Digital First - Pathology
Professor Jo Martin
National Clinical Director, Pathology
Chair, 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
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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
120
Siemens I2000fam (r = 2.13)
Abbot Architect (r = 1.67)
Siemens A Centaur (r = 1.62)
PTH recovered (pmol/L)
100
Beckman Access (r = 1.22)
Roche Elecsys (r = 1.03)
80
60
40
20
0
0
10
20
30
Synthetic hPTH added (pmol/L)
40
50
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