Innovative technologies for digital imaging and telecommunications are changing the way we deliver health care. Telepathology collaborations are one example of how delivering remote pathology services to patients can benefit from leveraging this change. Over the years, several academic and commercial teleconsultation networks have been established. Herein, we review the landscape of these international telepathology efforts and highlight key supportive factors and potential barriers to successful cross-border collaborations. Important features of successful international telepathology programs include efficient workflows, dedicated information technology staff, continuous maintenance, financial incentives, ensuring that all involved stakeholders are satisfied, and value-added clinical benefit to patient care. Factors that plague such telepathology operations include legal/regulatory issues, sustainability, and cultural and environmental issues. Pathologists, vendors and laboratory accreditation agencies will need to embrace and capitalize on this new paradigm of international telepathology accordingly.

Keywords:
Digital pathology, Informatics, International telepathology, Whole-slide imaging
1.
World Health Organization: Trade, Foreign Policy, Diplomacy and Health: Globalization. Geneva, World Health Organization, http://www.who.int/trade/glossary/story043/en/ (accessed April 5, 2015).
2.
Wamala DS, Augustine K: A meta-analysis of telemedicine success in Africa. J Pathol Inform 2013;4:6.
3.
Zhao C, Wu T, Ding X, Parwani AV, Chen H, Lauro GR, Feng X, Wu S, Yousem S, Pantanowitz L: International telepathology consultation: two years of experience between the University of Pittsburgh Medical Center (UPMC) and KingMed (China). J Pathol Inform 2014;5:S33-S34.
4.
Park S, Parwani AV, Aller RD, Banach L, Becich MJ, Borkenfeld S, Carter AB, et al: The history of pathology informatics: a global perspective. J Pathol Inform 2013;4:7.
5.
Oberholzer M, Christen H, Haroske G, Helfrich M, Oberli H, Jundt G, et al: Modern telepathology: a distributed system with open standards. Curr Probl Dermatol 2003;32:102-114.
6.
Brauchli K, Kurt B, Martin O: The iPath telemedicine platform. J Telemed Telecare 2005;11:3-7.
7.
Kayser K, Borkenfeld S, Djenouni A, Kayser G: History and structures of telecommunication in pathology, focusing on open access platforms. Diagn Pathol 2011;6:110.
8.
Virtual International Pathology Institute (VIPI): DiagnomX GmbH. http://www.diagnomx.eu/vipi/home.php (accessed September 29, 2015).
9.
Pantanowitz L, Wiley CA, Demetris A, Lesniak A, Ahmed I, Cable W, et al: Experience with multimodality telepathology at the University of Pittsburgh Medical Center. J Pathol Inform 2012;3:45.
10.
Minervini MI, Yagi Y, Marino IR, Lawson A, Nalesnik M, Randhawa P, et al: Development and experience with an integrated system for transplantation telepathology. Hum Pathol 2001;32:1334-1343.
11.
Romero Lauro G, Cable W, Lesniak A, Tseytlin E, McHugh J, Parwani A, Pantanowitz L: Digital pathology consultations - a new era in digital imaging, challenges and practical applications. J Digit Imaging 2013;26:668-677.
12.
Saliba V, Legido-Quigley H, Hallik R, Aaviksoo A, Car J, McKee M: Telemedicine across borders: a systematic review of factors that hinder or support implementation. Int J Med Inform 2012;81:793-809.
13.
Carter AB: Stepping across borders into the future of telepathology. J Pathol Inform 2011;2:24.
14.
Weinstein RS, Descour MR, Chen L, Bhattacharyya AK, Graham AR, Davis JR, et al: Telepathology overview: from concept to implementation. Hum Pathol 2001;32:1283-1299.
15.
Kayser K, Szymas J, Weinstein R: Telepathology and Telemedicine: Communication, Electronic Education, and Publication in e-Health. Berlin, VSV Interdisciplinary Medical Publishing, 2005.
16.
Dunn BE, Choi H, Recla DL, Kerr SE, Wagenman BL: Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience. Hum Pathol 2009;40:1092-1099.
17.
Halliday BE, Bhattacharyya AK, Graham AR, Davis JR, Leavitt SA, Nagle RB, et al: Diagnostic accuracy of an international static-imaging telepathology consultation service. Hum Pathol 1997;28:17-21.
18.
Nordrum I, Engum B, Rinde E, Finseth A, Ericsson H, Kearney M, et al: Remote frozen section service: a telepathology project in northern Norway. Hum Pathol 1991;22:514-518.
19.
Kaplan KJ, Burgess JR, Sandberg GD, Myers CP, Bigott TR, Greenspan RB: Use of robotic telepathology for frozen-section diagnosis: a retrospective trial of a telepathology system for intraoperative consultation. Mod Pathol 2002;15:1197-1204.
20.
Wilbur DC, Madi K, Colvin RB, Duncan LM, Faquin WC, Ferry JA, et al: Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations. Arch Pathol Lab Med 2009;133:1949-1953.
21.
Furness P: A randomized controlled trial of the diagnostic accuracy of internet-based telepathology compared with conventional microscopy. Histopathology 2007;50:266-273.
22.
Evans AJ, Runjan C, Clarke BA, Sidney C, Ghazarian DM, Tim-Rasmus K, et al: Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience. Hum Pathol 2009;40:1070-1081.
23.
Goode A, Gilbert B, Harkes J, Jukic D, Satyanarayanan M: OpenSlide: a vendor-neutral software foundation for digital pathology. J Pathol Inform 2013;4:27.
24.
Ho J, Ahlers SM, Stratman C, Aridor O, Pantanowitz L, Fine JL, et al: Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization. J Pathol Inform 2014;5:33.
25.
Weinstein RS, Graham AR, Richter LC, Barker GP, Krupinski EA, Lopez AM, et al: Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future. Hum Pathol 2009;40:1057-1069.
26.
Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, et al: American Telemedicine Association clinical guidelines for telepathology. J Pathol Inform 2014;5:39.
27.
Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, et al: Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2013;137:1710-1722.
28.
Thrall MJ, Wimmer JL, Schwartz MR: Validation of multiple whole slide imaging scanners based on the guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2015;139:656-664.
29.
Lowe J: Telepathology: Guideline from the Royal College of Pathologists. http://www.rcpath.org/Resources/RCPath/Migrated%20Resources/Documents/G/G026_Telepathology_Oct13.pdf (accessed April 10, 2015).
30.
Canadian Association of Pathologists Telepathology Guidelines Committee, Bernard C, Chandrakanth SA, Cornell IS, Dalton J, Evans A, et al: Guidelines from the Canadian Association of Pathologists for establishing a telepathology service for anatomic pathology using whole-slide imaging. J Pathol Inform 2014;5:15.
31.
Bagayoko CO, Müller H, Geissbuhler A: Assessment of Internet-based tele-medicine in Africa (the RAFT project). Comput Med Imaging Graph 2006;30:407-416.
32.
Ahmed SN, Mann C, Siddiqui F, Sheerani M, Syed NA, Snyder T, Enam SA, Boling W: Experiences from an international tele-epilepsy collaboration. Can J Neurol Sci 2009;36:582-586.
33.
Fitzgerald R: Medical regulation in the telemedicine era. Lancet 2008;372:1795-1796.
34.
LeRouge C, Garfield MJ: Crossing the telemedicine chasm: have the U.S. barriers to widespread adoption of telemedicine been significantly reduced? Int J Environ Res Public Health 2013;10:6472-6484.
35.
Mosquera M: Sen. Udall drafting bill to kill telemedicine barriers. Government Health IT, 2012. http://www.govhealthit.com/news/udall-drafting-bill-remove-telemedicine-barrier (accessed February 2, 2012).
36.
Nakashima N, Shimizu S, Okamura K, Hahm JS, Kim YW, Han HS, et al: Development of a broadband telemedical network based on internet protocol in the Asia-Pacific region. Methods Inf Med 2007;46:709-715.
37.
Martínez Álvarez M, Chanda R, Smith RD: How is telemedicine perceived? A qualitative study of perspectives from the UK and India. Global Health 2011;7:17.
38.
Williams BH, Mullick FG, Butler DR, Herring RF, O'leary TJ: Clinical evaluation of an international static image-based telepathology service. Hum Pathol 2001;32:1309-1317.
39.
Zbar RI, Otake LR, Miller MJ, Persing JA, Dingman DL: Web-based medicine as a means to establish centers of surgical excellence in the developing world. Plast Reconstr Surg 2001;108:460-465.
40.
Zolfo M, Arnould L, Huyst V, Lynen L: Telemedicine for HIV/AIDS care in low resource settings. Stud Health Technol Inform 2005;114:18-22.
41.
Jarvis L, Stanberry B: Teleradiology: threat or opportunity? Clin Radiol 2005;60:840-845.
42.
Swinfen R, Swinfen P: Low-cost telemedicine in the developing world. J Telemed Telecare 2002;8(suppl 3):63-65.
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