Telepathology: advancing diagnostics with digital innovation and remote collaboration – India’s progress so far

Telepathology, enabled by whole-slide imaging, digital communication, and cloud-based platforms, and artificial intelligence (AI), represents a key innovation in modern pathology practice, offering opportunities for virtual diagnosis, consultation, education, and multidisciplinary collaboration. Given the large inequity in the current distribution of pathology services in India, telepathology could play an important role in bridging the gap between urban and rural areas of the country. This narrative review aimed to present the status of telepathology in India through a description of technological advances, clinical applications, initiatives, and regulatory aspects, including the emerging role of artificial intelligence (AI) in telepathology. The search strategy used PubMed/MEDLINE, Scopus, Google Scholar, and other relevant resources identified eligible documents published in English between 1996 and 2025. Government documents and reports were also examined for relevant information regarding the study. Telepathology experiences in other low- and middle-income countries (LMICs) were also similarly reviewed and synthesized for comparative analysis. Digital pathology, driven by telepathology, is being increasingly adopted in India, both in academic and tertiary care, and select private healthcare institutions, as enabled by the Ayushman Bharat Digital Mission and similar initiatives. However, there are multiple challenges to the broader adoption of telepathology in India, including high infrastructure costs, limited accessibility in rural areas, workforce training, interoperability, and medico-legal and regulatory issues. While AI-based approaches offer great benefits in pathology, most tools need to be validated on Indian cohorts before they can be deployed in practice. Telepathology has the potential to improve equity in access to pathology services in India. Addressing the key challenges to adoption and building appropriate regulatory and workforce development frameworks will be critical to realizing the benefits of this technology in India.