For a growing laboratory network, extending pathology coverage involves more than adding equipment. Specimens need to be prepared, images reviewed, and findings communicated across locations — often under time pressure. In this webinar, HNL Lab Medicine shares how it built digital pathology workflows around its existing teams.
In a Pathology News webinar, three HNL Lab Medicine leaders explained how their organization approached this challenge: Kelly Frankenfield, Vice President of Pathology Operations; Elizabeth Moy, Pathology Gross Room Manager; and Dr. Sajjad M. Malik, Medical Director of Digital Pathology.
Their experience shows how digital imaging can fit into existing teams, with clear responsibilities for the people preparing specimens and the pathologists reviewing them.
HNL uses complementary scanning approaches for different clinical needs.
At its centralized histology operation, high-throughput scanners support routine surgical pathology. At selected remote hospital sites, Grundium Ocus M20 scanners support frozen section review, connecting locally prepared slides with a pathologist working elsewhere.
Placement depends on more than distance. Moy explained that a remote site also needs a qualified pathologists’ assistant (PA), or other appropriately trained personnel, to handle tissue and support the workflow.
For HNL, this meant choosing locations where local specimen preparation and remote review could work together. The approach allows pathologists to review frozen sections without being physically present at every participating site.
HNL’s frozen section workflow offers a concrete example of how responsibilities evolved during implementation.
Initially, the team tested having the PA complete scanning before the pathologist reviewed the image. It seemed straightforward, but testing revealed an interruption: the PA had to step away from the cryostat and move to a computer, sometimes while additional tissue still needed preparation.
HNL changed the handoff.
In the revised workflow, the PA or technical assistant loads the slides and initiates the overview scan. The pathologist then remotely selects the diagnostic area and completes scanning. Meanwhile, the PA can continue preparing additional tissue or levels.
As Moy put it: “The PA starts the scan; the pathologist finishes the scan.”
This division of work gives the pathologist control over diagnostic scanning while allowing specimen preparation to continue. The pathologist remains responsible for interpreting the image and communicating the findings directly to the surgical team.
Moy reported an average digital frozen section turnaround time of approximately 20–25 minutes, measured from specimen receipt to the result callback. That figure describes HNL’s experience with its own workflow; it is not a guaranteed turnaround time for other laboratories.
HNL’s presenters emphasized that reliable remote review depends on communication, training, and infrastructure.
The operating room, gross room, and pathologist need to know when a specimen arrives, when images are ready, and whether additional material is required. HNL uses Microsoft Teams to support coordination between the gross room and the reviewing pathologist.
The team also described a daily test-slide check before patient cases to verify scanner performance, image quality, and connectivity.
Training combined vendor-led virtual instruction with hands-on practice. HNL’s PAs and local teams shaped the final workflow, with support from Grundium. Their experience was particularly important when deciding how to divide scanning tasks.
Exceptions also needed attention. Cases involving multiple blocks, additional levels, or more than four slides could require a different sequence from a routine case. Clear responsibilities and communication helped the team manage these situations.
For Dr. Malik, an important benefit was access to colleagues with relevant subspecialty expertise.
Frozen section requests can involve a wide range of specimens. Digital access allows a pathologist to share a case with a colleague across the network when additional input would be useful.
The presenters also described benefits across HNL’s broader digital pathology program, including flexibility in distributing work and reduced reliance on transporting physical slides internally. These observations reflect the combined program, rather than the effect of any single scanner.
HNL also acknowledged continuing challenges, including system integration and the time required to scan some cytology preparations. Further use of Ocus scanners for fine-needle aspiration rapid on-site evaluation, or ROSE, was still undergoing validation at the time of the webinar.
For laboratories considering a similar approach, HNL’s experience offers a practical starting point: define the clinical need, confirm local staffing and technical readiness, and test how each task fits into daily work.
The frozen section example makes that lesson tangible. Changing who completed the scan allowed tissue preparation and scanning to proceed alongside one another. Understanding that handoff was an essential part of making the technology work for the team.
Watch the full HNL Lab Medicine webinar to hear the presenters discuss their workflow, implementation decisions, and lessons learned.
