The Interoperability Gap in Digital Pathology
What Interoperability Really Means in Digital Pathology
TL;DR
Digital pathology has progressed rapidly, but many workflows remain fragmented behind the scenes.
Technical connectivity between systems does not automatically result in usable, end-to-end workflows.
Interoperability challenges are largely structural, driven by voluntary standards adoption and limited enforcement.
True interoperability requires semantic and workflow alignment, not just data exchange.
Interoperability must be deliberately designed to enable scalable, future-proof digital pathology.
Intro
Digital pathology has come a long way over the past decade. What started as an experiment evolved into pilot projects and, eventually, into something that simply became part of daily practice.
Glass slides went digital. Screens replaced microscopes. Remote access and global collaboration stopped being remarkable, and AI algorithms, they moved from research concepts to real conversations in the lab.
And yet, behind the scenes, many digital pathology workflows remain far more fragmented than we ever imagined they would be.
The reality today: connected, but not cohesive
Most laboratories operate within a heterogeneous ecosystem:
Scanners from different vendors, each producing different file types
Multiple viewing environments depending on the task at hand
External AI and image analysis tools developed outside the core platform
LIS or LIMS systems that long predate digital pathology
On paper, each system does its job well. In practice, workflows are often stitched together in ways that mostly work. Until they don’t...
That breaking point rarely looks dramatic. It often looks like reopening the same case in yet another system. Exporting screenshots because context gets lost. Manually re-entering metadata because systems can’t reliably share meaning.
Pathologists flip between windows and IT teams maintain fragile integrations.
Over time, these workarounds quietly pile up.
Fragmentation doesn’t just slow people down. It limits what digital pathology can actually become.
If digital pathology is to mature clinically, operationally, and scientifically, interoperability isn’t optional; it’s foundational.
Why fragmentation becomes a bottleneck
Fragmentation creates friction across multiple dimensions:
Scalability
Every new scanner, AI tool, or use case requires custom integration work. Growth becomes linear instead of repeatable.
Efficiency
Manual steps, context switching, and duplicated actions consume time that should be spent on diagnostics and research.
Future-proofing
When integrations are bespoke, adapting to new regulations, standards, or technologies becomes risky and expensive.
Most importantly, fragmentation caps innovation. Advanced workflows, AI at scale, cross-site collaboration, secondary use of data, depend on systems that can work together meaningfully, not just exchange files.
What interoperability really means (and why it’s often misunderstood)
Interoperability is frequently treated as a purely technical checkbox:
Can system A send data to system B?
But that definition falls short.
HIMSS, a global authority on health IT maturity, defines interoperability not merely as data exchange, but as the ability of different systems and organizations to consistently interpret, use, and act on exchanged information across workflows.
In other words: Interoperability isn’t just about connections, but about meaning and action.
This helps explain a common frustration in pathology today:
Systems are technically “connected,” yet workflows still feel fragmented.
Many integrations operate at a foundational or structural level, data can move - but struggle to reach semantic and workflow interoperability. Context is lost, assumptions break, and users are left bridging the gaps manually.
A structural problem, not just a technical one
Fragmentation in digital pathology isn’t accidental, it’s structural.
Unlike EHRs, digital pathology never had an equivalent of large-scale programs like Meaningful Use, where interoperability was enforced through certification, testing, and financial incentives. As a result:
Standards such as HL7, DICOM, FHIR, and IHE are often implemented only partially
Conformance is largely voluntary
End-to-end validation across workflows is rare
Initiatives like IHE and DICOM Connectathons clearly demonstrate that interoperability is possible. But without regulatory or procurement enforcement, they don’t guarantee that interoperable workflows are actually deployed in production environments.
Since most hospital tenders do not explicitly require concrete IHE transaction support, vendors continue to rely on custom integrations. Fragmentation persists, not because standards don’t exist, but because adherence is optional.
The business impact is significant:
Integration effort increases
Time to market grows
Each deployment becomes a bespoke project rather than a scalable rollout
Interoperability is also a human problem
Even when systems are technically integrated, workflows can still fail in practice.
We regularly hear frustrations from pathologists who receive limited guidance on how different systems fit together. The tools may be connected, but users are not always supported or involved in shaping the workflow.
That’s where interoperability meets usability.
Systems don’t operate in isolation - people do.
If users aren’t supported, trained, and considered in design decisions, fragmentation simply shifts from the technical layer to the human one.
This is where our philosophy of connecting pixels with people truly comes to life.
Our philosophy: interoperability by design
We start from a simple premise:
Interoperability cannot be taken for granted. It must be deliberately designed.
Our approach is grounded in three principles:
Absorb variability at the integration boundaries
Real-world environments are messy. We design our platform to handle heterogeneity rather than fight it.
Preserve semantic meaning at the core
Data isn’t just data. Context, structure, and intent matter if systems are to work together meaningfully.
Align with standards and IHE profiles: practically, not theoretically
We don’t treat standards as a checkbox, but as a roadmap toward future certification-driven interoperability.
A concrete example is LIS integration. Many mature LIS platforms still rely on proprietary or customized HL7 variants rather than full end-to-end IHE PaLM workflows. Instead of forcing laboratories into unrealistic migrations, we normalize these real-world messages into a canonical internal model.
This allows labs to operate effectively today, while staying aligned with IHE-based workflows and future certification requirements.
Looking ahead
Initiatives like the European Health Data Space may become an inflection point but only if combined with concrete certification and testing frameworks, such as mandatory IHE-style conformance. Without that pressure, fragmentation doesn’t disappear; it merely shifts layers.
Digital pathology has proven its value. The next phase isn’t about adding more tools, it’s about making them work together.
Interoperability is not a feature. It’s the foundation that allows digital pathology to scale, mature, and truly deliver on its promise.
And ultimately, it’s about more than systems. It’s about enabling people. Pathologists, researchers, and IT teams to work seamlessly, confidently, and together.