Memorial Sloan Kettering Cancer Center implements full digital pathology workflow for primary diagnosis and archive access

MSK needed to manage a high volume of outside slides (30% of cases) that had to be returned quickly, creating medical-legal risks around losing critical slides. Pathologists also lacked instant access to archived prior slides, requiring manual retrieval from a slide file room, which slowed clinical workflows at a high-volume cancer center.

MSK implemented whole slide imaging starting with archival scanning, then progressed to primary digital sign-out. Slides were integrated with the laboratory information system, enabling pathologists to instantly access any patient's prior scanned pathology without manual retrieval. The program followed a phased approach from archival use to remote diagnosis validation.

By 2020, approximately 90% of faculty pathologists reported comfort signing out digitally with glass slides available on request, up from less than 25% in 2018. Instant access to archived slides fundamentally transformed pathology workflows and clinical patient care, eliminating the prior manual retrieval process entirely.

• Institutional leadership buy-in from the start is critical; framing digital pathology around a clear quality or operational need (e.g., archival, medical-legal risk) is more persuasive than abstract ROI arguments.
• Adoption follows a natural curve — early skeptics often become the strongest advocates once they experience the workflow benefits firsthand.
• A phased approach works but, in retrospect, a more aggressive 'big bang' rollout covering all use cases at once may drive value faster given today's more mature technology.