Not that long ago, the typical pathology lab ran its laboratory information system on a server tucked into a closet down the hall. Someone from IT babysat it. Upgrades meant weekend downtime. If a pathologist wanted to sign out cases from home, the answer usually involved a clunky VPN, a lot of patience, or a flat no.
That picture looks very different now. Across the U.S., labs have steadily moved their core software off local servers and into the cloud, and the holdouts are getting fewer every year. That shift was a big deal on its own. It also set the stage for the next one, which is already underway: digital pathology.
Why Labs Left the Server Closet
The move to the cloud didn’t happen because cloud sounded trendy. It happened because on-premise systems kept creating headaches labs no longer wanted to deal with.
Running an LIS locally means owning everything underneath it. The lab buys the servers, replaces them every few years, handles backups, patches security holes, and plans for disaster recovery. For a hospital system with a large IT department, that’s manageable. For an independent pathology group or a mid-sized reference lab, it’s a constant drain on time and budget that has nothing to do with diagnosing patients.
Cloud-hosted systems took most of that off the lab’s plate. The vendor handles the infrastructure, the updates, and much of the security work. Upgrades roll out without a weekend of downtime. Capacity grows with the lab instead of requiring a new hardware purchase.
What the Cloud Changed for Pathologists
The bigger change showed up in how pathologists work. Once the LIS lived in the cloud, it stopped being tied to a building.
Pathologists could review cases and sign out reports from another hospital, a satellite site, or their kitchen table. Groups that covered several facilities could share work across locations instead of sending people driving between them. Labs that acquired other practices could bring them onto one system without stringing together networks.
That flexibility mattered even more as pathologist shortages put pressure on staffing. A lab that can route work to whoever has capacity, wherever they are, keeps turnaround times under control far better than one that can’t.
The Missing Piece: The Slides
Here’s the catch. Even with a cloud LIS, most labs still run on glass. The case lives online, but the slides live in a tray. A pathologist can open the case from anywhere, yet still has to be physically in front of a microscope to actually read it.
That gap is why digital pathology is the natural next step. Scanning glass slides into whole slide images puts the actual diagnostic material online, right alongside the case. The same flexibility labs gained by moving their LIS to the cloud can finally extend to the slides themselves.
Adoption is still early. Only about one in ten U.S. labs has adopted digital pathology so far. But the pieces are lining up. Scanners have gotten faster and more reliable. Storage costs keep dropping. And digital pathology now has more than 40 Category III add-on codes, which gives labs a path to get paid for the extra work digitization involves.
What Digital Pathology Opens Up
For labs that already made the jump to the cloud, digital pathology builds on what they started.
Remote sign-out becomes truly remote, since pathologists no longer need glass in hand. Second opinions and consults move faster because a colleague across the country can open the same slide in minutes instead of waiting for a courier. Subspecialists can support multiple sites without relocating. Archived cases become easier to pull up for comparison, teaching, or tumor boards.
Digital slides also lay the groundwork for AI tools. Image analysis and decision-support software need digital images to work with. Labs that never digitize can’t take advantage of those tools no matter how good they get.
Where Labs Get Tripped Up
Plenty of early adopters have found that going digital made them slower at first, not faster. The scanner usually isn’t the problem. The workflow is.
In many setups, digital pathology gets bolted onto the existing system. The case stays in the LIS while the images land in a separate image management system, connected by an interface that tries to match one to the other. Pathologists read in one window and report in another. Lab staff track scanned and glass cases in different queues and chase down failed scans by hand. Someone has to confirm every slide in a case got scanned before it goes to the pathologist, and too often nobody catches a missing stain until the pathologist opens the case.
Every one of those handoffs costs time, and some carry real risk. When images and cases live in two systems, keeping the right slide attached to the right patient depends on an interface and the people watching it.
Doing It the Right Way
Labs that get the most out of their digital pathology software tend to treat it as a workflow project rather than a hardware purchase. A few things make a big difference:
- Keep the case and its images in one record so slides stay tied to the right patient automatically
- Run digital and glass cases through the same worklist and rules
- Track every expected slide, including recuts and stains, before a case reaches the pathologist
- Turn failed or blurry scans into tracked tasks instead of things someone has to remember
- Capture digital billing codes on the case rather than reconciling them by hand later
Labs also don’t need to flip a switch overnight. Most start with one site, one specialty, or a small group of pathologists, then expand once the workflow proves itself. Working with existing scanners and viewers keeps the upfront investment manageable.
The Same Logic, One Step Further
The move to the cloud was about freeing the lab from its building. Pathologists gained the ability to work from anywhere, and labs stopped spending energy on servers. Digital pathology follows the same logic one step further by freeing the diagnosis itself from the microscope.
Labs that already run in the cloud are in the best position to make that move. The infrastructure is there. The remote workflows are there. What’s left is getting the slides online and making sure the system that runs the lab treats them as part of the case, not an afterthought.