To the Editor.—We read with interest the recent paper published by Volynskaya et al1 in which the authors explain how their pathology informatics platform used digital pathology for primary diagnostic work at a multisite health care system in Canada. The success of their workflow was largely attributed to integrating the anatomical pathology laboratory information system (APLIS) with the whole slide imaging (WSI) system. Their HL7-based interface, coupled with a bar code–tracking module of the APLIS, permitted pathology cases with whole slide images to be launched directly from the laboratory information system (LIS).
We agree with this LIS-centric approach to managing laboratory workflow, with or without implementing WSI. Indeed, reports2–5 from diverse countries of the success of several other WSI implementations all stress the pivotal role of APLIS and WSI system integration. Our own experience in Catania, Italy, similarly indicates that successful adoption of a fully digital pathology laboratory depends upon the integration of the APLIS and digital imaging systems.6 Such integration streamlines workflow, diminishes the potential for human error, improves the sign-out experience for pathologists, and permits automation. For example, linking the APLIS and digital pathology system (DPS) allows pathologists to review digital slides while simultaneously having access to prior cases, gross photos, and pertinent case metadata.
To date, the development of an interface between the APLIS and DPS has been driven mostly by individual pathologists pleading to their vendors to customize these systems. Clearly, greater cooperation, interoperability, and standardization are necessary to help drive adoption of digital pathology. Without such collaboration, it will be interesting to see who captures most pathologists' attention and dominates the market: those LIS vendors who gently incorporate greater imaging functionality into their systems or the digital pathology vendors who improve their case management, workflow, and reporting capabilities for pathologists.