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From Bricks to Clicks: Deeper Levels of Innovator's Dilemma

If you have not had a chance to read Clayton Christensen's Innovator's Dilemma, you may wish to move it to the top of your reading list. Or, if you prefer, you can watch "a disruptive innovation" unfolding right in front of your eyes.

A couple of days ago, a press release announced a partnership between LD Path and Ibex Medical Analytics to roll-out the first clinical-grade #AI-assisted cancer diagnostics service in the UK. LD Path is one of several established independent histopathology businesses that have found their market fit by servicing the capacity gap of the fragmented and understaffed NHS Pathology laboratories. The company operates as a platform service that provides subspecialist histopathology reporting. A timely switch to digital pathology and lean logistics enabled and simplified distributed work. This proved to be an attractive proposition for a number of experienced pathologists prepared to offer 'as and when', reporting from home in their own time. By endorsing AI power-tools, LD Path can now aspire to become a more substantial player on the cancer pathology market, traditionally serviced by local NHS laboratories and local pathologist.

This development needs to send a clear signal to every organisation that currently runs histopathology service and to every leader trying to grasp the elusive nature of strategic inflection. Complacency or a frequently repeated local quality and local relationships narrative may not hold for long in the post-pandemic healthcare ecosystem. I can see many commercial avenues that strategically savvy NHS or independent laboratories may wish to pursue.

By leveraging digital technology and the platform business model, providers who can secure reporting capacity by engaging the scarcest resource in the system- pathologists- could start offering a range of affordable solutions to geographically remote laboratories struggling with recruitment and retention. These can range from ad-hoc to fully integrated overflow solutions. As we showed a few years ago with EASY Path project, all that is required to kick-start this type of collaborative venture is a high-throughput scanner, a bit of IT integration, and lot of goodwill. And since 2016, the equipment got better more affordable.

In this context, the introduction of clinical-grade AI in the UK pathology market is likely to be a real game-changer. First, the significance of particular clinical-grade AI solutions introduced by Ibex Medical Analytics goes beyond its specific clinical application. In the context of the disruptive potential of distributed pathology services, they can be pivotal for building the confidence of users who are accustomed to the service under the same roof. I am sure that as we scale up digital pathology, we will also witness the emergence of services specialising in quality assurance assisted by computational pathology power tools. Second, the pathologists, understanding the vulnerability of their position in the diagnostic chain, and the seller's job market will naturally gravitate towards the systems that can support them to deliver clinically excellent and safe service for their patients. In the platform business model, pathologists are also users and have a choice.

The unavoidable fact about the disruptive potential of the platform service model is that it cuts through walls and micro-monopolies; the advantage is on the side of those who are open and integrative. This may not be a disadvantage for the forward-thinking NHS organisations. The momentum behind the integration of pathology services, system support for the implementation of digital pathology, a simple method to minimise transactional costs, and growing enthusiasm for remote work can provide a unique opportunity for NHS services, the emerging networks and Integrated Care Systems, with a political and organisational will to engage at scale and integrate technology, processes, and workforce and move from 'bricks' to 'clicks'.

 We will revisit computational pathology on these pages, over and over again. I certainly do not see the AI tide through a lens of dystopian trajectory to the technological singularity. Pathologists are not going to become redundant, and we are not going to merge our minds with machines to transcend our diagnostic selves. The field is more likely to resemble advanced chess. Advanced chess games are played between teams comprising both humans and machines. Interestingly, many tournaments are not won by top tier grandmasters or those equipped by most powerful computers, but the teams who coached themselves to optimise the use of computers to combine positional judgment of a human with the calculating ability of a computer.

But let's hear about AI from the source. Our next guest speaker on Wednesday 15 July 2020, 13:00-14:00 BST will be Dr Judith Sandbank. Register by following the link.

Judith is the pioneer of the implementation of Artificial Intelligence in clinical practice. In collaboration with Ibex Medical Analytics, she has led the first successful implementation AI in the routine diagnostic practice in the World! Since 2018, Maccabi Pathology implemented clinical-grade computational pathology tools to assist pathology diagnostics of prostate and breast cancer. For colleagues who are closely following the field, this development does not come as a surprise. Israel's Maccabi Healthcare Services is widely recognised as a unique and innovative healthcare system, and Ibex Medical Analytics is the pioneer in artificial intelligence-based cancer diagnostics in pathology.



However, when we turn our eyes away from our devices, software power tools, and technological promises, we cannot fail to notice that our 'living strategy' may not be fit to address the gaps additionally exposed by the pandemic. Shortage of pathologists is only a part of the problem, and we may be able to tackle it from a few angles. System interventions like consolidation, technology, standardisation, and distributed work will make processes better and more efficient. They will also help make the profession become a more attractive career choice. Reformatting the profile of our diagnostic teams through the scaling up of the existing or introduction new professional roles will enable different delegation of tasks and leveraging expertise which is out of the scope of medically qualified pathologists. We will discuss the strategic potential of advanced diagnostic power teams in another article. Nevertheless, the fundamental challenge of any knowledge work will always be its knowledge and skills base. And its rapid expansion, in particular through the advances of 'omic' and needs to develop multimodal, highly-specialised diagnostics, is going to stretch our ability to provide modern and equitable pathology. In simple terms, borrowed from IT, since we cannot upgrade our brains to cope with cognitive overload, we need to upgrade the ways that we train and learn. Reflecting on the lessons from the lockdown, I have recently had interesting discussions about this topic. Digital and distributed pathology, could help us to up the game of life-long development to the entirely new level. Learning from the examples from other industries, we can, for example, introduce bespoke, accelerated, and consistently relevant learning. At the end of the day, we are teaching people; pathology is only content. We will also have a chance to switch from the pseudo-competitive and marginal gains approach to learning in teams and as teams. And pathology education and training probably should and will become unrestricted by geography. Over the last few months, same as many colleagues, I spent a lot of time topping up my Continuous Professional Development portfolio online. Many forward-thinking colleagues recognise the need for new, high-quality and user-friendly content. Out of curiosity and with a leap of faith, I have joined a gynaecological pathology online journal club. I have to admit that I haven't attended a journal club for years; never with an unknown audience on the other side of the World. But since I welcome the international participation at the #dPath20 Webinars that I produce I had no excuse. Despite being a bit camera shy – even a self-professed extrovert gets a dent in self-confidence after the lockdown-style haircut expertly created by his ten-year-old daughter- it was a great experience—one of the best I've had for years. It was an incentive to read a few expertly selected papers, the opportunity to focus on the relevant topic and an hour spent in a friendly international company. I am looking forward to the next one. The journal club is superbly organised, structured, and competently chaired by @Natalie Banet, a pathologist from Rhode Island. Natalie also produces Deeper Levels, a very interesting podcast about pathology, medicine and science. Mostly Before we go. Recordings of our previous webinars are now available; please follow the links here and here and let us know if there are problems with access. Jonin us at our next #dPath20 Webinar by using the Registration Link. #dPath 20 is hosted by South Yorkshire and Bassetlaw Pathology Transformation Programme and Bradford University Digital Health Enterprise Zone. The Webinar is supported by the media team from Bradford University and will be moderated by Branko Perunovic and Samar Betmouni

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