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

PTH

re

cove

red

(p

mo

l/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

Patient benefits

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

National change

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

Questions