department of Pathology and himself are still at the forefront of medicine delivering equitable care to patients in Kingston and the region. “We’re not seeing the patients, but we’re making an impact and we are a part of that care pathway. Our core laboratories are operating 24/7 and continuously generating high-quality results that provide optimal care for our patients. Part of our job and what I enjoy is taking the various lab results and collating them to arrive at a diagnosis, much like putting pieces of a puzzle together,” he says.
According to Dr. Good, forming these digital networks using technology and what’s available in Kingston is the way forward for the field of Pathology. “Regional collaboration to tap into the expertise we have at academic centres is the future. I’m looking forward to the full implementation of our digital network. It’s a relatively novel concept for Ontario. We’re looking at also modeling this for other regions in Ontario. As we move towards more complex diagnostics and treatments, we recognize the need for regionalization and working together as a centre of expertise with work flowing in and out to be better for patient care,” he explains.
A lot of the innovative work being accomplished by Dr. Good and his team in Pathology comes from the support of SEAMO, being instrumental in increasing the number of funded positions within the Department. He elaborates, “This has allowed us to bring in certain individuals with sufficient protected time for leading-edge research, individuals to develop the tools we need for accurate diagnosis and classification of hematological disorders and even bringing in world-class subspecialty experts to elevate KHSC’s hematology and transfusion medicine laboratories to centres of excellence.”
The goal of Dr. Good is to continue to be a leader in digital transformation of Pathology in Kingston and continuing to embrace new technology. “The incorporation of a number of specialized testing platforms in the last few years allows us to be more accurate and specific in our diagnoses, potentially changing the treatment regimen for patients. This is a very good example of personalized medicine, refining our diagnoses using the technology available to us, leading to a more specific treatment. We hope that patient outcomes are starting to improve as a result of better diagnostics and as novel treatments are being developed.”