In 2023, API awarded one of its highest honors, the Lifetime Achievement Award, to Dr. George Birdsong of Emory University and Grady Health System. Dr. Birdsong has led the transformative work in the past decade of moving cancer pathology reports from narrative records written individualistically to structured synoptic reports that can be shared and aggregated for cancer registries, clinical trials, epidemiologic research, among other uses, within the U.S. and globally. Dr. Birdsong also played a pivotal role in bringing DICOM standards to pathology for whole slide imaging. He is the former chair of the Pathology Electronic Reporting (PERT) Committee and served as the CAP liaison to the International Collaboration on Cancer Reporting (ICCR). He has been involved also with SNOMED International, the Clinical Laboratory Improvement Advisory Committee (CLIAC) of the Centers for Disease Control and Prevention, and has worked in numerous advisory groups and committees over the years. Dr. Birdsong is also a recipient of the CAP 2018 Lifetime Achievement Award. We are honored to recognize him with the 2023 Lifetime Achievement Award on behalf of the Association for Pathology Informatics for his invaluable contributions to the field of pathology informatics.

I had the pleasure to interview Dr. Birdsong in recognition of Black History Month and learn more about his professional and personal journey: 

Grace: Dr. Birdsong, thank you for taking time in your busy schedule to speak a little bit about your professional and personal journey into pathology informatics. First of all, how have you been? What have you been working on since we saw you at last year’s PI Summit?

Dr. Birdsong:
2023 and 2024 have been very busy. Like many institutions, we are short staffed in the pathology department. Locally, I have been working on implementation of digital pathology here at Grady Hospital. We have made some progress, but we still have a long way to go. With the International Collaboration on Cancer Reporting (ICCR), I am continuing to work on implementation of structured electronic versions of the ICCR datasets with the Structured Reporting Implementation Committee, which I hope will include SNOMED encoding. With colleagues from the CAP, I am working on promoting the concept of the Integrated Disease Report, which will present the data necessary for managing complex disease processes such as cancer in a less fragmented, more readily understandable fashion.

Grace: I’m curious, what drew you to the field of pathology in the first place? What was the landscape like for you as a newly minted graduate of University of Texas Southwestern Medical Center Medical School in 1984?

Dr. Birdsong:
As a senior medical student, I was drawn to pathology because I perceived pathology and laboratory medicine as providing the “final answer” or the discipline that could get closest to the final answer for patients with complex diseases, as opposed to a more probabilistic answer that might come from internal medicine.

Grace: Can you share with us the state of pathology when you began your training? Who were your mentors?

Dr. Birdsong:
Anatomic pathology was largely still based on H&E morphology and a few cytochemical stains such as mucicarmine, and stains for microbial organisms, etc. Immunohistochemistry came into widespread use during my residency. The lab here went from just a few IHC stains when I started to approximately 60-70 (I think) by the time I graduated. Use of PCR in research began during my residency, but clinical applications were still a few years away. The ability to do your own computerized literature searches on terminals in the library (as opposed to only being able to do literature searches with the assistance of a librarian) came into being during my residency. The Clinical Laboratory Improvement Amendments (CLIA ‘88) became law during my cytology fellowship, and the CLIA regulations were finalized a few years later. 

I viewed all my attendings as mentors in one way or another, but the ones most responsible for leading me into my career were Dr. Zuher Naib in cytology, and Dr. Karlene Hewan-Lowe regarding informatics. Dr. Hewan-Lowe did general surgical pathology and renal pathology. In the late 1980s she was scanning her renal electron micrographs into computerized image databases, and I thought that was one of the coolest things in pathology at the time. My interest in storing pathology data in structured databases arose when I began doing cytology-histology correlations as part of quality assurance, and I quickly realized that the task would be much easier if the data was stored in a structured database. I had no formal training in use of computers or IT. It was extremely clumsy at first. I tried using pre-windows excel spreadsheets, but quickly learned that I needed to learn how to use a database program.

Grace: Representation is immensely powerful, especially for subsequent generations of African Americans looking to enter the medical field. As a highly regarded expert in pathology informatics, how do you understand the legacy you are forging for young pathologists on the rise?

Dr. Birdsong:
I am a little embarrassed to admit that for a long time I did not realize how important this is. It was only after I had been working for 15 years or so, and young African-American pathologists would come up to me at meetings and say things to the effect of “I was so glad to see you here” or “I didn’t know if there would be a place for me in this specialty,” that I realized the importance of representation. Growing up, even as a small child I was aware of African-American physicians and other professionals, so it never occurred to me that medicine would not be a career option. Actually the first hints of the importance of representation came when I was a 4th year medical student, and I told one of my classmates that I had decided to apply to pathology residencies. My friend replied “Are there any blacks in that field?” He looked at me as if I had just told him I was going to walk into a lion’s den. I replied “Well, there is about to be one more.” At one of my interviews, one of the attending pathologists was African-American, but I had not been scheduled to interview with him. When I showed up, they hastily rearranged my interview schedule so that I could meet with him, which I appreciated, but I would not have been offended if they had not done that; I was not even aware that this pathologist was part of the program.

Grace: In what ways do you think pathology informatics could be more engaged with issues of representation for the Black community? What kind of changes are you seeing and what more would you like to see?

Dr. Birdsong:
That is a multi-faceted question. For pathology residents we should be more aggressive about involving residents in informatics projects, or at least making the contributions of informatics to patient care and the practice of pathology more visible to residents. The problem is larger than that, however. It extends to getting medical students interested in pathology, and before that getting college and high school students who may not be interested in becoming physicians, but who are interested working in the medical field or in information technology interested in medical informatics, and hopefully pathology informatics.

Grace: Dr. Birdsong, I would like to thank you so much for your time and insight in helping me recognize and honor the role and significance of the Black community throughout the United States and in healthcare. And, of course, thank you for your dedication to pathology informatics and API!

To our API members:  Be sure to say “Hello” to Dr. Birdsong at our next PI Summit 2024, May 20-23 in Ann Arbor, MI at Eagle Crest Resort! 

Learn more about API's commitment to training and education in pathology informatics for all populations.