Mapping Your Daily Diagnostic Flow

• On a typical weekday, walk me through how a case moves from grossing to sign-out in your lab.
• Which roles touch the glass slides and digital images at each step? Options: Grossing technicians, Histology technicians, Slide scanner operators, Pathologists (attendings), Residents and fellows, Cytotechnologists, Laboratory managers, IT support, Other
• Approximately how many glass slides and unique diagnostic cases does your department generate per typical day? Options: Under 100 slides / under 25 cases, 100–500 slides / 25–125 cases, 500–1,500 slides / 125–350 cases, Over 1,500 slides / over 350 cases
• How often does a case require off-site consult or subspecialty input today? Options: Multiple times per day, A few times per week, A few times per month, Rarely, Never
• Is there any campus, laboratory, or subspecialty where remote sign-out or primary-digital diagnosis is currently prohibited? Options: Yes, No
• When prohibitions apply, list the campuses, services, or policies that prevent remote sign-out and describe the reason (regulatory, clinical leadership, contractual, other).

Where Workflows Fray Under Pressure

• If slide volume increased 20% tomorrow, identify which part of your workflow would fail first and why.
• Walk me through the last time a scanner backlog or transport delay impacted patient care, who raised the issue, and what the consequence was.
• Choose up to three steps that most often create bottlenecks for turnaround time. Options: Specimen accessioning and labeling, Grossing and tissue processing, Slide staining and coverslipping, Slide scanning queue, Viewer performance at sign-out, Pathologist availability for review, Case routing and consults, LIS case linking
• Estimate the average time from slide completion to first pathologist review for routine surgical pathology cases. Options: Under 24 hours, 24–48 hours, 48–72 hours, Over 72 hours
• What downstream functions break when scanners fall behind on a high-volume day, for example tumor boards, frozen sections, or consult turnaround?
• Name the one bottleneck that, if removed, would shorten your overall turnaround enough to change clinical decisions.

The Real Cost of Staying Microscope-First

• If you keep a microscope-first model for three more years, identify the concrete costs you expect to accumulate in staffing, transport, or lost revenue.
• Provide a recent example where intra-system slide transport or access limitations caused a clinically significant delay or repeat testing.
• How many open pathologist FTEs do you currently have, and how long have those positions remained vacant on average? Options: No vacancies, 1–2 FTEs, under 6 months, 1–3 FTEs, 6–12 months, Multiple vacancies, over 12 months
• Point to the recurring expense that surprises executive leadership the most when you break down the pathology budget.
• Would your leadership approve capital or operating funds for a digital pathology investment that only returns parity after five years? Options: Yes, with conditions, Yes, unconditionally, No, Undecided

What's Getting in the Way of Digital Adoption

• Identify the regulatory, clinical validation, or policy barrier most likely to stop this project before pilot completion.
• Tell me about prior attempts to change diagnostic workflows here, how pathologists responded, and which actions helped or hindered adoption.
• Does your institution require a formal clinical validation protocol and written sign-off before enabling primary-diagnostic use of new imaging systems? Options: Yes, strict protocol required, Yes, but flexible, No formal protocol, Unsure
• List the top three technical concerns your IT or data governance teams raise about storing and serving whole slide images.
• Select up to two vendor capabilities that you believe would most reduce clinician resistance to digital sign-out. Options: High-fidelity viewer matching microscope field of view, Validated image quality and concordance studies, Integrated AI assistants with clear clinical controls, Familiar user interface for pathologists, On-site validation and training support, Clear regulatory documentation
• Confirm whether any institutional policy, accreditation, or legal constraint would prevent you from piloting AI-assisted diagnostic tools. Options: Yes, No, Under review

Who Else Is Trying to Solve This

• Who else are you actively evaluating for digital pathology options, including internal teams and outside vendors? Options: Current incumbent vendor, Other external vendors, Internal IT or informatics team, Point-solution scanner vendors only, Open-source tools, No alternatives under evaluation
• Choose the approaches you are most likely to pursue, select any that apply. Options: Renew with incumbent, Run an external vendor pilot, Build an in-house image management solution, Adopt a hybrid model (scanners + hosted viewer), Delay decision
• Describe the evidence or performance improvements that would have to exist for you to keep the current approach instead of moving to a new system.
• Has anyone on your leadership team formally proposed solving scanning or image management internally rather than partnering with an outside vendor? Options: Yes, formal proposal exists, Yes, informal discussion only, No
• Could your team still prefer an internal solution even after an external pilot demonstrates equivalent diagnostic performance? Why or why not?
• If the pilot proves diagnostic parity, which contractual or organizational issue would most likely delay a purchase decision? Options: Budget timing, Procurement rules, Regulatory sign-off, Internal preference for internal build, Other

Can This Be Deployed Where You Need It

• Identify the single integration or infrastructure gap that would stop deployment before day one.
• List the laboratory information systems, middleware, and reporting systems that must exchange orders and results with the image management platform.
• Do APIs or HL7 interfaces already exist for those systems, and who in IT is the point owner for each? Options: APIs exist, owners named, APIs partially available, owners unclear, No APIs, owners not assigned, Unsure
• Estimate the number of IT FTEs you can allocate to integrations and validation work over the next 90 days. Options: 0 FTEs, 0.5–1 FTE, 1–3 FTEs, Over 3 FTEs
• Where will slide scanning physically occur and do those rooms meet climate, power, and network requirements today? Options: All sites ready, Some sites need upgrades, No sites ready, Unsure
• Are there documented data retention policies, storage tiering rules, or archival limits that will constrain whole slide image retention? Options: Yes, strict retention and tiers, Yes, flexible retention, No formal policy, Unsure
• Confirm whether named clinical leadership is prepared to own per-site validation, acceptance testing, and final sign-off before go-live. Options: Yes, named owners ready, Partial commitment, owners not named, No, leadership not committed, Unsure

Pilot Success and Acceptance

• Describe your fallback plan if the pilot cannot meet your image quality or diagnostic concordance thresholds.
• Select the objective acceptance criteria that matter most for pilot success, pick up to five. Options: Diagnostic concordance vs glass (target %), Average scanner throughput (slides per hour), Viewer responsiveness under load, Successful LIS order/result integration, Pathologist satisfaction scores, AI sensitivity and specificity targets, No critical safety incidents
• Who on your clinical and operational team must sign the pilot acceptance, and what evidence will satisfy each signer?
• Explain how you will measure AI tool performance during the pilot and which case types or subspecialties you will include.
• Provide the quantitative image quality thresholds, for example minimum resolution, color fidelity standards, or allowable artifact rates, that would cause you to stop the pilot.
• Assuming the pilot meets every stated acceptance criterion, can your procurement team commit to a purchase intent or PO within 30 days? Options: Yes, No, Maybe, needs conditions

Decision Timing and Next Steps

• What single timing or budget issue could collapse your timeline and force an accelerated go/no-go decision?
• Provide the stakeholders, committees, and their review cadence that must approve this project before contract execution.
• Choose your target go-live window for primary-diagnostic use across the initial sites. Options: Next quarter (0–3 months), In two quarters (3–6 months), This year (6–12 months), Longer than 12 months, Unsure
• Name the individual who controls budget approval and the person who will sign the final purchase order.
• Assuming budget approval this quarter, are you able to start a pilot within 4 weeks? Options: Yes, No, Only with prerequisite approvals
• Point out the one answer on this form that would cause you to stop the project immediately.

• Solution Experience: Clinical Workflow Walkthrough

• Confirm the current state and its cost
• You confirm the demonstrated scanning workflow meets your required throughput and QC to prevent backlog and overtime.
• Run a site-specific scanner throughput simulation using the provided weekly slide volumes and deliver the results before the pilot planning meeting.
• You confirm the viewer workflow supports diagnostic parity for the subspecialties you prioritized.
• Prove the scanning throughput and quality workflow
• Produce a draft pilot validation plan that lists measurable acceptance criteria, test cases, timelines, and required clinical evidence.
• You confirm the AI triage scenario produces the expected reduction in manual review and is acceptable within your validation constraints.
• Provide per-site weekly slide volumes by case type, peak scanner-hours, and current consult turnaround metrics.
• Prove the diagnostic viewer workflow for primary sign-out
• You agree on specific pilot acceptance criteria, required evidence, and named owners for the pilot phase.
• Prove AI triage and integration in a realistic case flow
• Identify the named clinical owner(s) and the IT owner who will sign off on pilot acceptance per site.
• Confirm pilot site list and a target two-week window for pilot kickoff.
• Prove the remote consult handoff and collaboration flow
• Validation check, confirm this matches your needs
• Agree pilot acceptance gates and next evidence steps

• Solution Experience: Clinical Workflow Walkthrough
• Solution Experience Deck
• Solution Brief

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• Install and Commission Whole Slide Scanners
• Calibrate Scanners and Establish QC Protocols
• Bulk Slide Digitization (Backlog Scanning)
• Deploy Enterprise Image Management Platform
• Integrate Image Platform with LIS/EMR
• Configure Diagnostic Viewer and Annotation Tools
• Enable Remote Consultation and Case Collaboration
• Integrate and Deploy AI-Assisted Analysis Tools
• Scanner and Workflow Validation for Primary Diagnosis
• Provision Enterprise Image Storage and Archive
• Configure Backup, Replication and Disaster Recovery
• Train Pathologists on Digital Diagnostic Workflows
• Train Laboratory Technicians on Scanning Operations
• Provide Equipment Financing and Incentive Qualification

Install and Commission Whole Slide Scanners

• List the physical locations (building and room numbers) and available install windows for scanner delivery and on-site commissioning.
• How many scanners do you plan to install at each site? Options: 1, 2-3, 4-6, 7+
• Provide target throughput per scanner expressed as slides per hour at 40x for routine H&E cases. Options: <100, 100-300, 301-600, 600+
• Identify the slide and specimen types to be scanned routinely (H&E, immunohistochemistry, special stains, cytology, frozen sections). Options: H&E, Immunohistochemistry (IHC), Special stains, Cytology, Frozen sections
• Specify required WSI output formats and any naming convention rules your archive or downstream tools expect. Options: OME-TIFF, DICOM WSI, Proprietary vendor WSI, Other
• Who will be the on-site owner for commissioning activities and who provides building access and electrical/IT contact?

Calibrate Scanners and Establish QC Protocols

• Describe the calibration targets and reference tissue slides you will supply for optical and color calibration (e.g., color chart, tissue control).
• State the required frequency for optical calibration and white-balance checks for each scanner. Options: Per shift, Daily, Weekly, Monthly, Other
• List the quality-control (QC) metrics you require recorded per scanned batch (for example: focus score, resolution, color balance, z-plane completeness).
• Name the role responsible for QC triage and remediation when a slide fails automated QC.
• Are automated QC rejection workflows required to prevent failed WSIs from ingesting into the archive? Options: Yes, No
• Specify the required audit-log retention period for QC events and calibration records. Options: 30 days, 90 days, 1 year, Custom

Bulk Slide Digitization (Backlog Scanning)

• Estimate backlog volume in number of glass slides and your preferred completion timeline for backlog digitization.
• Indicate the stain-mix composition of the backlog by percentage (H&E, IHC, special stains, cytology). Options: H&E, IHC, Special stains, Cytology
• Explain how accession identifiers on glass slides must be preserved or mapped to resulting WSI filenames to match your LIS records.
• Select the barcode symbology used for slide tracking in your lab. Options: Code 128, DataMatrix, QR, Custom label, No barcode
• Describe chain-of-custody and interim storage requirements during bulk scanning and transport between stations.
• Choose the backlog QC sampling strategy you require for acceptance. Options: 100% visual check, 10% random sample, 5% random sample, Custom

Deploy Enterprise Image Management Platform

• Select your preferred deployment model for the image management platform. Options: On-premises, Cloud-hosted, Hybrid
• Name the laboratory information system (LIS) and electronic medical record (EMR) products that the platform must integrate with.
• Identify required authentication methods for clinician access (for example LDAP/Active Directory, SAML single sign-on). Options: LDAP/Active Directory, SAML single sign-on, Local accounts, Other
• Provide expected concurrent pathologist sessions and peak case-load numbers the platform must support. Options: <10, 10-50, 51-200, 200+
• What evidence will validate platform integration with your LIS (for example HL7 message traces, successful order-pull and result-posting test cases)?
• List metadata fields required for indexing each case (accession number, slide ID, stain, magnification, barcode).

Integrate Image Platform with LIS/EMR

• Enumerate the HL7 message types and triggers required between the platform and your LIS (for example ORM order, ORU results, ADT updates).
• Provide available API endpoints or FHIR resources your IT team can provide for metadata exchange or document references.
• Describe required field mappings between LIS accession fields (case ID, patient MRN, specimen container) and image-platform metadata.
• Identify your LIS/EMR technical contact for interface testing and their preferred hours for integration work.
• Describe the test data set and sandbox access you will provide for end-to-end interface validation.
• Will patient-identifiers or MRN formats require transformation or mapping during integration? Options: Yes, No

Configure Diagnostic Viewer and Annotation Tools

• List the annotation and measurement tools your pathologists require in the viewer (for example caliper, polygon ROI, cell counter, bookmarks).
• Provide the acceptable first-image-load time over your WAN for a 40x WSI used in primary sign-out. Options: <2s, 2-5s, 5-15s, 15+s
• State required stain-normalization or color-profile options (for example ICC profiles or stain-vector normalization) for consistent display across sites.
• Describe multi-monitor or synchronized-slide behaviors needed for shared sign-out or multi-site review.
• Who will approve viewer UI presets and workflow defaults for primary diagnosis?
• Will you require audit logs for viewer annotations, report edits, and sign-out events? Options: Yes, No

Enable Remote Consultation and Case Collaboration

• Select the remote consultation modes you plan to use. Options: Asynchronous consult (shared WSI link), Live case sharing (real-time session), Screen-share sign-out, Other
• Provide your target turnaround SLA for remote consults (in hours or business days). Options: <1 hour, 1-4 hours, Same day, 48 hours, Custom
• Specify the expected number of external consulting pathologists and the access privileges they require.
• Describe secure-sharing and data-embargo policies that apply when WSIs are shared outside your firewall.
• Indicate concurrence, co-signoff or consult-to-sign workflows required for consult cases.
• List any regional data residency or HIPAA-related constraints that affect cross-site consultation.

Integrate and Deploy AI-Assisted Analysis Tools

• Enumerate AI use cases you want in scope (for example tumor detection, IHC quantification, mitotic count, tissue segmentation).
• Specify required model input and output formats and overlays (for example WSI tiles, JSON overlays, DICOM structured report).
• Provide target performance thresholds for each AI model you plan to deploy (for example sensitivity >= 90% for tumor detection).
• Describe available institutional validation datasets for benchmarking (number of annotated slides and cases by stain and subspecialty).
• Identify who will own clinical validation, regulatory traceability, and documentation for AI outputs.
• Select preferred runtime location for AI inference. Options: On-premises, Edge appliance (near scanner), Cloud-hosted, Hybrid

Scanner and Workflow Validation for Primary Diagnosis

• List the clinical subspecialties you intend to validate for primary diagnosis during the pilot (for example GI, dermatopathology, GU).
• Choose the concordance study design you prefer for primary-diagnosis validation. Options: Prospective side-by-side, Retrospective blinded, Hybrid
• Provide the number of cases per subspecialty and the number of pathologists required to achieve statistically meaningful concordance.
• What measurable acceptance criteria will confirm diagnostic equivalence for primary diagnosis (for example concordance rate >= 95%, minimum image resolution metrics)?
• Name the clinical sign-off owners required for per-site validation and final acceptance.
• Specify the validation artifacts that must be archived for regulatory audit (validation protocol, case discrepancy logs, signed run sheets).

Provision Enterprise Image Storage and Archive

• Estimate average WSI file size at 20x and 40x for H&E and for typical IHC slides (MB or GB per slide).
• Provide total active and nearline storage capacity needs for Year 1 and Year 5.
• What retention periods and retrieval SLAs will confirm storage readiness (for example 7-year retention, retrieval latency < 10s for a 20x WSI)?
• Select storage access protocols required by your environment. Options: S3-compatible object, NFS, SMB, Other
• Indicate whether eDiscovery and legal-hold workflows are required for pathology cases. Options: Yes, No
• Specify required encryption and transport standards for data at rest and in transit. Options: AES-256, TLS 1.2+, FIPS-validated modules, Other

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• Master Services Agreement (MSA)
• Statement of Work (SOW)
• Hardware Purchase Agreement
• Software Subscription Order Form
• Service Level Agreement (SLA) & Support Addendum
• Data Processing Agreement / HIPAA Business Associate Addendum (BAA)
• Acceptance & Validation Criteria
• Regulatory & Validation Responsibilities Schedule
• Training & Knowledge Transfer Agreement
• Payment Schedule & Order Confirmation
• Change Order Agreement
• Termination & Transition Assistance
• Confidentiality Agreement

• Go-live Health Check (weeks 1-4)
• First Measurement Review (weeks 4-10)
• 90-day Realization Review
• Monthly Operational Check-in (recurring)
• Quarterly Outcomes Review (executive)
• Annual Outcomes and Capacity Review

• Agree the prioritized enhancement list for the next quarter with delivery timelines.
• Ensure operational KPIs remain within agreed thresholds or have active remediation plans.
• Reduce the count of critical unresolved tickets and document action owners and dates for remaining items.
• Agree next month's operational priorities and any required configuration changes to maintain throughput.
• Deliver the updated operational KPI extract and ticket status report before the next monthly check-in.
• Implement the agreed configuration change or patch in the test environment and report test results.
• Archive resolved incident records and update the incident review log for regulatory traceability.
• Executive KPI summary
• Confirm whether adoption and AI concordance are meeting executive expectations or require program-level adjustments.
• Re-confirm success criteria and owners
• Ensure regulatory and validation obligations are on track and assign any outstanding documentation tasks.
• Publish the quarterly outcomes dashboard with annotated trends and risk items.
• Deliver a prioritized enhancement plan with acceptance criteria for the next quarter.
• Compile and share validation evidence packages required for upcoming audits.
• Yearly trend analysis
• Validate whether long-term diagnostic turnaround and storage growth are within acceptable bounds or require strategic remediation.
• Ensure data retention and archival processes meet regulatory requirements and retrieval SLAs.
• Agree on capacity adjustments or storage tiering actions to cover the next 12 months.
• Produce the annual outcomes dossier including supporting logs and audit evidence for retention compliance.
• Publish the 12-month capacity plan with procurement or tiering recommendations.
• Schedule any required large-scale validation exercises for major configuration or storage changes.
• Confirm all planned per-site deployment tasks are complete or have a documented remediation plan with owners and dates.
• Identify the top three operational blockers that would prevent meaningful KPI measurement and agree remediation steps.
• Schedule the First Measurement Review with the data sources and owners identified.
• Publish a Go-live validation summary including outstanding defects and owners.
• Collect and share the data extract for the First Measurement meeting from the image management and LIS logs.
• Implement short-term mitigations for any critical integration failures and report status before the next meeting.
• Present first-cycle KPI data
• Decide whether weekly active pathologists using the viewer and diagnostic turnaround time for primary cases are on acceptable trajectories or require intervention.
• Produce a timebound remediation plan for each KPI gap with clear deliverables and dates.
• Confirm the data sources and cadence for ongoing KPI reporting.
• Deliver the cleaned KPI dataset and visualization for the 90-day Realization Review.
• Implement agreed scanner configuration or workflow adjustments that address identified bottlenecks.
• Close or reclassify low-priority tickets that do not affect KPI trajectories.
• Outcomes summary versus targets
• Agree final disposition for each outstanding remediation item with deadlines that close the onboarding window.
• Confirm the incumbent system is either decommissioned or formally retained read-only with documented data archiving and access controls.
• Validate clinician proficiency levels and commit to any final training required to sustain outcomes.
• Publish the 90-day realization report showing metric trajectories and remediation status.
• Execute the incumbent decommission or read-only retention plan and provide evidence of data archival completion.
• Schedule targeted refresher training sessions for clinician cohorts below proficiency thresholds.
• Operational KPI dashboard
• Deployment and migration validation
• Decision on remediation closure
• Root cause diagnosis for gaps
• Major incidents and risk register
• Retention and archival compliance
• Open tickets and burn-down
• Incumbent system decommission status
• Capacity planning and storage sizing
• Operational issues and defect review
• Early adoption signals and usage patterns
• Integration and backup health
• Enhancement prioritization
• Open issues and blockers
• Agree corrective actions and timelines
• Long-term enhancement roadmap
• Training and proficiency update
• Short-term enhancement priorities
• Regulatory and validation posture