Pathoverse Part 4: Cloud Infrastructure for Scalable Digital Pathology
This article summarizes part 4 of our “Into the Pathoverse” webinar, recorded at Pathology Visions 2025 in San Diego and available on-demand. This segment starts at 27:00 in the full video. Watch the full video.
In the fourth segment of the Pathoverse webinar, Sasha Paegle from Amazon Web Services (AWS) offered a clear and insightful look at how cloud technologies are reshaping the digital pathology landscape. While most people recognize the Amazon brand, Sasha began by highlighting a point that often surprises audiences: Amazon has been deeply invested in healthcare and life sciences for more than 18 years. AWS, the cloud-computing arm of Amazon, now has one of the world’s most experienced teams in healthcare-focused information technology.
Sasha himself is an example of that blend of scientific and technical expertise. Trained originally as a molecular biologist, he moved into the worlds of omics, high-performance computing, and large-scale data analytics—eventually joining the AWS Healthcare & Life Sciences team. His background mirrors a broader trend within AWS: individuals who combine decades of IT experience with a deep understanding of biomedical research, clinical workflows, and patient-centric innovation.
AWS in Healthcare: A Long History of Modernization
Over nearly two decades, AWS has worked with healthcare organizations to modernize their IT infrastructure with a consistent vision: use cloud-based technologies to improve patient outcomes. While AWS is often associated with storage or computing power, Sasha explained that the platform has grown far beyond those capabilities. Today it includes a suite of industry-specific services designed explicitly for healthcare. These include:
- Amazon HealthLake, which unifies structured and unstructured data across modalities for analytics, search, and machine learning
- Amazon Comprehend Medical, a natural language processing service tailored to clinical text
- Transcribe Medical, for speech-to-text clinical documentation
- Amazon HealthOmics, purpose-built for storing and computing on omics data, from FASTQ files to BAMs
- Amazon HealthImaging, a newer service now poised to play a major role in digital pathology
This expanding ecosystem reflects AWS’s broader goal: reduce the technical burden on healthcare organizations so they can focus on value, insights, and clinical impact.
Global Scale and Reliability for Medical Imaging
Sasha then shifted to AWS’s global footprint, a critical foundation for enabling the Pathoverse. AWS currently operates across 38 global regions, allowing healthcare organizations to take advantage of cloud compute resources closer to where the data originates. This reduces latency, improves accessibility, and enables fast, secure exchange of medical images—whether across hospital systems or across continents.
Durability and reliability are also central design principles of AWS infrastructure. The systems behind services like S3 and HealthImaging are engineered to minimize downtime and withstand demanding clinical workloads. Their stability has earned AWS broad recognition across industry analysts. Sasha noted that AWS was recently named the #1 cloud provider by KLAS, its first year being evaluated in that category. IDC and Gartner have reached similar conclusions.
What “Managed Services” Mean in Healthcare
To help the audience understand AWS’s approach, Sasha introduced the idea of managed services, a concept that can sometimes feel abstract. He explained it using a simple metaphor: imagine AWS’s core technologies—compute, networking, storage—as a massive collection of Lego bricks. Expert users can assemble those bricks into almost anything, but it takes time and specialized knowledge.
Managed services are essentially pre-built structures made from those bricks. AWS engineers take the foundational components and assemble them into ready-to-use solutions that remove undifferentiated heavy lifting. This allows partners like PathPresenter to focus entirely on building high-value applications rather than spending weeks or months configuring basic infrastructure.
AWS HealthImaging: Built for Speed, Scale, and Interoperability
Sasha described HealthImaging as one of the most important of these managed services, particularly in the context of the Pathoverse vision. HealthImaging is purpose-built to store, manage, and serve medical images at scale—supporting fast retrieval, high performance, and cost efficiency. Its design principles include:
- Store once, use many times: images remain available for multiple workflows without duplication
- Lower cost of development, with AWS estimating up to 40% time and cost savings compared to building imaging pipelines from scratch
- Instantaneous image access, ensuring clinicians experience virtually no lag
- Built-in lifecycle policies, automatically moving images between storage tiers based on usage patterns
- Industry-specific APIs, including full DICOM API support
- HIPAA eligibility, enabling secure exchange of protected health information
Sasha noted that when he joined AWS five years ago, many organizations insisted that medical images—especially high-resolution ones—could never be processed efficiently in the cloud. Since then, AWS has repeatedly proven that assumption wrong, first by optimizing object storage for low-cost, high-speed access, and later by launching HealthImaging to support high-performance, multimodal imaging workflows.
From Radiology to Pathology: The Evolution Ahead
While HealthImaging originally centered on radiology, Sasha confirmed that the service is now evolving toward full support for pathology images, including whole-slide imaging from any scanner platform. This expansion directly aligns with the goals of the Pathoverse: enabling organizations to store digital slides once and reuse them many times—for diagnosis, consultation, education, AI development, research, and more.
Over time, AWS aims to make HealthImaging a universal imaging backbone capable of supporting Radiology, Pathology, Cardiology, Ophthalmology, and other imaging-heavy specialties. This multi-modality future will make it possible for platforms like PathPresenter to orchestrate workflows seamlessly across data types and clinical domains.
Enabling the Pathoverse Vision
Sasha concluded by tying AWS’s capabilities back to the broader goals of the Pathoverse: removing friction, enabling interoperability, and supporting diverse use cases—from remote consults to AI-driven insights to global data exchange.
The cloud, he explained, thrives at the intersection of scalability and collaboration. As AWS continues developing services like HealthImaging, HealthLake, and HealthOmics, the foundation for universal digital pathology becomes stronger—and the vision of a connected Pathoverse becomes increasingly achievable.
Dive farther Into the Pathoverse:
Part 1: Introducing the Pathoverse and How We Got Here – Dr. Raj Singh, PathPresenter
Part 2: Seeking Seamless Remote Consultations – Dr. Raj Singh, PathPresenter
Part 3: Lowering Barriers and Driving Consult Efficiency – Todd Vanden Branden, Grundium
Part 4: Cloud Infrastructure for Scalable Digital Pathology – Sasha Paegle, AWS
Part 5: Accelerating Clinical Trial Enrollment – Travis Wold, Imagenomix
Part 6: Virtual Restaining for Scalable, High-Accuracy Pathology AI – Dr. Saad Nadeem, DeepLIIF/Memorial Sloan Kettering
Part 7: Conclusions: This is Just the Beginning – Dr. Raj Singh, PathPresenter
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