In 2007, the Futurescape of Anatomic Pathology meeting provided plenty of discussion about the technologic future of the field. Toward the end of that meeting, a "Reality Check" discussion provided a critique of the meeting with respect to the day-to-day activities of practicing pathologists. (1) At this year's conference, we are providing an update on our institution's attempts to apply some of the tools and techniques presented here last year. Some tools and techniques have worked, and some have not. The introduction of new technology often involves a steep learning curve. Because these tools and technologies are not simply "plug-and-play," pathologists, technologists, and administrators must recognize that we cannot simply adopt and implement them. We must validate, verify, and make operational these technologies, which are indeed works-in-progress. The internal environment at Baystate Health (Springfield, Massachusetts) is well suited to implementing new technologies. We are a subspecialty-focused and academic-private practice and hybrid model, including extensive anatomic, clinical, and molecular pathology sections integrated into 1 department. Annually, the department processes 40 000 to 50 000 surgical specimens and 6 to 7 million laboratory tests. We also have an average of 1 new breast cancer case per day. Thus, we have ample raw material to test the emerging tools and technologies.