Telepathology, the practice of pathology at a long distance, has advanced continuously
since 1986. Today, fourth-generation telepathology systems, so-called virtual slide
telepathology systems, are being used for education applications. Both conventional
and innovative surgical pathology diagnostic services are being designed and implemented
as well. The technology has been commercialized by more than 30 companies in Asia,
the United States, and Europe. Early adopters of telepathology have been laboratories
with special challenges in providing anatomic pathology services, ranging from the
need to provide anatomic pathology services at great distances to the use of the technology
to increase efficiency of services between hospitals less than a mile apart. As to
what often happens in medicine, early adopters of new technologies are professionals
who create model programs that are successful and then stimulate the creation of infrastructure
(ie, reimbursement, telecommunications, information technologies, and so on) that
forms the platforms for entry of later, mainstream, adopters. The trend at medical
schools, in the United States, is to go entirely digital for their pathology courses,
discarding their student light microscopes, and building virtual slide laboratories.
This may create a generation of pathology trainees who prefer digital pathology imaging
over the traditional hands-on light microscopy. The creation of standards for virtual
slide telepathology is early in its development but accelerating. The field of telepathology
has now reached a tipping point at which major corporations now investing in the technology
will insist that standards be created for pathology digital imaging as a value added
business proposition. A key to success in teleradiology, already a growth industry,
has been the implementation of standards for digital radiology imaging. Telepathology
is already the enabling technology for new, innovative laboratory services. Examples
include STAT QA surgical pathology second opinions at a distance and a telehealth-enabled
rapid breast care service. The innovative bundling of telemammography, telepathology,
and teleoncology services may represent a new paradigm in breast care that helps address
the serious issue of fragmentation of breast cancer care in the United States and
elsewhere. Legal and regulatory issues in telepathology are being addressed and are
regarded as a potential catalyst for the next wave of telepathology advances, applications,
and implementations.