Published on March 11, 2014
Digital First - Pathology Dr Rick Jones Deputy Director Yorkshire Centre for Health Informatics Specialist Adviser National Pathology Programme, NHS England
Around 95% of clinical pathways rely on patients having access to efficient, timely and cost effective pathology services. Pathology touches all of our lives, from before we are born to, in many cases, after we die.
Pathology Commissioning in a digital age - a challenge to the NHS • Pathology Modernisation Programme and Carter Report highlight need for scale of change • Local test production vs national change • Patient access and chronic disorders • Kaiser Permanante • Economies of scale • Integration of care pathways • Savings for primary and secondary care out-patients …digital innovations
Digital solutions in pathology • Not just an add on • User needs; patients, clinicians and commissioners • Touch points within care pathways • National changes not regional quick fixes
Information Technology & Patients • NHS IT Strategy • Patient-centric • Meeting growing demand • Online access to GP records by 2015
National Pathology Programme
Other innovations + digital quick wins Not just about new technologies but new ways of using existing technologies Telecare - remote monitoring of emergencies and lifestyle changes to manage ricks of independent living. Telehealth - remote monitoring of specific health indicators such as INR, blood pressure, blood oxygen or weight. Telemedicine - remote consultation between patient and clinician or between GPs and specialists. Can be real time or via data such as high resolution histopathology images Lab Tests online – patient access
Big data • Unlocking opportunities of data • Highlighting variations • Care.data • Clinical Practice Research Database • TPP SystmOne • Cancer Research UK • Patients in control of Requires • Standardisation – names, units, reference ranges, coding, methods…
Uptake of Innovation BNP in Cardiac Failure Assessment The increase in requesting of BNP between the two audit periods. Still very poor uptake
QQ plot • How does the distribution of log(TSH) compare to the normal? • Discrepancies as expected • Bulk of distribution is a good fit
Age and Sex Variation - Albumin
Methods for TSH: tight agreement
PTH results – pure PTH 0 20 40 60 80 100 120 0 10 20 30 40 50 PTHrecovered(pmol/L) Synthetic hPTH added (pmol/L) Siemens I2000fam (r = 2.13) Abbot Architect (r = 1.67) Siemens A Centaur (r = 1.62) Beckman Access (r = 1.22) Roche Elecsys (r = 1.03)
Example 1: Isle of Wight NHS Trust • SMS text messaging to inform patients of sexual health service results since 2004 • Extended to include appointment reminders • Reduced DNAs from 22.5% to 14.1% per annum • Reduced clinical appointments by more than 3000 • Low cost and widely used – 92% of people owning a mobile • Secure channel and patient confidence • Speed and access to testing
Example 2: The National Pathology Exchange (NPEx) • National data exchange service for lab-to-lab communications • Lab services automated, referral of sample often paper based • NPEx creates interface with LIMS system to national hub • Converts local codes to NLMC SNOMED • Allows progress and physical location of tests to be tracked • Provides details of other labs for commissioning purposes • Secure NHS data centre • Faster service, fewer errors, auditable trail, market intelligence
Example 3: Integrated Management of Results For large departments spread across multiple locations, an integrated lab system is crucial to improving efficiency, adapting to growing needs and enhancing multidisciplinary working. • In 2002 Leicester Pathology Service (LPS) was operating labs at 4 locations using 5 lab systems across haematology, biochemistry, immunology, blood transfusion, histology, cytology and microbiology. • Developed iLaboratory (from iSoft) For labs: • By 2010 80% of routine work automatically authorised using ‘rules and gauges’ checks • Regular updates supported increased demand on services (10% per year) For patients: • Test results sorted and dispatched quickly • Multidisciplinary reports for patients before appointment - ‘one stop shop’ for blood tests, ECGs and chest x-rays for example.
Example 4: Renal Patient View Digital is a natural fit for helping patients with long-term conditions to self-manage their disease, leading to a greater sense of control and recognised as improving patient experience and outcomes. • RPV developed by Renal Information Exchange Group (RIXG) in 2003 • Online patient portal for kidney patients to access their tests • Includes patient information and advice • Service piloted in 4 units • Now used by 80% of renal units in UK • Over 17,000 registrations and 1,000 daily logins • Highlighted as good practice in 2012 NHS Information Strategy Play Video
Other digital examples: Improving Processes, Improving Outcomes • Positive patient ID for safer blood transfusion • RFID tracking of forensic samples • positive cervical smear generating a colposcopy appointment • positive BNP result generating an ECHO cardiogram appointment • positive calprotectin result generating a colonoscopy appointment, positive Chlamydia or pre-op MRSA test triggering a prescription for an appropriate antibiotic
Leaner Pathways Laboratory services to reduce patient and clinician time • Monitoring chronic disease • Monitoring therapeutic interventions • Linking results to patient pathways or treatment • Information to minimise testing
Levers for change • Professional • Standards, Risk Based Quality assurance • Commissioners • CPA/UKAS • DH Returns Requires: • all diagnostics to be digitised • Call for action - pathology teams to take the lead • Challenge innovation fund
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