24 July 2018
In the backdrop of the NHSI published plans to create 29 pathology networks across England and consolidate pathology services in a bid to save £200m, Barts Health NHS Trust is leading the way.
Barts Health NHS Trust, the largest NHS Trust in the UK, provides a huge range of clinical services to people in east London and beyond. It has one of the largest pathology units in the country with over 600 staff performing in excess of 23 million tests per year, the equivalent of 2.5% of the total NHS pathology workload. Pathology services currently operate from four major hospital sites (The Royal London, St Bartholomew’s, Whipps Cross and Newham) and a number of community and satellite locations, including Mile End hospital. Approximately 2.5 million people living in east London look to Barts Health services to provide them with the healthcare they need.
Since three Trusts merged to form Barts Health in 2012, the pathology service has been configured in the widely acknowledged and recommended hub and spoke model. The trust offers a wide repertoire of specialist services from the hub site, including not only the main pathology disciplines, but also Clinical Transplantation, Molecular Haematology, Retinoblastoma, Flow Cytometry and Genomics. The hub laboratory occupies a purpose built facility located at The Royal London Hospital.
Professor Jo Martin, president of the Royal College of Pathologists and Director of Academic Health Sciences at Barts Health, is on record stating that the benefits of consolidation will not be achieved without a strong IT infrastructure supporting the new proposed pathology networks. Barts Health also saw the necessity for a modern, flexible and agile IT solution to support such a high throughput service. The Trust identified that management of multiple systems and hardware platforms following the merger ws far from optimal, and the migration from three seperate Laboratory Information Management Systems (LIMS) to a single unified platform across all sites would provide efficiency and workflow improvements to the Trust. CliniSys, with their market leading LIMS, WinPath Enterprise, was chosen.
The WinPath Enterprise migration project was one of the Trust’s largest programmes in 2016/17. The benefits of rationalising three different LIMS into a single WinPath Enterprise solution observed so far include:
- improved patient care through better turnaround times, standard reference ranges and optimised workflows, in line with the Carter Report
- Full blood counts have a target turnaround time of 4 hours and 98.8% of all samples now meet this target, which equates to a 12.7% improvement on a like for like comparison.
- Higher system availability – 99.99999%.
- Improved stability with out of hours support calls to pathology IT have dropped significantly by 74%
- Reduction of clinical risk with improved, standardised patient identification and more complete patient history across primary and secondary care
- Unified methodologies across all hospitals and laboratories in the network, improving the standardisation of service data flows
- Financial benefits - By reducing the number of systems, processes, servers, licencing etc. Barts Health have reduced IT costs due to the removal of process duplication. Equivalent to a 7 figure saving over a nine-year contract. “The project will pay back in under three years” states Nicole Gresham – Associate Director of Pathology
- Integration simplification of the numerous clinical systems, allowing standardisation across all pathology disciplines
- The ability to leverage big data from the numerous integrated systems
- Improved links with Cerner Millennium and departmental systems for clinical information sharing across multiple providers in east London
- The inclusion of a sunset system to hold an archive of all legacy data, thus meeting data retention requirements.
Sarah Jensen, Chief Information Officer comments “Project delays should never be accepted as the status quo in delivering these types of large-scale improvement initiatives. Having a flexible and scalable IT system across all hospitals in the network means that we are better placed to put the patient first and say yes more often to new innovative projects”.
Sarah continues “Having a single pathology system makes integration with key Trust systems such as our Cerner Millennium EPR far more simple to deploy and maintain. A less complex solution leads to fewer faults and issues, not to mention the overhead maintenance. The new LIMS also has a more modern secure architecture which puts us in a much better position in the event of any future cyber-attacks on the NHS”.
Professor Finbarr Cotter, Clinical Director for Pathology and Consultant Haemato-Oncologist says “A single LIMS system will expedite open access to data for all physicians and is supportive of “shared care. Having one system covering the whole East End of London has got to lead to an enhanced patient experience and improve service quality”.
Professor Cotter continues: “The new system will enable pathology across our four hospitals to work together in a more collaborative fashion than previously possible. This will result in an enhanced service for the clinicians and therefore offers our patients a centre of excellence providing all aspects of a quality pathology service”.
Nicole Gresham – Associate Director of Pathology further adds: “Having a solution that allows a degree of bespoke local configuration and is flexible enough to meet local demands for services, such as Stroke and Trauma care, while maintaining a single database is extremely powerful and has allowed us to better engage with all service users.”
Nicole continues “With the successful introduction of WinPath Enterprise, a single LIMS across all our networked laboratory sites and the Managed Service contract it is exciting to see Barts Health Pathology putting in all the enablers to build a bright future. Working with our partner CliniSys, this will enable us to provide better patient care with a pathology service we can be proud of.”
Professor Cotter comments, “With the NHS working within financial constraints, outreaching rather than consolidation or outsourcing is our preferred operating model and we are proud to be supplying a superior NHS pathology service from within the NHS”.
Strengthening relationships with the Clinical Commissioning Groups (CCGs) and being able to show them real benefits and value added reasons to use the pathology service is crucial for any Trust. Some of the value added areas where Barts Health are focusing include the provision of reporting algorithms to deliver enhanced levels of clinical interpretations and advice. This data interpretation can then be used to reduce hospital appointments and hospitalisation by moving the care pathway into the community which is a faster and more cost effective approach. After all, the approximate cost of a first hospital appointment is around £270. Barts Health NHS Trust is passionate that pathology services remain local to the community, the hospital trust and GPs, ensuring a timely and efficient service for their patients.
A clinically led “diagnostics working party group”, under the Transforming Services Together (TST) collaboration, is a great example of the close working relationship between the CCGs and the pathology service. GP leads from each of the three CCGs (Newham, Waltham Forest, Tower Hamlets) are represented. Various topics are discussed with a focus on tackling unnecessary testing, reducing inconsistencies and variation in test ordering and addressing inappropriate testing behaviours.
Dr Lesley Perkins, GP and Clinical Lead for Diagnostics Redesign at TST, comments: “These meetings are essential in improving our services to our patients and help us identify target areas such as how we report things better.
“By addressing some of these areas, we have delivered significant savings for the CCGs over the last 18 months and the deployment of a single pathology IT solution across all hospitals has further enabled the biggest target reduction of inappropriate testing for all three CCGs.”
With the go live of the WinPath Enterprise system, Barts Health Pathology Service now has the confidence, in partnership with the CCGs, to mandate a paperless ordering solution across the region. This creates a safer requesting process by negating all transcription errors and results in faster booking in times in the laboratory. The final few practices go live with paperless ordering in May, which will generate substantial savings for the NHS and a good service for patients.
Barts Health considers having a regional system-wide healthcare solution providing total visibility for east London and west Essex, a population of over 4.5 million, as essential. CCG participation and engagement has been crucial in all Barts Health projects especially in the opening up of Healthcare patient records allowing all history / results to be seen by all carers. Clinical benefits are already being observed in this approach and test repertoires have been unified across all three CCGs such as unified analysis of ESRs and C-Reactive Protein. Reduction of unnecessary duplications and integrated referral investigation pathways are leading to improved chronic care management. After all, 50% of all blood test relate to chronic disease management.
Upgrading and consolidation to a single pathology IT solution and central LIMS database is the cornerstone in a much larger unification project following the merger that includes the replacing of all old and redundant kit with new and modern IT systems. Barts Health NHS Trust believe that this is a vital step to unify the trusts after the merger and helps provide all staff with a sense of becoming a cared for partner.
Pathology at Barts Health has recently entered into a managed service contract with a single company, Roche Diagnostics, to work in partnership to manage all of their laboratory contracts and equipment. As well as managing all the ongoing contracts with different suppliers, Roche Diagnostics will be procuring and replacing most of the incumbent analysers over the next 18 months. This will reduce variation across sites and eliminate the need to train different staff on different systems. As well as these benefits, it means the service can concentrate on running the service itself and, together with the single WinPath Enterprise LIMS, has a solid foundation to improve and expand their pathology services.
For this reason and because they have one of the largest and complex pathology services in the country, Barts Health has been selected as one of just five national pathfinder laboratories to lead the way in determining the best way to improve pathology services. Pathology is one of the areas the national Carter review has identified as being able to improve services by reducing variation and standardising processes.
Nicole Gresham states, “With our new single Laboratory Information Management System [WinPath Enterprise] and the standardisation of equipment, there is no better time for us to review our processes to find out what we do well and what we might be able to improve as we move forward.”
LTS Health consultancy was used to provide detailed business intelligence modelling of future state services to inform key decisions such as equipment selection and workforce structure. This was vital to aid in the redesign of Essential Services Laboratories, and the centralisation of ‘cold’ GP work has allowed for reallocation of resources minimising bank and agency spend and making significant staff savings. Such service modelling will help shape the future development of pathology nationally and provide advice to the rest of the country, while simultaneously identifying if there is anything that would make the trust better and allow for business growth in an ever-competitive market.
Nicole Gresham comments “Reinvestment in the service is vital to maintain our position in delivering a “total pathology solution” across an area. Network improvements, adoption of digital pathology, moving to a paper free environment and expansion of point of testing assets are just some of the future projects we will be focusing on.”
Professor Finbarr Cotter comments: “It is a real accolade for pathology at Barts Health to be selected as one of only five NHS pathfinder pathology units in the country to look at innovative ways to deliver pathology to the NHS. This recognises that there have been major improvements with our infrastructure.
We have the opportunity to fine tune our service delivery and help create evidence for the rest of the health service.”