Introduction

The Health Informatics Service played a leading role in a major two-year partnership programme to enhance a national exchange hub which enables patient test requests and pathology results to be sent digitally between labs in seconds.

The National Pathology Exchange (NPEx) caters for NHS and non-NHS organisations across the UK and beyond. Pathology, the study of disease, is central to diagnoses of patients’ conditions and care pathways. Early diagnoses by pathologists, scientists and laboratories helps prevent premature deaths and assists both acute care and long-term care of patients.

With growing demographic and financial pressures on GPs and hospitals, transformation of testing and care delivery models across primary and secondary care is essential. Pathology has an important role to play and is leading the way in digitalising healthcare including the use of devices, apps and patient testing at home. The increased knowledge and use of technology by patients, especially younger patients, offers more opportunities for wider use of digital healthcare including at home.

 

The NPEx enhancement programme was funded by a £2million grant for ‘work packages’ to improve the hub’s coverage, scope and features. Objectives included:

• More capacity for complex pathology request and result reporting.
• Better business continuity and cover for laboratory failure.
• Wider integration of point-of-care and home-care devices for patients.
• An expanded NPEx network with more participation for partner, non-NHS, commercial organisations and private laboratories.
• Greater resilience at scale through upgrades to infrastructure, hardware architecture and ‘fail-over’ sites to support the major expansion of volumes, traffic and high availability.
• Comprehensive disaster recovery to increase resilience and cater for many scenarios.
• Improved connectivity/deployment of NPEx to non-NHS customers - who may or may not reside in the UK. A replacement to the current solution which involves configuring remote ethernet devices, couriering them to the customer.
• Complex results reporting functionality. Support new data models for structured reporting or reports typically done through paper or PDF format because of complexity. Expand into complex disciplines such as microbiology, cytology and genomics.
• Point of care integration between devices and electronic patient records systems.

The exchange plays a key role in the transformation strategies of many regional Integrated Care Systems (ICS), the new partnerships between health and care organisations being established across England.

The second year of our enhancement work coincided with the unforeseen Covid-19 pandemic which began in 2020. However, through early, high quality delivery of several key elements, we were in a strong position to support the NHS in its response to the pandemic, locally and nationally.

The two-year programme was a success on many fronts - partnership and collaborative working with range of stakeholders, excellence in digital healthcare and project management and achieving multiple objectives despite the disruption of the pandemic. It helps pave the way for further digital healthcare innovation and developments across and beyond the NHS.

 

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Connecting patient diagnostics regionally and nationally

Nation-wide, the transformation of NHS pathology and diagnostic services is required as part of the wider digital transformation in healthcare. NPEx is the national service for NHS pathology laboratories hosted by us (The Health Informatics Service) in partnership with X-Lab Ltd.

NPEx is seen as a ‘quick win’ enabling interoperability between hospitals without the high cost, long delays and risks of implementing a Laboratory Information System software solution across multiple laboratories within a region. Even areas which are implementing a regional Laboratory Information System still need NPEx for national-level connectivity, business continuity and flexibility.

In particular, there are new private pathology service providers in the UK and abroad which are not on the NHS HSCN network (Non-HSCN) but who are keen to use NPEx for direct digital access to NHS laboratories to offer more competitive services or to buy services from the NHS.

So, there are many reasons why organisations want access to the NPEx network.

 

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Delivering world-class standards

In addition to the defined objectives, we were required to upgrade the NPEx system to world class standards. These included:

• software architecture upgrades for new NHS standards for local and national bodies.
• secure standards accreditation for software and service management processes (IASME / ISO27001) and EQA (ISO 15189);
• emerging standards for digital medical devices (ISO 13485) and clinical safety (SCCI 0129/0160). Full accreditation and quality standards were to be embedded in all aspects of the NPEx service.

We were the ideal partners to deliver on this programme. Well-established, innovative, collaborative and award-winning, we are the only NHS informatics service to hold three ISO standards of ISO9001 (Quality Management), ISO20000 (Service Management) and ISO27001 (Security).

We are also widely experienced in partnership programmes and supporting public, private and charitable organisations across the UK and Ireland. With over 230 expert staff leading the digital transformation of primary, secondary and third sector care and being linked to the NHS means our knowledge of public healthcare values, systems and digital healthcare services is unrivalled.

 

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Our specialisms within the partnership

The overall NPEx scheme was split into a number of individual work packages or programmes. THIS’ programmes focused on infrastructure resilience, connectivity and standards. X-Lab’s focused on system development, complex reporting microbiology, histopathology and genomics, point-of-care and home-care testing.

Our management and delivery of the services aligned with best practice in the Treasury’s Managing Successful Programmes (MSP) and PRINCE 2 project management methodologies. These ensure rigorous planning and monitoring from start to closure, along with flexible decision-making suited to any fast-changing environments.

 

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Multiple benefits for patients and service providers

The NPEx enhancement programme was completed successfully by The Health Informatics Service and X-Lab Ltd.

It represents a major achievement which touched the entire NPEx service along with NHS trusts and staff across the country. Stakeholders showed great commitment to this programme of change. Technical and business staff were thanked for their effort and leadership, and teams praised for leading and embedding change. The programme offers a strong return on investment of the £2million grant with multiple beneficial outcomes.

• Much quicker turnaround times for patient diagnostics, less clerical errors and less need for patient retests. Ability to track samples is now also a feature of the service.
• The volume of messaging transactions and the number of laboratories using NPEx has risen from 67 to over 140.
• All the above labs now have microbiology capability as a discipline, which represents a 100 percent increase in that particular capability.
• Extended messaging capability enables end-users to configure NPEx for complex reporting, increased digital pathology, improved customer experience, visibility of complex reporting requirements, turnaround time for virology and TB tests and improved clinical safety.
• Building-out the NPEx infrastructure improved its resilience, capacity for high volumes and customer experience, achieved cost reductions through improved architecture and improved clinical safety and compliance requirement satisfaction.
• More devices used at point-of-care and in home testing can be integrated into the NHS pathology infrastructure. Benefits of this include increased choice for customers wishing to onboard NPEx and improved customer experience, interoperability for community diagnostics and clinical safety.
• Connectivity for non-HSCN organisations, commercial or NHS partner organisations has been extended. This enables them to take part in pathology messaging, as performers or referrers.
• There has also been a significant growth of private laboratories on the NPEx network.  Benefits include increased secure connectivity, improved clinical safety and customer service, a raised profile for the NPEx service and removal of reliance on extra hardware.

 

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Testimonials

Overall, the NPEx programme has received positive feedback from hospital trusts in locations including Kent, London, Nottingham, Derby, Leeds, Gateshead Lancashire and Wirral.
University Hospitals of Derby and Burton NHS Foundation Trust:

 

“Our experience with NPEx is really good. Amazingly quick response to all queries from new tests to advice. Very helpful too. The main benefit is the massively reduced turnaround time for reporting of referred results and the reduced transcription errors.

 

“For laboratories, tracking of samples progress is also a real benefit. In blood sciences we don’t have much to do with this however it did help with offering procalcitonin between sites although our sister site offered it, but NPEx was an easy option.

 

“For patients, and particularly during the Covid-19 pandemic, rapid result reporting and the ability to send to multiple sites were beneficial.”
Wirral University Teaching Hospital NHS Foundation Trust (Chester and Wirral Microbiology Service):

 

“The process of bringing NPEx into the laboratory has been enjoyable, the staff like the user interface and the audit / traceability functions.

 

“NPEx has enabled us to open up our referral network to one of our closest neighbours with whom we previously had no connection. We also used NPEx for over 100 Covid-19 referrals per day to PHE Manchester. Previously we used a rather clunky method of exchanging information.

 

“There is a quicker turnaround time due to the ease of data entry for Manchester, results come straight into our Laboratory Information System via the NPEx interface with an auto-release. This means reports issued in Manchester flow straight through our system and into the electronic patient records in the Countess of Chester Hospital, Wirral University Teaching Hospital and Clatterbridge Cancer Centre.

 

“We are now seriously considering using NPEx for the volume of serology and virology referrals that we currently send to Manchester via another method. The Wirral University Teaching Hospital will also be looking to use NPEx for haematology, chemistry and immunology referrals.”
St George’s University Hospitals NHS Foundation Trust (South West London Pathology):

 

“Overall, it’s been a positive experience once tests are set up and configured correctly. The benefits become apparent very quickly, such as quicker turnaround time and less clerical errors due to booking-in for example.

 

“It is also saving laboratories a lot of time by eliminating the need for manually entering patient and test data into the LIMS, and then manually entering the results and posting or emailing these back to the relevant lab. For patients, the benefits are quicker turnaround of results and less clerical errors leading to less patients being retested.

 

“We are continuously looking to add more tests and more partner sites to our portfolio. An increasing number of staff are being trained to use NPEx and going forwards, the plan is to have it very tightly integrated as part of the labs routine staff training
Nottingham University Hospitals NHS Trust:

 

“The NPEx user-experience is akin to a parent watching his child grow up. As an early user of NPEx the product was like a new-born baby, requiring a great deal of work. Now, the product could not be simpler to use.

 

“Regarding laboratories, we have been able to carry out work for six other hospitals. We can return the result back to the requesting lab within 15 minutes of the result being transmitted from the analyser. We have also been instrumental in helping new labs setup to test their NPEx installation. The whole process is seamless, efficient and requires little additional monitoring.

 

“Results for COVID-19 and any other assay requested on NPEx is with the requestor within minutes, not days. There is no need to wait for a paper report and the time taken to transcribe it. No more transcription errors. The wait for the patient to receive treatment is dramatically reduced, which is the ultimate goal.

 

“In future, we are looking to venture into requesting microbiology and cellular pathology on NPEx, these are complex requests with different structures. The NPEx team in collaboration with Nottingham University Hospitals NHS Trust are working with a number of trusts to test and facilitate this for the whole NPEx community. We need to promote the full use of NPEx in all disciplines and enable pathology networks within the UK and beyond.”

 

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Statistics

• NPEx enhancement 2-year programme funded by a £2m grant
• 148 labs now adopted NPEx (55% increase in uptake)
• 100% increase in microbiology as a discipline