Computer‐ and Internet‐Based Tools for Neuropathology in the 21st Century

The rapid development of new technology in the overlapping areas of computing, telecommunications and robotics has had a tremendous impact on the practice of medicine. The clinical workspace has undergone a steady transformation with the introduction of sophisticated electronic monitoring tools, digital imaging systems in radiology and complex laboratory information systems and digital medical records. With increasingly sophisticated computing and data storage resources, robust telecommunications and expanding network bandwidth, continued technologic innovation is driving fundamental change in the delivery of health care.

There are many examples of these developments throughout medicine. In radiology, there has been a complete digital transformation of the radiology workspace. Picture archiving and communication systems (PACS) have developed into robust tools to manage the workflow and daily work experience of practicing radiology. In the transition to digital content, radiologists have gained access to a number of sophisticated computer‐aided diagnostic and analytical tools. In surgery, innovations in these same areas have found expression in the development of robotic surgical systems. These devices have continued the trend toward minimally invasive surgery initiated by laproscopic procedures. By adding benefits such as stabilization of instruments, mechanical advantages and improved visualization, robotic surgery has shown promise in providing greater ability to perform complex minimally invasive surgery. There is also evidence that robotic surgery can confer substantial advantages in clinical outcomes in subspecialty areas including urologic surgery (2).

Innovations in the same areas allowed critical care medicine to the adapt telemedicine into remote intensive care unit (ICU) programs. Using specialized systems to integrate technology to provide remote monitor access, information systems with access to patient data, PACS systems, audio–video conferencing and alerting systems, remote care teams are able to support the delivery and supervision of specialized care in ICUs. There are currently more than 30 remote ICU care programs with over 3000 beds. Driven at least in part by critical staffing challenges caused by a nationwide shortage of intensivists, these remote ICU care programs have been effective in extending critical care services to a larger population of ICU patients than would otherwise be possible (1).

The pace of technologic change, and therefore its direct impact, has been less dramatic in anatomic pathology and its subspecialties, including neuropathology. The tremendous technical challenges inherent in capturing, storing and efficiently transmitting the data contained in glass slides have provided a high barrier to the digital transformation of pathology material. Technologic innovation, as well as the availability of low‐cost storage, has begun to overcome these barriers, creating the possibility for the emergence of a digital pathology workspace. This change offers the possibility of new diagnostic and research tools to supplement traditional pathologic characterization of samples. The development of digital pathology, along with both its promise and challenges, is the topic of the first article in this mini‐symposium by Guzman and Judkins.

As with the challenge faced by intensivists in staffing ICUs, the demand for expert neuropathologic intraoperative diagnoses often exceeds the local supply. Horbinski and Hamilton reviewed the history and development of telepathology systems as one solution for providing expert neuropathology services in the face of widely distributed geographic needs. They also summarized their experience in using this technology in neuropathology over the past 8 years, drawing practical insights that are a useful guide for neuropathologists, more than a few of whom are likely to use these systems in the future.

The Internet and World Wide Web (www) provide both a structure to support much of the technology that facilitates these changes, as well as an incredibly powerful means for aggregating and disseminating information. Fung and Tihan reviewed key features of both the Internet and www that are essential for understanding these changes and their impact on the practice of medicine. While neuropathology content available through these resources is in its infancy, it is critical that neuropathologist become comfortable adapting these resources to their diagnostic and research work.

As we draw to the end of this first decade of the 21st century, neuropathologists can look forward to the continued introduction of technologies that promise to transform the pathology workspace, bringing new and innovative tools to our diagnostic and research efforts. It is our hope that these articles will provide a useful introduction to some of the key developments that have and will continue to impact the practice of neuropathology. In so doing, hopefully, we will not only draw your attention, but also stimulate you to engage in leadership roles to guide the further development and implementation of these tools. It is only by doing this that we will be able to determine the kind of tools that will come to characterize the art and science of neuropathology in the 21st century.