April 30, 2024

The Digital Pathology Dilemma: Navigating Cloud and On-Prem Solutions

Labs across the globe are realizing the value of digitization in pathology and how it can resolve challenges of growing demand, shrinking resources, and disconnected diagnostic processes. Yet deliberation over the deployment of these solutions – namely, the difference between on-premise (on-prem) or cloud-based infrastructure and whether both are fit for the unique needs and challenges of a pathology lab – has posed blockers to adoption and ultimately prevented labs from realizing the benefits of these novel solutions.

Understanding these technologies and the various benefits they can offer is a critical step for choosing a solution that can support a smooth transition to digital today and continued success as needs evolve tomorrow. At Paige, our goal is to help labs make sense of their choices, build trust in secure and scalable cloud-based solutions, and ultimately select a platform that will lay the foundation for delivering the best possible care for patients now and in the future.

On-prem vs cloud vs SaaS – Key terms to know

Digital Pathology software can be deployed on-prem or in the cloud.

On-prem is short for on-premise, and as the name suggests, is when the entire software is hosted on in-house local servers and accessed by each individual user. Alternatively, cloud-based is when the software is deployed on servers hosted remotely in the cloud, which is typically provided by public cloud providers such as Amazon Web Services (AWS) or Microsoft Azure. The services are then accessed via the Internet. Many cloud-based software applications use SaaS models, or Software as a Service, which simply means that access to the software is licensed on a subscription basis rather than deployed for each customer, making it available to multiple devices without the need for separate installations.

In the case of digital pathology, these distinctions matter of course to IT teams, but also to end-users, as they will dictate what the digital adoption journey looks like and whether pathologists can fully tap into some of the more advanced promises of digital pathology.

Differences and Benefits

The key, practical differences to note fall into a few categories:

Privacy and security

On-prem solutions are often believed to be more secure because the institution retains complete control over the data. However, the institution is then also tasked with building and maintaining all security controls, which requires specific expertise and large overhead. Cloud-based solutions are built on top of trusted providers like Microsoft who have extensive resources dedicated to building industry-leading privacy and security protocols, offering proven levels of security superior to what is possible from a single on-site team. Moreover, with the SaaS provider often taking ownership of privacy and security, the burden to in-house teams is dramatically reduced. For example, Paige is fully HIPAA and GDPR compliant and has an ISO 27001 certification, which is an international standard on how we manage information security. With this already established, labs can confidently focus their resourcing on other aspects of digital transformation without compromising on the security of the solution.

Footprint and scalability

For on-prem solutions to be deployed in more than one geography, entire data centers would need to be established in each location, while cloud providers already have a footprint in nearly every region across the globe that a lab could easily tap into. Similarly, on-prem solutions require IT teams to purchase additional hardware to process more slides or offer access to extra users as their needs evolve. Cloud solutions are enabled for scale out-of-the-box, eliminating the cost and resource required to advance capacity at any time.


On-prem solutions not only necessitate the purchase of tons of hardware upfront, but require extensive planning around the network, storage, and individual workstations that could introduce hidden costs along the way if not done effectively. With cloud infrastructure, such planning is often done incrementally and collaboratively, helping labs ensure their needs will be fully met. Yet even if plans did change or scale, additional purchases are rarely required. SaaS platforms also often charge customers based on their individual use rather than flat fees which could prove to be much more cost effective than upfront capital purchases for software and/or infrastructure.

Remote readiness

One of the greatest benefits of going digital in pathology is the ability to read slides remotely, allowing pathologists to work more flexibly and collaborate with colleagues across the globe. On-prem labs would not be able to easily take advantage of this benefit without complicated architecture and underlying infrastructure, while labs using cloud-based platforms would instantly have on-demand secure access to their cases from anywhere with an Internet connection.

Updates and feature delivery

Another exciting driver of digital pathology is that it is rapidly advancing, especially in the case of artificial intelligence (AI). As new features are created, products are launched, or updates are available, pathologists with on-prem software would need to endure downtime as their IT teams made patches or installations themselves. On the other hand, pathologists using SaaS solutions would have updates seamlessly delivered to their platforms with minimal or no downtime, allowing them to adopt and enjoy new technologies as they became available. In Paige’s case, software updates are delivered to pathologists weekly, ensuring they are empowered by the most up-to-date tools and cutting-edge and AI guidance possible.

Deployment and support

Initial software deployment is a sometimes disjointed and always lengthier process with on-prem solutions, and ongoing monitoring, support, and troubleshooting poses yet another burden to in-house teams. Cloud-based solutions offer centralized deployment (but made redundant), streamlining deployment and offering dedicated monitoring and support that alleviates this burden to labs while ensuring the highest quality software performance.

Where cloud shines

On top of these core functions, cloud-based tools also offer advantages that are not possible with traditional on-prem deployments and are essential to getting the most from digital pathology. The first is the turnkey nature of cloud-based platforms. All the hurdles that come with on-prem solutions might make it impossible for the lab to go digital in a short amount of time and without a large capital investment, even if they believe in digitization’s benefits. Cloud technologies reduce the barriers to entry by lowering costs, minimizing time requirements, and handling many of the most challenging or complex aspects of software implementation to help more labs adopt digital pathology practices. Additionally, because cloud-based solutions are far more customizable to the needs of individual labs or users, they empower labs to be much nimbler. Instead of needing to spend money today on infrastructure to support the scale that may be required 5 years down the line, labs have the option to take an iterative approach and build out their capacity as their needs grow. This is particularly useful in the cases of storage, numbers of users, or AI applications, all of which will continue to change as technology advances and businesses transform. Finally, on top of offering stronger security and privacy, cloud-based software provides better disaster recovery and business continuity, which is especially important when being deployed in the clinic and impacting real patient lives.

The Paige Platform

For all these reasons, Paige took a completely cloud-based approach to our digital pathology platform. Our system is a 100% web-based, SaaS solution accessible to any pathologist with an Internet connection. Designed with scale in mind, the platform offers limitless integrations with surrounding pathology hardware and software, and our dedicated teams support labs in customizing their solution at any time to meet their changing needs. Importantly, Paige keeps privacy and security at the core of everything we do to give labs the confidence they need to rely on Paige as the central hub in their diagnostic workflows.

The final consensus

Cloud-based technology is undoubtedly the way of the future in pathology. Powered by reliable cloud platform, labs can reap the benefits of robust data storage, seamless workflows, efficient case management, and connected diagnosis. There is also tremendous potential associated with the incorporation of AI into practice that can only be fully realized when implemented through fast, flexible cloud solutions. Labs who choose cloud technologies today will seamlessly stay at the cutting-edge in the industry for years to come – and ultimately, the entire experience of cancer care will be improved.