Telepathology in Canada

By Nancy Gupta and Sukirtha Tharmalingam

When disease is suspected, how long does it take a patient to go from biopsy to diagnosis and treatment plan? It depends where you live. Across Canada, it can take anywhere from days, weeks, or months.

woman looking through telescope in laboratory

One possible factor contributing to this variance is the need for review by highly trained subspecialty pathologists, who are in short supply (approx. four pathologists/100,000 population of Canada; there were only 1,565 pathologists in Canada in 2018) and concentrated in major urban centres. Additionally, pathology relies on peer review and second opinion, which usually requires that samples of glass slides be transported between sites. This extra step can add to the delay in diagnosis for patients.

Telepathology addresses these challenges by enabling access to pathology services using a network and whole-slide imaging systems that link pathologists to virtual slides. Rather than transporting glass plates, they can review digital images. Canada Health Infoway, along with provincial/territorial partners, began investing in telepathology to improve health care delivery for Canadians.

Dr. Andrew Evans pioneered telepathology in Canada in 2003 at University Health Network and started creating a digital pathology network system. So far, important progress has been made in the use of telepathology across jurisdictions to provide pathology services in remote and rural areas without a resident pathologist, connecting pathologists with specialists and sub-specialists to review complex cases.

Telepathology can also be used to deliver pathology services across provincial boundaries. The first phase of the Multi-Jurisdictional Telepathology Project, which supports secondary consultation among pathologists and includes Ontario, Manitoba and Newfoundland and Labrador, was implemented in 2018. The evaluation of this project found promising results, which you can read about in the full evaluation report.

In addition to connecting geographically distant members of the health care team, telepathology can improve workflow efficiencies. Dr. Bernard Têtu has seen this first-hand after helping to introduce telepathology in Quebec: “…the patients are the first to be benefited from telepathology because it avoids transfers. It avoids two-stage surgeries.” He also notes benefits for pathologists working remotely. “The pathologist who practices alone is no longer alone. Like some of my pathologist colleagues have said, we now have virtual colleagues.”

While realizing the benefits of telepathology, the complex and dynamic nature of the health care system should not be underestimated. Organizational leadership and mutual collaboration between the pathologist-technologist-surgeon trio are some of the critical factors required for successful implementation.

To learn more about the different models used to connect pathology services across the country including their impact and challenges in implementation and adoption, read our background summary.

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About the authors
Nancy Gupta

Nancy Gupta

Nancy Gupta is a Performance Analyst with Canada Health Infoway where she supports data driven decision making and evaluates the impact of digital health investments. She holds a Master’s in Public Health-Specialization in Epidemiology from Lakehead University.

Sukirtha Tharmalingam

Sukirtha Tharmalingam

Sukirtha Tharmalingam is Manager of Evaluation Methods at Canada Health Infoway where she works with diverse stakeholders and partners to evaluate the impact of digital health investments.