3 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.
4 Pathology Commissioning in a digital age - a challenge to the NHS Pathology Modernisation Programme and Carter Report highlight need for scale of changeLocal test production vs national changePatient access and chronic disordersKaiser PermananteEconomies of scaleIntegration of care pathwaysSavings for primary and secondary care out-patients…digital innovations
5 Digital solutions in pathology Not just an add onUser needs; patients, clinicians and commissionersTouch points within care pathwaysNational changes not regional quick fixes
6 Information Technology & Patients NHS IT StrategyPatient-centricMeeting growing demandOnline access to GP records by 2015
8 Other innovations + digital quick wins Not just about new technologies but new ways of using existing technologiesTelecare - 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 imagesLab Tests online – patient access
9 Big data Unlocking opportunities of data Highlighting variations Care.dataClinical Practice Research DatabaseTPP SystmOneCancer Research UKPatients in control ofRequiresStandardisation – names, units, reference ranges, coding, methods…
10 Uptake of Innovation BNP in Cardiac Failure Assessment The increase in requesting of BNP between the two audit periods.Still very poor uptakeOne point to make – data from Rick Jones:Same source of data with repeat measures allows uptake of innovation to be monitored.
11 QQ plot How does the distribution of log(TSH) compare to the normal? Discrepancies as expectedBulk of distribution is a good fitQuantiles of log(TSH) are compared to the quantiles of the standard normal.
15 Example 1: Isle of Wight NHS Trust SMS text messaging to inform patients of sexual health service results since 2004Extended to include appointment remindersReduced DNAs from 22.5% to 14.1% per annumReduced clinical appointments by more than 3000Low cost and widely used – 92% of people owning a mobileSecure channel and patient confidenceSpeed and access to testing
16 Example 2: The National Pathology Exchange (NPEx) National data exchange service for lab-to-lab communicationsLab services automated, referral of sample often paper basedNPEx creates interface with LIMS system to national hubConverts local codes to NLMC SNOMEDAllows progress and physical location of tests to be trackedProvides details of other labs for commissioning purposesSecure NHS data centreFaster service, fewer errors, auditable trail, market intelligence
17 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 % of routine work automatically authorised using ‘rules and gauges’ checksRegular updates supported increased demand on services (10% per year)For patients:Test results sorted and dispatched quicklyMultidisciplinary reports for patients before appointment - ‘one stop shop’ for blood tests, ECGs and chest x-rays for example.
18 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 2003Online patient portal for kidney patients to access their testsIncludes patient information and adviceService piloted in 4 unitsNow used by 80% of renal units in UKOver 17,000 registrations and 1,000 daily loginsHighlighted as good practice in 2012 NHS Information StrategyPlay Video
19 Other digital examples: Improving Processes, Improving Outcomes Positive patient ID for safer blood transfusionRFID tracking of forensic samplespositive cervical smear generating a colposcopy appointmentpositive BNP result generating an ECHO cardiogram appointmentpositive calprotectin result generating a colonoscopy appointment, positive Chlamydia or pre-op MRSA test triggering a prescription for an appropriate antibiotic
21 Leaner PathwaysLaboratory services to reduce patient and clinician timeMonitoring chronic diseaseMonitoring therapeutic interventionsLinking results to patient pathways or treatmentInformation to minimise testing
23 Levers for change Professional Standards, Risk Based Quality assurance CommissionersCPA/UKASDH ReturnsRequires:all diagnostics to be digitisedCall for action - pathology teams to take the leadChallenge innovation fund