Sanjai Nagendra, MD, MMM, Medical Director of Center for Esoteric Testing, Atlantic Regional Laboratories, Laboratory Corporation [NYSE: LH]
It is estimated that 70 percent of medical decisions are made based upon the results of tests performed in the laboratory. Technological changes continue to revolutionize the laboratory industry. These changes will have a dramatic impact on Indian healthcare in the next decade. There are four significant areas of advancement in laboratory medicine: Digital pathology, artificial intelligence, smartphone medicine, and precision medicine.
"Although digital pathology programs are expanding across India, there are many challenges"
By 2030, 60 percent of India’s population will still be concentrated in rural areas with limited access to medical care and technology. As living standards continue to ris, and people adopt westernized lifestyles, the global incidence of cancer will increase 75 percent from 2008 levels by 20301. If the current system stays in place and with the shortage of rural pathologists and laboratories, many of these cancers will needlessly go undiagnosed.
Technological innovation is an essential in improving healthcare delivery. One such innovation is digital pathology. Traditionally, pathologists examine glass slides from sections taken from cancer. To avoid excessive turn-around-time issues, the examination is usually performed close to the site of surgery in large cities. Due to technological advancement, traditional glass slides can now be scanned, converted to digital images, sent through the Internet and examined by a pathologist anywhere in the world. Here is a scenario of the current and future state:
CURRENT: A 58-year-old woman in rural Bihar notices a lump in her left breast. She goes to the local surgeon who takes a biopsy of the mass. The slides are prepared locally, but no pathologist is available in the area to interpret the slides. Because of the vast distances, the slides are sent to the pathologist in Patna by courier. Unfortunately, the glass slides arrive in Patna broken; no diagnosis can be rendered.
FUTURE: After the surgeon takes a biopsy of the mass, the slides are prepared locally. The technician scans the slide digitally and sends the images to a pathologist in Patna. The pathologist in Patna is not 100 percent sure of the diagnosis and immediately sends the image to his colleagues in Delhi. A diagnosis is rendered to the patient two days after surgery, and treatment for cancer begin immediately after that.
Although digital pathology programs are expanding across India, there are many challenges. Prices are continuing downward. However, the costs of scanners and storage are still very high. Having been trained to read glass slides through the microscope, many pathologists are also resistant to reading digital images. Despite these obstacles, digital pathology promises to be an exciting technological innovation which can improve patient care.
Artificial intelligence (AI) and machine learning -technology will also significantly improve patient care in the future. In the current state, pathologists meticulously evaluate multiple slides for the presence or absence of disease. The examination is cumbersome and subject to human error. However, with the help of AI and machine learning generated algorithms, the images can be pre-screened by a computer and then examined by a pathologist for final verification. This method will allow pathologists to render near 100 percent accurate diagnoses with much-improved turn-around-times.
Smart phone Medicine
India’s smartphone usage continues to rise exponentially; it is estimated that 36% of Indians will own a smart phone by 2022. Smartphones attached to accessories will be able to perform many different tests, including blood counts, urine analysis, diabetes testing, cancer diagnosis, and fertility testing. This technology has the potential of revolutionizing care in rural India. Laboratory centers can be set up in the most rural parts of India; people will no longer need to go to cities to access routine laboratory testing.
Rise of Precision Medicine
Currently, medical diagnoses, guidelines, and treatments are based upon clinical studies of diverse population groups. However, with the rise of medical informatics and genomics, a new science of precision medicine has been born. Simply defined, precision medicine is providing the right patient the right drug at the correct dose at the right time.
For example, in the current state, a cancer patient is given a particular chemotherapy drug based upon statistics drawn from a large pool of people. This is a one size fits all approach. With the advent of precision medicine, the appropriate drug is chosen for the individual patient based upon the tumor’s DNA sequence. These targeted therapies will improve cancer survival rates.
In the future, the technological advancements in Pathology and Laboratory Medicine will provide patients with improved access to healthcare. These improvements will hopefully bridge the health care delivery gap between agrarian and urban centers and offer improved care to all.