Enterprise Imaging Podcast Artificial Intelligence

Flight Path Ep. 6: Liron Pantanowitz on digital pathology as a journey, not a destination

Mike Moore November 3, 2026

Flight Path Episode 6 thumbnail with Dr. Liron Pantanowitz of UPMC

Liron Pantanowitz, MD, PhD, MHA, Chair of Pathology, University of Pittsburgh and UPMC. Hosted by Mike Moore. Runtime 34:44.

Episode summary

Digital pathology has been called the last frontier of the digital health record, the specialty that turns tissue on glass into pixels a health system can move, read, and learn from. Few people have done more to map that frontier than Dr. Liron Pantanowitz, Chair of Pathology at the University of Pittsburgh and UPMC and one of the most influential voices in digital and computational pathology.

Liron and host Mike Moore trace the real story of going digital: why it's an evolution rather than an event, how the focus moved from hardware to software to applications, and why the hardest problems were never the scanners but the standards, the workflow, and the economics around them. Liron makes the honest case for investment when the ROI is largely indirect. CPT reimbursement still lags, so the benefits show up as efficiency, distributed workload, lower courier and archive costs, and reduced medical-legal risk.

He weighs one of the field's live debates head-on: should pathology join the enterprise imaging table and contribute to a vendor-neutral record? The upside is enterprise funding, patient access to their own images, and a multimodal data foundation for AI. The tensions are real too: misinterpretation risk when non-pathologists view slides, the lack of a universal viewer for proprietary image formats, and pathologists' understandable protectiveness over their images. His adoption advice is refreshingly practical. Go stepwise, not big-bang. Build bottom-up with pathologist champions, not top-down mandates. And expect a journey with no finish line.

The episode closes on AI. Liron sorts the hype from the help with a clear taxonomy (workflow triage, diagnostic support, prognosis, quality control, and research) and is candid about data commercialization, generalizability, and the trust and governance the field has to get right. His bottom line: the train has left the station, and the work now is evidence, standards, and AI literacy so the whole enterprise moves together.

In this episode

  • Why digital pathology is an evolution (hardware, then software, then applications), not a one-time switch
  • How to make the investment case when the ROI is mostly indirect and CPT codes lag
  • The honest pros and cons of contributing pathology images to a shared, vendor-neutral enterprise record
  • A practical adoption playbook: stepwise over big-bang, bottom-up over top-down
  • A clear-eyed taxonomy of where AI helps in pathology today: triage, diagnostic support, prognosis, QC, and research
  • What data commercialization gets right and wrong, and the governance the field has to protect

Chapters

  • 0:00 Welcome, and why leaders should care
  • 1:00 Why pathology? The doctor's doctor
  • 2:09 From Kodachrome slides to agentic AI
  • 3:46 Being an early adopter when there are no guidelines
  • 5:48 Pathology as the last frontier; UPMC's digital journey
  • 8:37 Making the investment case when the ROI is indirect
  • 12:19 Should pathology join the enterprise imaging table?
  • 16:06 Storage, workflow, and a stepwise adoption playbook
  • 20:42 The "there's always a newer version" trap
  • 22:56 AI in digital pathology: a use-case taxonomy
  • 26:56 Data commercialization, ethics, and trust
  • 30:23 The next five years
  • 33:23 Closing thoughts and how to connect

In their words

“It's the doctor's doctor, where you get to be a detective and figure out what's going on, what the disease is, and thereby help patients.”

“Early on we were all about the hardware, which scanners did we need. Then we realized it's more about the software, and now we realize it's really about the applications.”

“I don't think there's a day you sit back and say ‘we did it, we're fully digital,’ because it still requires upgrades, new applications, troubleshooting, and IT has its downtimes.”

“That train has left the station.”

About the guest

Dr. Liron Pantanowitz, MD, PhD, MHA, is Chair and Professor of Pathology at the University of Pittsburgh and UPMC. He is triple board-certified in Anatomic and Clinical Pathology, Cytopathology, and Clinical Informatics, served for sixteen years as Editor-in-Chief of the Journal of Pathology Informatics, and co-authored the reference textbook Digital Pathology. He holds an adjunct appointment in Mechanical Engineering at Carnegie Mellon, reflecting his work at the intersection of pathology, engineering, and AI.

Read the companion piece

Digital pathology is a journey, not a destination, and that changes how you should plan covers the indirect ROI, the case for and against joining the enterprise imaging table, and three signs your imaging foundation is ready for what pathology needs.

About Flight Path

Flight Path is Mach7's show about where healthcare imaging is going and the people helping it get there, hosted by Mike Moore. New episodes every other Tuesday.

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