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Enabling information to flow

Departments throughout the NHS are now waking up to the fact that they need to deliver better outcomes, with less resources in a shorter period of time than ever before and pathology is certainly no exception. National Health Executive spoke to pathology informatics expert Dr Richard Jones to find out how the application of ICT is enabling pathology laboratories to make a big difference to the efficiency and effectiveness of the health service

One of the driving forces behind technological development over the last two decades has been enabling people to access increasingly large amounts of information, in the shortest amount of time possible.

“At a practical level very few people inside or outside the NHS realise that nearly 100% of test results for GPs have been sent electronically since 2004. That’s the results of 70m test samples per year and they arrive with the GPs with in 24 – 48 hours of the test being taken.” Explained Dr Richard Jones, Strategic IT Lead for Pathology Services at Leeds Teaching Hospitals NHS Trust.

“The sophistication of IT systems in Pathology in the UK leads the world and our move into the “Knowledge Economy” is underpinned by solid internal IT support.”

It is this quick and easy access to information which will enable clinicians to deliver better outcomes, as resources become increasingly tight through the period of austerity which the NHS is currently facing.

An example of this in practice is where pathology teams from around the country have put together their own online resources for both colleagues and clinicians alike, which give detailed information about tests and provide a wide variety of other support for clinicians. One such resource is the work of the Leeds and Bradford Pathology Partnership which gets about a million hits a year, all by clinical users.

“It is basically an online laboratory handbook which provides a range of information around the services we provide, includes guidance on how to interpret tests .”

An example of the support the site provides is an option called Tests and Tubes, which gets 14,000 hits per week.

“This lists all of the tests (around 600) which we do in pathology and contains information about which tube samples need to be provided in, along with the methodology which we use around the test.”

This site is not unusual. Many trusts throughout Britain have similar resources available to clinicians. However it perfectly illustrates how ICT has enabled information to be shared in an increasing efficient and convenient way, resulting in superior patient care.

Although all online pathology resources are now valuable resources, some provide more information than others.

“There is a site which is owned by Julian Barth, president of the Association of Clinical Biologists, which provides detailed, evidence-based guidelines for various biochemical investigations in laboratory medicine and is very thorough.”

This site allows health professionals to select a test and then gives the user a detailed account of how to deal with that situation.

“This is an essential resource, especially for junior doctors. Each explanation even has an evidence based flow chart to help with diagnosis and treatment.”

A similar site called Lab Tests Online enables patients and other members of the public to properly interpret the codes and results of pathology tests.

“This site originally began life in America, but has now been largely taken over by pathologists in Britain and now has resources spread throughout many places in the world. This is essentially to allow patients to better understand the tests being performed on them, through understanding what is involved in the test and what it is looking for. This is a great example of how ICT enabled front line pathology staff are helping patients, through providing comprehensive information to them.”

Aside from helping patients, the site is also used regularly by clinical staff, who are keen to keep up-to-date with the very latest information.

“Between 20-30 per cent of hits to the site are from clinicians who find the site to be a useful resource to refresh their knowledge of these tests.”

Although this application of ICT in pathology is already showing many benefits, there is a growing demand for efficiencies to be made to the system and as much waste as possible to removed from pathology in general. This could prove tricky given the number of efficiency drives which pathology services have been through in the past.

Dr Jones outlines the areas where the use of ICT is again helping to find those efficiencies.

“One project which is very important is work going on to provide a National Laboratory Medicine Catalogue, which will provide a set of standards for pathology testing in a way which has never been done before. This catalogue will work much in the same way as the other sites mentioned earlier, except in a slightly more sophisticated way.

“The project is ongoing, but it is now beginning to list all of the tests which are available under the NHS, along with links out to evidence and why those tests should or should not be available. At the moment the profession is going through that list to find tests which need to be dropped.

“This can often be because one test is very similar to another test and they need to be rationalised. Obviously the information available for each test varies as this is a work in progress, but there is a huge amount of work going on to develop the catalogue, which might even one day link off to Map of Medicine. This is a great example of the kind of digital and professional development that has flowed out of the pathology IT strategy papers.”

Although this site is very similar to the one created by Dr Jones and his colleagues at various trusts around the country, once it is finished it will be the definitive list of pathology tests.

“This will mean that if a test is not on this list, it will not be made available on the NHS.”

Dr Jones believes this will help to reduce waste by cutting back on the amount of tests which are carried out needlessly, either because they have already been done or are simply not suitable.

“There are a lot of tests being carried out which have a very questionable value. We all have lists of the tests which we can carry out but this would enable us to either use tests more effectively or not to use a test at all, perhaps because it is out of date.

“We also need a mechanism to deal with new tests which come in to us. One thing which happens quite often is that there a paper will be published in a journal and then the following morning we will inundated for requests for that test.

“Of course, just because something gets published doesn’t mean that it is actually proven and the test could be completely unsuitable, so to have a resource which would allow us to inform people on a big scale would be very useful. In the same way, if a test is really good, then this catalogue could allow us to share that information more easily.”

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