Telepathology and Mobile Health System for Province-Wide Pathology Consultation in Henan, China: Retrospective Evaluation Study

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 Henan Province, China, high diagnostic demand, rapid population growth, and limited pathology expertise exacerbate regional health care inequities, leading to delayed diagnoses and restricted access to specialist care. OBJECTIVE: This study aimed to design, implement, and evaluate a province-wide telepathology system integrating web and mobile platforms to enhance diagnostic quality, efficiency, and equitable access across health care tiers. METHODS: We conducted a retrospective, multicenter observational study using deidentified data from 120 health care institutions between 2016 and 2024. The system used a 3-tier architecture with virtual private network-secured transmission and a Browser-Server framework, supporting standardized whole-slide image acquisition, remote review, and reporting via web interfaces and a WeChat (Tencent) mini-program. System performance was assessed by consultation volume, turnaround time, concurrency, and diagnostic concordance in a subset of 1027 cases with paired tertiary-hospital expert diagnoses. Economic impact was estimated using previously published per-case savings, reflecting patient travel and ancillary cost reductions. Additional assessments included workflow integration, mobile platform use, and system stability under peak load. RESULTS: Over 8 years, the network processed 72,916 consultations encompassing 355,104 whole-slide images, supporting 220-300 concurrent users with stable performance. Median turnaround time was 10.06 (IQR 1.63-29.10) hours, with 96.41% (70,298/72,916) of cases completed within 72 hours. County-level hospitals contributed 77.63% (56,603/72,916) of consultations, demonstrating substantial engagement from lower-tier institutions. In the diagnostic subset, originating-site preliminary classifications achieved 0.90 sensitivity and 0.75 specificity relative to expert reference diagnoses, with 17.2% discordance corrected through remote expert review. Estimated annual direct cost savings ranged from US $0.14 to $0.63 million. Mobile-enabled access facilitated remote review and reporting without compromising data security, supporting integration into routine clinical workflows across diverse hospital settings. CONCLUSIONS: The Henan Province telepathology system demonstrates that a centrally coordinated, scalable digital health platform can improve diagnostic efficiency, quality, and equity in resource-constrained settings. High county-level hospital use highlights its potential to reduce geographic and structural diagnostic inequities. Future work should explore formal cost-effectiveness evaluation, artificial intelligence-assisted diagnostic support, and cross-regional interoperability to enable broader adoption and sustainable integration into health care systems.