Digital media archive for gross pathology images based on open-source tools and Fast Healthcare Interoperability Resources (FHIR)

Macroscopic examination of surgical pathology and autopsy cases is a fundamental component of anatomic pathology. The photographic documentation of such clinical specimens is essential, and it may be required in certain instances. Our department began using consumer-grade digital cameras in 2005 to improve the practice of gross photography. However, the lack of an application to correctly catalog the photographs resulted in thousands of digital image files scattered across shared network drives, with limited case and patient metadata, making image retrieval a cumbersome and sometimes impossible task. Thirteen years later, we examined the legacy method of acquiring and accessing gross photographs in our department and determined the need for a web-based digital media archive to capture images with structured metadata. Using several open-source tools, including MediaWiki, we developed a flexible platform for building our digital media archive with a data schema based on the Fast Healthcare Interoperability Resources standard. Following a short pilot, we replaced the legacy method of handling gross pathology images with a new acquisition workflow and digital media archive. Through March 2021, 233 distinct users have accessed the system, 58 of which have uploaded 21,024 images. Of those images, 13,684 (65.1%) correspond to surgical pathology images, 4045 (19.2%) belong to neuropathology cases, and 3295 (15.7%) originate from autopsies. We demonstrate the design and implementation of a customizable anatomic pathology digital media archive solution in an academic pathology department setting using a modern standard for exchanging healthcare information electronically. The system’s efficiency and scalability for our current operation will enable us to integrate with other applications and pathology informatics initiatives in the future.