I received a number of responses to my recent re-posting of Digital Pathology Market Shows Sluggish Growth reproduced from Laboratory Economics.  

The comments I received ranged from "I told you so" to "Dr. Gown is completely wrong" to "the numbers do not reflect other benefits of digital pathology outside billable revenues" to "this is only for the U.S. market and not reflective of the world's market".

I would agree with all these statements except the first one. 

I never saw the CMS data for CPT code 88361.  While this is only one measure of adoption, vis-a-vis number of billable tests using this code, it is only reflective of US data.  It is a little discouraging at what is "allowed" versus what is "submitted". Not sure how Laboratory Economics extrapolates this data into market value exactly. 

This data of course does not take into account other intangible deliverables beyond billable revenues (image analysis), i.e. education, conferences, risk management, "same slide, same time" consultation, and remote pathology services (which actually could have a PC billing component as well).

Those of us with an interest in the technology for use in clinical diagnostics often struggle making the business case for digital pathology, particularly when competing with other needs/interests/resources/ opinions such as cost of scanners versus cost of immunostainers or laboratory information systems which are mission critical elements.  Add to that the other needs of a laboratory -- clinical laboratory equipment, reagants, human resources, etc... I could agree with the comment in the story about cost:benefit ratios. The replacement chemistry analyzer, flow cytometer or Coulter counter that help to generate tens of millions annually will win that battle.

Nonetheless, the risk management point I have used to help groups and hospitals make the decision to invest in digital pathology.  Whether it is for consults, cases that travel or are sent in or cases with limited material or no tissue block (i.e. frozen sections, cytology, isolated tumor cells on a single slide, etc...), a digital reproduction as an added measure for patient safety remains a useful advocate for the technology and immeasurable value.  

People may look at the risk of using of the technology but there are also these use cases where there may be risk without using technology available today.

I do not agree with Dr. Gown's remarks about looking at 100 year old slides.  I had the honor and pleasure of looking at slides in the AFIP archive dating back to the 1940s and 1950s for several studies and looking at slides 50 or 60 years old is not easy.  I don't think coverslip medium, tissue fixation methods and stains come with a 50-year warranty like home roofs.  A number of other pathologist's at other national laboratories would have put a different spin on this.  My quote would have been something to the effect that "Digital pathology images are consistent, persistent and efficient".  There is nothing that would change this value proposition 100 years from now.  This assumes the images are not stored on 5 1/4" "floppies" which you both can't do due to file size or read nowadays due to lack of 5 1/4" drives. 

All my college term papers, first resume and med school application essay are on 5 1/4" disk.  I really miss my Radio Shack TRS-80...

Anyways, 10 years ago several people told me "If it is not glass, you can kiss my a**".  Those people now use digital pathology in some way, shape or form or they left medicine to raise their family, sell furniture or cashed in several years ago on some old stock they had in a computer company named after a fruit but the name escapes me.

Lastly, there seems to be significant interest in the technology outside of the US for a myriad of reasons. While the US has about 80% of the world's pathologists and pathology sub-specialists, we only represent about 5% of the world's population.  There are many other markets but the story does not cover government or payor data for the EU, Asia, Middle East or other world regions. For pathology services providers I think this represents potential markets for customers likely in some sort of TC/PC arrangement but would add other billable deliverables (i.e. CPT 88305) to the equation of digital pathology market value. And folks will not wait for formal FDA clearance for primary H&E diagnoses to tap into these markets.