The Benefits of Using NPEX & The Vision for Sending and Receiving Pathology Tests Nationally

Keith BurrillPathology IT Systems ManagerUniversity 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

LABA

Create referral order Refer sample and form.

Receive result(s)

LABB

Receipt sample Analyse sampleReport result(s)

Referral processes costs Recipient process costsStaff time etc Staff time etcIndicate test is send away Sample receiptPrepare request form for send away Issues with patient identification

Issues with identification of test(s) requestedCost of monitoring transportation Issues with location and consultant identification

Reporting costs

Receipt of resultsReferred result reporting TAT - electronic vs. paper based

Enter results into LIMSReporting TAT - electronic vs. paper based

Benefits of automation

Web Server

NPEx

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 Swindon 14,993

•NPEx investigations Salisbury 12,697 Swindon 25,887

• Unique investigations traded Immunology 130 Chemistry 80

Acetyl choline receptor Ab 78Adrenal antibodies 6Almond 49Alt.ve Haemolytic Complement 1Animal danders 8Anti B2 Glycoprotein 1 92Anti Cardiolipin Ab 944Antibody Titre 1Anti-Neutrophil cytoplasmic Ab 1119Apple allergen 3Aspergillus fumigatus 139Avocado 1Baker's yeast 2Banana allergen 7Bee venom 3Beef allergen 1

Clinical Biochemistry, examples

11-Deoxycortisol 217-OH-progesterone 724 HR CORTISOL 1525-OH-vitamin D2 & D3 249A1AT Phenotype 11ACTH 7Adrenalin 1Aldosterone 23Aldosterone/Renin Ratio 18ALP isoenzymes 1Alpha-1-antitrypsin 17Aluminium 1Androstenedione 4Arsenic whole blood 1Beta-2-Transferrin 1CA 19.9 97CA153 31Cadmium whole blood 1Caeruloplasmin 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