Pathways to Excellence | Winter 2023

Pathways to Excellence

remote diagnostics permanently approved after push by nation’s pathologists

The pandemic changed the way we all accomplish things, both in personal lives and professional roles. The impact is no greater than in health care, where we have reinvented how we care for patients and keep them and ourselves safe.

The forced change has in many cases created improved procedures that may not have been realized otherwise. For pathologists, one newly approved process – long debated even prior to 2020 – has evolved and is here to stay.

NO LONGER EXCEPTIONAL USE

Aaron R. Huber, D.O., Director of Surgical Pathology, and Christa Whitney-Miller, M.D., Vice Chair of Anatomic Pathology and Interim Department Chair, were among 76 authors from medical centers across the nation who last fall asked the U.S. Congress to permanently legalize remote diagnostics for patient care. The open letter, published in Nature Medicine, pointed to the

effectiveness of remote diagnostics and asked lawmakers to extend a regulatory exemption that allowed pathologists to review and diagnose patient specimens remotely during the pandemic. The authors called for this change to be permanently written into the federal Clinical Laboratory Improvement Amendments (CLIA), which was last updated 34 years ago.

Although no one can claim the letter was the sole reason the change was granted, the voices of so many respected, experienced pathologists are thought to have certainly played a role.

“We are all pleased with the decision,” Huber said. “We expected

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Aaron R. Huber, D.O.

it eventually, of course, but the speed with which Congress acted is appreciated.”

TECHNOLOGY HERE TO STAY

Due to the need to isolate beginning in 2020 and with so many people working from home, the temporary waiver was welcome, allowing remote sign-out of pathology cases using digital pathology or glass slide review without obtaining a separate CLIA number. The exception preserved continuity of patient care, ensuring ongoing quality by involving pathologists where subspecialty review is required.

Vektra L. Casler, M.D., joined the URMC faculty in 2021, well after the initial scramble to shift all processes to accommodate the pandemic. Part of her role is to coordinate technology – and specifically whole-slide scanning – to build an infrastructure that allows for many more slides to be imaged at one time, rather than only a handful, as had been the capability until recently.

“We had low-throughput scanners scattered in various labs, which hold only 12 or so slides,” Casler said. “Our highthroughput scanner is designed to scan much more quickly and hold hundreds of slides, operating autonomously after a tech loads it. This frees up tech time and produces a much larger number of near giga-pixel-sized specimen images approved for remote review and diagnosis.”

Over the next several years, the department will begin to secure additional whole-slide scanners, Casler said. The new technology not only will be able to process the health system’s specimens, but it also will be able to eventually provide support for other institutions that will reimburse for imaging and consultation services.

MORE THAN CLINICAL IMPLICATIONS

Surgical Pathologist Sarah K. Findeis, M.D., said the impact of remote sign-out is significant for patient care, and it goes beyond that, as well.

“Remote work provides not only more flexibility and a better work-life balance for our faculty and trainees, it also allows us to optimize our work processes so that we can provide better, more timely patient care,” Findeis said.

“COVID-19 accelerated the need for clinical remote work, and we’ve also learned from the early adopter institutions that there are wide-reaching, unexpected, positive ripple effects in the education and research fields. Discovering even more of those ripple effects would be a game-changer for the field of pathology.”

HIGH-QUALITY RESULTS, REGARDLESS

The outcomes resulting from the clinical use of the new technology and remote sign-outs during the pandemic were as pathologists nationwide had predicted: the quality of work being conducted remotely remained extremely high. Ohio State and Memorial Sloane Kettering did much of their work remotely during the pandemic, too, Huber said. MSK studied its onsite versus remote cases, confirming that location didn’t matter and neither did the device – phone, tablet, computer monitor – used for evaluation.

“We are in a digital age, no matter what,” Huber said, adding that specialists such as radiologists have for years been looking at films remotely. “For pathologists, it was the legislation that needed to catch up.”

SMOLLER STEPS DOWN AS DEPARTMENT CHAIR

Bruce Smoller, M.D., announced in September he was stepping down as department chair. He remains on faculty as a practicing dermatopathologist and teacher. Christa L. Whitney-Miller, M.D., vice chair of Anatomic Pathology, is serving as interim chair while a national search is conducted.

As its leader since 2014, Smoller oversaw many of Pathology’s key achievements, including the opening of a centralized lab facility offsite on Bailey Road. The 130,000-squarefoot facility consolidated the majority of testing and created

consistent standards and cost-efficiency. The facility was a pivotal ingredient in the department’s rapid and progressive COVID response; as of 2022, the lab had conducted more than 1 million COVID tests.

Smoller pursued new processes to ensure the highest levels of patient care by having all results read and reviewed by subspecialists, and he developed training programs in Medical Technology, Phlebotomy and Histotechnology. He also championed academic excellence through the creation of five fellowships and expansion of residencies by 20 percent. A strong advocate for diversity and inclusion efforts, Smoller is leaving the department with a more diverse and gender-balanced leadership team.

Vektra L. Casler, M.D.

Sarah K. Findeis, M.D.

Ihopeyour 2023 is off to a great start! This is, of course, my first Pathways to Excellence newsletter as interim chair.

First and foremost, I’d like to thank Dr. Smoller for his service. The department grew substantially under his stewardship: We consolidated services across the UR Medicine enterprise, with much of that work now going to the Central Lab at Bailey Road; the number of faculty has increased; our molecular lab is now performing panels of next-generation, sequencing-based mutational analysis for myeloid and solid tumor malignancies; the microbiology lab has performed more than 1 million COVID tests; and Anatomic Pathology has a new high-throughput whole slide scanner… to name a few clinical accomplishments.

We have increased the number of residents and our fellowship offerings; we have medical technology and phlebotomy training programs, and a histotechnology training program in the works. Our academic productivity has increased – we had 33 posters and one platform presentation at USCAP this year, along with three short courses/interactive microscopy sessions led by our faculty!

Congratulations to Archibald S. Perkins, M.D., Ph.D., who received funding from the U.S. Department of Defense; Benjamin J. Frisch, Ph.D., whose American Cancer Society Award started in January, and Rajnish Bharadwaj, M.B.B.S., Ph.D., who recently received notice of funding from the NBIADA – congratulations!

Congratulations to Xiaoyan Liao, M.D., Ph.D., as well, who was recently promoted to associate professor.

As we look to this new year, planning for the move of Anatomic Pathology to Bailey Road is underway. Their move also will be a phased one, with the Histology and Immunohistochemistry labs moving first, followed subsequently by the Gross Room and then the faculty. Recruiting for faculty and residents continues in earnest; and the search for a permanent chair has begun.

As always, many thanks to all the faculty and staff, for all you do to support the patients we touch across Upstate New York. Here’s to 2023!

GIVE BACK

We are grateful for your continued support.

To make a tax-deductible gift to Pathology & Laboratory Medicine, visit www.pathology.urmc.edu and click "Make a Gift." You can also contact Melissa Head at (585) 273-2890 or melissa.head@rochester.edu.

Christa Whitney-Miller, M.D.

NEWS BRIEFS

VERTINO TAKES REINS AS LEADER OF BASIC SCIENCE AT SMD

Paula Vertino, Ph.D., a professor of both Biomedical Genetics and Pathology and Laboratory Medicine, as well as a longtime faculty member in our Ph.D. program, has been appointed senior associate dean for Basic Research.

Vertino was recruited to the Wilmot Cancer Institute in 2018 to transform its research endeavors by breaking down silos and promoting collaboration and team science.

SMOLLER HONORED WITH CAP LIFETIME ACHIEVEMENT AWARD

The College of American Pathologists presented Bruce Smoller, M.D., with the Lifetime Achievement Award during its CAP22 national conference in New Orleans. He was recognized for his long and distinguished career in academic pathology and dermatopathology.

Smoller has led organizations and several departments of pathology and published more than 235 original articles, 39 book chapters and 13 textbooks on dermatopathology. He has been honored with numerous awards for research and teaching.

ROBERTS PROMOTED TO DIRECTOR OF EDUCATION

Vicki Roberts has been promoted to Director of Education, a new role in the department’s administrative leadership team. Roberts, who has been with Pathology since 1989, has had an integral role in the development, management and expansion of educational programs, including our Clinical Medical Technology program, which now has its sixth class.

PATHOLOGY SNAPSHOTS

Above: Our trainees represented URMC at the American Society for Clinical Pathology, held in Chicago in the fall. From left: Dingani Nkosi (resident), Mona Deerwester (fellow) and Leah Militello (resident). Right: Our Blood Bank team received a Greater Rochester Quality Council Silver Award for resourcefulness in maintaining a 2-day+ blood supply reserve at Strong Memorial during pandemicrelated shortages.

Above: Anwar Iqbal, Ph.D., (third from left) director of the Microarray CGH Laboratory, director of Clinical Cytogenetics Development and associate director of the Cytogenetics Laboratory, moderated a session about advances in genome mapping at #ASHG22 in Los Angeles.

A FIRST FOR PEDIPATH: NATIONAL SPP MEETING COMES TO ROCHESTER

For the first time ever, Rochester was the host city for the fall meeting of the Society for Pediatric Pathology (SPP), held at URMC in October.

The event, co-sponsored by our department and the SPP, featured three days of academic presentations, as well as extracurricular outings including a boat cruise on the Erie Canal and banquet at the historic George Eastman Museum.

Pedipath faculty Phil Katzman, M.D., and Leon Metlay, M.D., were co-chairs for the event, which they joked is sort of like hosting the Olympics without the corporate sponsorships. Each year the SPP holds two large meetings— one in the fall and another in the spring that coincides with USCAP.

The fall meeting is traditionally hosted by a children’s hospital, and while Golisano Children’s Hospital is one of the largest in Upstate New York, it’s much smaller than most places that have hosted the SPP meeting in the past. For that reason, the event was an opportunity to showcase our city and institution and network with experts and trainees from across the country.

In total, 110 people attended the hybrid conference in person, with another 70 who joined virtually. Poster presentations were held in Flaum Atrium and platform sessions in the Class of ’62 Auditorium. The meeting also included talks by clinicians and investigators from URMC Pediatrics and Maternal-Fetal Medicine, who collaborated with atPhology.

FOCUS ON FACULTY

I think there seems to be a slightly better appreciation for its place in health care, especially post-COVID-19 pandemic. I am hoping this continues since the public health value of autopsy has not been fully tapped.

What is one thing you believe could help bring more young people to the field of pathology? Awareness of the field and the many opportunities that are available, whether as a physician, researcher, medical technologists, etc. In addition, understanding the scope of our work and its role in the health care setting, be it in transfusion medicine and helping clinicians manage critical patients with complex blood product needs or morgue with piecing together the reason for unexpected clinical outcomes.

What do you do in your free time? I absolutely love to bake and watch documentaries on just about anything. However, with two toddlers, most of my time is spent baking with play dough and watching cartoons, which I secretly and thoroughly enjoy.

Being back in person meant a return to public speaking behind a podium, which pathologists rarely have the chance do in their daily work.

“I was uncharacteristically pushed in the forefront most of the meeting so I did a lot of the introductions which I’m not used to, but it was good,” Katzman said.

The sun shone brightly for the group outing on the Colonial Belle, giving guests time to chat and get fresh air before heading to dinner at the Eastman Museum.

The meeting itself featured a variety of engaging presentations, made all the more appealing by the ability to have in-person discussion with other attendees.

“I had a blast and a half,” Metlay said. “After a few years without in-person meetings, to be able to stand and talk to somebody was just cool.”

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HOMETOWN

Bois d’Orange, Gros Islet, Saint Lucia

FAMILY

Husband Janai; son Noah, 3; and daughter Ava, 1

EDUCATION

2011 M.D.

Spartan Health Sciences University (West Indies)

2016-17 Fellowship

Forensic Pathology

Hennepin County Medical Center, Minneapolis

2015-16 Fellowship

Surgical Pathology

University of Iowa Hospitals and Clinics GM

2012-15 Residency

Pathology, Anatomic Pathology & Clinical Pathology

University of Iowa Hospitals and Clinics

Department of Pathology and Laboratory Medicine

University of Rochester Medical Center

601 Elmwood Avenue, Box 626 Rochester, NY 14642

URMC forensic pathologist Marisa Jacob-Leonce, M.D., assistant professor of Pathology and Laboratory Medicine, shares her thoughts on her field, what drew her to it and where it is headed.

What brought you to URMC? What did you find attractive about our department? I had actually been working across the Caribbean region for a while, mainly doing Locum work and lecturing at a medical school. After much reflection, I knew I was not being challenged and needed to develop more professionally. I did not know much about Upstate New York or URMC but saw the job posting and, after doing my research into both, quickly realized it would be a potential fit. During the interviews, all the doctors and administrative support staff made me feel comfortable and seemed genuine. It appeared that there would be room to grow professionally; including opportunities to get involved in research, with better utilization of experiences and skill sets that I already had. The mentorship program offered to faculty was a huge seller as well.

Current research? Most recently, I analyzed the non-natural deaths of U.S. citizens while abroad.

What is it about your specialty that excites you? What excites me about pathology is its diversity as a specialty and the constant broadening of knowledge base required to do the job well and assist our clinician counterparts. After all, we are the “doctor’s doctor.” In terms of autopsy, it excites me when we discover something that the clinical team (and myself) knew nothing about, especially when it can now explain previously unanswered questions – questions we didn’t know we had – and fill in the gaps. These types of cases provide for awesome teaching moments and humility in medicine. They also oftentimes provide closure for the families involved.

The URMC Autopsy group is small but mighty. How would you describe the team? It’s a very hard working and dedicated team with members who truly enjoy what we do. We also love teaching and sharing information with anyone who will listen and is interested in what we do.

Was there one moment, or individual, that showed you forensic pathology was your chosen field? Yes, I actually entered medical school knowing that I wanted to become a forensic pathologist. At about age 15, there were two homicides of teenage girls on my island. While seeing the news stories, they spoke about the pathologist and autopsies, etc. Right around this time, I started watching shows about forensic files and my interest quickly grew. A few years later, a family friend, the Hon. Charles Cadet (now deceased), heard about my interest and called the only pathologist on the island, Dr. King, and arranged for us to meet. I saw three autopsies the day we met at the age of 17! I am forever grateful for that opportunity and still keep in contact with Dr. King.

What do you think prepared you most for your career? My family, but more specifically my mom. She always encouraged me and believed in me even when it was sometime difficult for me to believe in my abilities and myself. Coming from a small island with limited resources, I often wonder how I got this far. I think also truly having a love for pathology and teaching. I get excited talking about cases and pathology in general, which keeps me motivated and energized. I would like to think that my career has just started and there is so much more that I can offer to pathology and medicine.

Where is your specialty going in the future? I do not fully know but I imagine the demand for pathologists in general is going to be at an all-time high with significant shifts in our role as health care providers and how we perform our tasks. Much more of our time is going to be spent working with digital platforms, as well as analyzing data and trends on a more minute level. When it comes to autopsies,

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FOCUS ON FACULTY MARISA JACOB-LEONCE, M.D.