The S-Curve Framework: Predicting the Future of Anatomic Pathology

摘要

A challenge in business is to anticipate future technical advances as well as rates of diffusion of new technologies into the market place. Students of the history of science and technology are familiar with so-called S-curves of innovation. The S-curves show the relationship between performance and effort over time. The S-curves are classically sigmoidal in shape, thus the term S-curves (Figure 1). The S-curve framework can be useful for forecasting market trends as well as for understanding human perceptions of innovations. Arthur C. Clarke, the famous writer once noted, “One tends to be overoptimistic in the short run and underoptimistic in the long run. We can only extrapolate linearly and progress is always in an exponential curve.” 1 Much has been published on the topic of innovation.2The implementation of telepathology and, more recently, pathology digital imaging, an enabling technology for virtual slide telepathology, may be following an S-curve. It is too early to know for certain, but this would appear to be the case. The recent increase in interest in telepathology and pathology digital imaging, and the accelerating growth of the virtual microscopy industry, all of which are interrelated, suggests that telepathology is entering a new era in its level of use in laboratories.It may be noteworthy that the development and implementation of digital radiology and teleradiology are following an S-curve for their implementation following a long interval between the initial work on developing the technologies in the laboratory and their eventual widespread deployment in clinical settings. Pathology could follow radiology's example and go entirely digital sometime in the future. It is possible that teleradiology and telepathology may end up following similar curves of innovation with pathology's time line trailing radiology's time line for going digital by a decade or two. On the other hand, somewhat different market forces drive radiology and pathology practices.Telepathology was first used in the 1960s (so-called television microscopy) but did not begin to achieve sustained growth as a clinical imaging modality until the 1990s. For all practical purposes, events in the late 1980s involving the introduction of robotic telepathology, store-and-forward telepathology, and the development of hybrid telepathology systems, integrating robotic dynamic telepathology with store-and-forward telepathology, marked the initiation of the S-curve of innovation for virtual slide telepathology. Some current drivers that increase the use of virtual slide telepathology include (1) the growing base of installed virtual slide scanners, (2) incorporation of virtual slides into education programs, and (3) the emergence of new laboratory business models and services that leverage virtual slides as their enabling technology.In Arizona, and in my previous department in Chicago, interest in telepathology was initiated by concerns regarding pathologist interobserver variability in rendering surgical pathology diagnoses. The first scientific paper using the word telepathology was presented at a College of American Pathologists conference entitled “Pathology Practice in a World of Changing Technology,” January 16 through 18, 1987, held in Hawaii.3 This Futurescape conference we are attending here in Chicago marks the 20th anniversary of that earlier College of American Pathologists conference.This conference provides me with an opportunity to discuss where we are in relation to the S-curve of innovation for telepathology and virtual slide microscopy. The introduction of virtual slide telepathology will have a significant impact on both telepathology and pathology digital imaging.Historically, low-resolution video whole slides (virtual slides) were used in my laboratory in Chicago in 1986 for purposes of orienting histopathology slides and tracking slide viewing by telepathologists using a robotic telepathology system that I invented and patented.3 That