Medical case review for all. PidPort, opening thefuture of regional cooperation

We interviewed Dr. Yuu Sawada, Professorof the Department of Dermatology, School of Medicine, University ofOccupational and Environmental Health, and Dr. Natsuko Sasaki, a lecturer inthe same department, about the background to PidPort’s introduction andexamples of its use.

Challenges before the introduction

・With purely online conferencing systems, it wasdifficult to select medical images and data from among other files, making itdifficult to hold conferences online.

・Because it was difficult to send documents containinga lot of data by email, participants were unable review detailed information inadvance.

・Information about a medical case was only sharedduring the conference and could not be reviewed after, so there were manylimitations on the participants’ experience.

Effectsafter the introduction

・The ability to manage data centrally in the cloud hasfacilitated the sharing and viewing of case photos and data, eliminatedoperational and facilitation challenges, and enabled online conferences to beheld regularly.

・Participants can now review cases in PidPort at anytime, allowing them to obtain a deeper understanding in advance of conferences.

・The number of participants has been increasing owingto conference popularity among doctors, as it is easy to participate from anylocation and easy to check case information, creating opportunities for activediscussions.

Please tell us details about theinitiative to hold case review meetings at the University of Occupational and Environmental Health.

My department at the University ofOccupational and Environmental Health, the Department of Dermatology, hosts theRegional Cooperative Pathology Conference in cooperation with doctors atclinics associated with the University of Occupational and Environmental Healthof Kitakyushu City. This initiative was started to examine the clinical presentationand pathological findings of selected cases, with a focus on cases from severalclinics in the vicinity of approximately ten participating institutions.

Normally, patients referred by clinics are treated atour hospital after skin biopsy and pathological examination. As there are fewopportunities for clinicians to see the pathology itself after they refer apatient, many clinicians are concerned about the pathology and diagnosis of thepatients that they have referred. In particular, dermatologists are moreinterested in visible presentation, such as the array of skin rashes, and manywant to know the pathology that determines the diagnosis, rather than simplypreparing the specimen and ending the process at that point. For example, weoften receive requests to review cases involving samples from referred patientsthat have been returned “malignant” yet carry some lingering doubts.Case review meetings are not held solely for the benefit of the participants. For clinicians, providingexplanations can also lead to new insights and learning opportunities. Having aforum to collaborate and exchange views in a face-to-face environment is alsovaluable for promoting stronger mutual cooperation and understanding. Weare also engaged in educating the young doctors, for example by opting toenliven forums by discussing rare cases, and we are employing various tacticsto make conferences interesting for the doctors.

We understand that you attempted to holdcase review meetings online once in the past, but gave up on the idea. Whatwere the challenges faced?

Doctors used to come to a university forcase review meetings. However, hosting conferences became difficult under thecoronavirus, and was suspended. As conditions improved and we sought to resumethis practice, many doctors had become accustomed to the online conferencingsystem, and many requested that conferences should be held online. Thus, weresolved to hold the case review meetings using an online conferencing system.

However, the online conferences were notmanaged very well. Case photos and data from the meeting system that we hadswitched to an online format were stored in the computer’s local file system,which caused issues with file sharing. For cutaneous cases, it isnecessary to look at the clinical presentation, the shape of the skin rash, andthe relationship between the pathology (virtual slides) and a magnified pictureof the skin (dermoscopy). To compare these, the target images needed to beselected from their folders and manually switched between. It was extremelydifficult to run the meeting while manipulating the screen at the same time,and there were times when the online conferencing system itself was almostclosed by mistake when an image file was closed. Furthermore, even if thematerial was shared in advance, the amount of data was too large and could notbe emailed; even if file transfer services were used, long download times wereinvolved; hence, sharing materials was always complicated.

Furthermore, files could not be edited while screen-sharing, making itinconvenient for the doctors to inspect specific areas that they wanted tomagnified or enlarge. These issues meant that the onlineconferencing system ceased to be used after only one attempt.

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How did the case review meetings changeafter you started using PidPort?

With the introduction of PidPort, casereview meetings have become part of our practice. Sharing data in the cloud wasthe optimal solution to the related difficulties with file sharing. Moreover, although virtual slides wereviewable in the electronic medical records from outside the hospital only fromapproved external institutions, with the cloud system’s stronger security, wecan now access data freely. Since adopting PidPort, virtual slides, clinicalphotos, and any other images can be centrally managed, and conveniently viewedwithout navigating between folders. As there are also doctors thatcome to the hospital in person, we are holding online–offline hybrid meetings,and although we continue to use the online conferencing system, switching filesno longer requires time; running the conferences has become a much morestreamlined process.

Doctors can now review previouslyhandled cases in their spare time, and at the same time as seeing the screenshared in the online conferencing system, can review virtual slides and otherimages of interest from their other devices at hand. Thus, the review ofmedical cases is facilitated for clinical doctors as well. It has only been inuse for approximately 3 months, but it is user friendly and remoteparticipation is possible, so it has received praise from doctors and thenumber of participants is increasing. We already have around 20 doctorsparticipating; since November 2023, once a month without fail, we analyzeapproximately 15 cases within only 90 minutes, leading to productivediscussions. In the future, we strive togradually increase participation and to promote strong regional collaboration.

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Thank you for reading to the end.

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