JMIR Publications

ABSTRACT

Background:

Telepathology has emerged as a transformative digital health solution to address the global shortage of pathologists and the unequal distribution of diagnostic services, particularly in underserved and rural areas. In China, these challenges are especially pronounced in provinces such as Henan, which faces high diagnostic demand and limited pathology expertise, contributing to diagnostic inequity across regions.

Objective:

This study aimed to design, implement, and evaluate a province-wide telepathology system in Henan, China, integrating mobile and web-based platforms to support diagnostic quality assurance, reduce turnaround time, and enhance equitable access to specialist pathology services.

Methods:

A multicenter retrospective observational evaluation was conducted using routinely collected, deidentified platform data (2016-2024) from a telepathology network deployed across 120 healthcare institutions. The system adopted a three-tier architecture with secure VPN-based transmission and a Browser/Server framework, supporting standardized whole-slide image acquisition, transmission, remote review, and reporting via web interfaces and a WeChat mini-program. System performance was assessed by utilization volume, turnaround time, concurrency testing, and diagnostic concordance in a retrospective subset with paired diagnoses.

Results:

From 2016 to 2024, the network processed 72,916 telepathology consultations with 355,104 whole-slide images (mean 9 slides per case) and supported 220-300 concurrent users with high stability. The median turnaround time was 10.06 hours, and 96.41% of cases were completed within 72 hours. In a retrospective subset of 1,027 consultations with paired diagnoses, originating-site preliminary classifications showed a sensitivity of 0.90 and specificity of 0.75 compared with tertiary-hospital expert reference diagnoses; 177 cases (17.2%) were discordant. County-level hospitals accounted for 77.63% of consultations, indicating substantial utilization by lower-tier institutions. Using a previously published per-case savings estimate (~50 USD) and applying it to annual consultation volumes in the network, the estimated direct cost savings were approximately 0.14-0.63 million USD per year.

Conclusions:

The Henan Province telepathology system demonstrates that a scalable, province-wide digital health platform, with optional mobile access, can support diagnostic quality assurance, efficiency, and equity in resource-limited settings. Future work should include formal cost-effectiveness evaluation, AI integration, and cross-regional interoperability to support broader adoption.