Telepathology Development and Stakeholder Perspectives in China: Cross-Sectional Survey

Abstract Background Telepathology is widely recognized for improving diagnostic access in remote areas and is strongly promoted in China to address the shortage of pathologists. However, a comprehensive national assessment of its implementation and multistakeholder perspectives remains lacking. Objective This study aims to conduct a comprehensive analysis of the infrastructure, practical application, and user experience of telepathology in China from 2018 to 2023 and to identify the key factors affecting its adoption and satisfaction levels. Methods A repeated cross-sectional survey was administered to hospitals across China (2018-2023), alongside a parallel survey of telepathology users (2023). Data were analyzed from hospitals (sample sizes ranging from 464 to 188 across years), pathologists (n=262), and patients (n=141). Regression analysis was applied to investigate factors associated with professional satisfaction and willingness to adopt the technology. Results The proportion of hospitals with telepathology software grew at an annual average rate of 7.60%, increasing from 29.5% (137/464) in 2018 to 42.6% (80/188) in 2023. The median number of telepathology cases per hospital increased from 51 to 200, with the fastest growth observed in the eastern region. Among pathologists, 61.1% (160/262) used telepathology weekly, 61.5% (161/262) spent 11 to 20 or 21 to 30 minutes. Pathologists reported a 95.8% (251/262) satisfaction rate, and 95% (249/262) were willing to continue participation. Convenience of system operation and service processes were associated with enhanced satisfaction and sustained engagement willingness ( P <.05). Among patients, 92.2% (130/141) received diagnostic results within 24 hours, with 100% (141/141) satisfaction, and 99.3% (140/141) were willing to recommend telepathology. Conclusions Telepathology in China grew significantly from 2018 to 2023, with high satisfaction among both pathologists and patients. For sustained development, a multilevel approach is essential: improving system usability, implementing supportive policies (eg, funding and insurance coverage), and conducting targeted promotion of its proven benefits. This integrated strategy is key to making telepathology a sustainable solution for equitable diagnostic access nationwide.