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Pathology and the Perils of Social Distancing

By Dr. Eric Glassy

On March 26, 2020, a little over a week after President Trump declared a national emergency, the Centers for Medicare and Medicaid Services (CMS) temporarily lifted the CLIA license requirement for the sign-out of pathology cases at remote locations. Details on the CMS announcement can be found here.

Pathologists can now perform primary diagnosis using digital pathology or glass slides at remote sites, away from the main hospital or laboratory. The waiver also includes the review of clinical pathology images and data, such as electropherograms, gel images, FISH, molecular tests, flow cytometry, and other diagnostic information. It is important to remember that the primary designated site must have a CLIA license and most importantly, appropriate validation studies have been performed, as approved by individual Laboratory Medical Directors. The CAP published criteria for validation in the Archives of Pathology, here.

Since that CMS waiver, many pathologists are taking advantage of the sign-out flexibility and minimizing their exposure to the SARS-CoV-2. They no longer have to travel to work and unnecessarily expose themselves to the circulating virus which puts them, their co-workers and their families at risk and also puts patients at risk for delayed care should pathologists be unable to diagnose cases due to illness or quarantine.

Digital pathology has certainly proven its worth in the midst of this pandemic. But with this opportunity comes risks— not from COVID-19 or mis-diagnoses or HIPAA violations. Rather, risks to our professional stature and relationship with colleagues.

Let’s face it, pathologists often engaged in social distancing well before COVID-19. As a specialty, we are not known for our interpersonal skills or extroverted style. We often suffer from the stigma of not being a real part of the patient care team, preferring to be office-bound.

We cannot allow the pandemic to make things worse and reinforce this perception. Remote sign-out means that there is even less chance for interaction with colleagues. It is important that during this pandemic, and as digital pathology becomes more widely adopted, we make liberal use of phone calls to our clinicians about cases and actively engage when attending virtual meetings. Be as visible as possible in in conversations and in your proactive outreach.

And after this pandemic abates, and pathology departments return to full staffing, we need to actively re-engage our medical staff, administration, and other members of the health care team, whether we are in person or taking advantage of working through remote pathology platforms

Remote sign out should not be seen as an excuse to avoid our responsibilities as pathologists.

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