Transcript Keith Burrill: Benefits of using NPEx

The Benefits of Using NPEX &
The Vision for Sending and
Receiving Pathology Tests
Nationally
Keith Burrill
Pathology IT Systems Manager
University Hospital Southampton
Background – possible options
• UHS major teaching hospital on the South Coast
• UHS variety of work processed for numerous organisations,
includes channel islands and some private and foreign, as well as
local ‘networks’. UHS also refers some work for testing
•Options appraisal:
• Paper reporting / courier delivery – general move away from
this
• Fax ~ VIOP, Governance arrangements – only option for some
clients
• Email – Advanced Encryption Standard (AES) 256 bit / PDF
reporting – or NHS mail within the NHS
• Client collection reporting system, PDF, NBTS, Cardiff
• NPEx lab to lab links
NPEx Option
• Only option to provide electronic referral and reporting (incl. HL7)
• Eliminates transcription errors, reduces turnaround
• Initial primer funding from Pathology Modernisation monies
(OJEU)
• Required investment and User Acceptance Test (UAT) across LIMS
vendors, sites and NPEx
• Project delivery
• Data Share / IG requirement
• Virtual Private Network (VPN) & SSL certificate over N3
• National Laboratory Medicines Catalogue (NLMC)
• UAT – test NPEx and test LIMS accounts
• Test pack & test scenarios e.g. unsolicited results, comment reporting
• Referral and reporting function
• UAT again post changeover to live
Benefits of automation
Referral processes costs
Staff time etc
Indicate test is send away
Prepare request form for send away
Recipient process costs
Staff time etc
Sample receipt
Issues with patient identification
Issues with identification of test(s) requested
Issues with location and consultant identification
Reporting costs
Referred result reporting TAT - electronic vs.
paper based
Cost of monitoring transportation
Receipt of results
Enter results into LIMS
Reporting TAT - electronic vs. paper
based
LAB
A
Create referral order
Refer sample and form.
Receive result(s)
NPEx
Web Server
LAB
B
Receipt sample
Analyse sample
Report result(s)
Design elements
•Problem 1 - Sample and test codes not standardised between labs
•Solution
• NPEx provides facility to map investigations between labs to SNOMED CT/NLMC
• Investigation constituent test s are further mapped to SNOMED CT/NLMC
• All above without impacting local LIMS coding
• Problem 2 – Laboratory sample numbers may not be unique
across laboratories
• Local sample numbers despatched to NPEx on creation of
request - triggered by request item/ test being booked in, then despatched
• The received sample number is used as Order Number, the solution is
to make the Order ID unique to Trust by employing National
Administrative Code (NAC)
• On reporting both numbers stored in same message to ensure pairing and can
be tracked in NPEx Quick Search window by either party
Shipment example
Southampton Lab system receipt
NPEx clients and Case Study
• Southampton (Clinisys Labcentre)
• Swindon (Clinisys Winpath) Live switchover March 2013
•Paper, fax, LIMS access, migrated to NPEx
Currently Immunology and Clinical Chemistry
• Salisbury (iLabTP) Live Switchover March 2013
• Implemented Immunology, UAT Clinical Chemistry
• Hampshire Hospitals (Clinisys Winpath) – Basingstoke and
Winchester
• UAT both Trusts operating both functions, referral, processing
• Triggered Oxford joining NPEx?
NPEx and Non-NPEx referrals
Stats March 2013 – Jan 2014
• NPEx specimens (from previous slide)
Salisbury 7,813
Acetyl choline receptor Ab
Swindon 14,993
Adrenal antibodies
•NPEx investigations
Salisbury 12,697
Swindon 25,887
• Unique investigations traded
Immunology 130
Chemistry 80
Almond
Alt.ve Haemolytic Complement
Animal danders
Anti B2 Glycoprotein 1
Anti Cardiolipin Ab
Antibody Titre
Anti-Neutrophil cytoplasmic Ab
Apple allergen
Aspergillus fumigatus
Avocado
Baker's yeast
Banana allergen
Bee venom
Beef allergen
78
6
49
1
8
92
944
1
1119
3
139
1
2
7
3
1
Clinical Biochemistry, examples
11-Deoxycortisol
17-OH-progesterone
24 HR CORTISOL
25-OH-vitamin D2 & D3
A1AT Phenotype
ACTH
Adrenalin
Aldosterone
Aldosterone/Renin Ratio
ALP isoenzymes
Alpha-1-antitrypsin
Aluminium
Androstenedione
Arsenic whole blood
Beta-2-Transferrin
CA 19.9
CA153
Cadmium whole blood
Caeruloplasmin
2
7
15
249
11
7
1
23
18
1
17
1
4
1
1
97
31
1
15
Next steps
•National System – Link to Manchester Network referral to
Southampton, specialist tests e.g. Cobalt
• Poole are interested…
• Complete Clinical Chemistry implementation with Salisbury
• Labcentre upgrades enabling Microbiology and Cell Path UAT
with NPEx
• Connect to other Labs Via NPEx?
Summary: NPEx Benefits and Vision
• NPEx Implemented, operational and supported. Has been well
received by our clients
• Justified by local network volume & benefits delivered which
enables…
• Further connectivity as is a Single National System.
Does not require re-registration on local servers – as
current for likes of PMIP, or local GP requesting & reporting
deployed solutions.
• Thank you for listening, and thanks in particular to all parties
whom have worked with us during these NPEx implementations