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9 March 2021

A vision for diagnostic services across Scotland

Gerald Blair

The Integrated Clinical Environment, or ICE, is used in seven out of the 14 health boards in Scotland for order communications and results reporting. Imagine if it was used across Scotland, as a single point of information about tests of all kinds… At a recent webinar, Clinisys outlined the art of the possible.

“Today,” said Richard Craven, “I want you to imagine the art of the possible.” Imagine, the chief executive of Clinisys told a recent webinar, that just one year from now any clinician, anywhere in Scotland, could order any test and see the results alongside the results of any other test conducted for their patient.

Then imagine that any other clinician contributing to the care of that patient could see the same information within their current system. A pipedream? Not a bit of it. Craven told his audience that the technology required not only exists; but is in use in half of the health boards in Scotland.

It is the Integrated Clinical Environment, or ICE, an order communications and results reporting solution, that is being developed to support shared service models and can be accessed through a portal. Or, as Craven put it: “How do we bring this to reality? Clinisys’ answer is ICE. It is in use in seven out of the 14 health boards in Scotland; so you are half-way there.

“And we are working to build regional ICE hubs in England, starting in London and the South West. So, we are confident we can do this and extend the concept of ‘right test, right time, right place’ to… ‘from anywhere’.”

The Integrated Clinical Environment: built for integration

Clinisys ICE is a user-friendly electronic testing and results reporting service that has been designed to integrate with electronic patient record,  laboratory information systems and a range of other diagnostic systems that support international messaging standards, such as those produced by HL7.

This means it can cope with a mixed environment of EPR and LIMS systems, and enable health boards to get the most out of their investment by leaving them in place while extending their use. Other features support health boards that want to move quickly towards shared service models.

For example, OpenNET allows one instance of ICE to talk to another instance of ICE, while the ICE application programming interface, or API, enables it to integrate with third-party systems. Users can order and view results through the ICE portal,  to safely identify patients and draw together their results.

ICE product manager Gerald Blair explained that Clinisys has worked hard to make sure that ICE can better work with a number of local and national identifiers. Naturally, these include Scotland’s community health index, or CHI, number, which is mandated on all clinical communications.

Another feature of ICE enables a lab using one instance of ICE to publish a catalogue to another instance. The organization running the second ICE system can choose whether to make some or all of the catalogue visible to its users. But if it does, clinicians can “mix and match” the tests that they order; and see the results in that one, consolidated view.

“Published services is a new view that allows a laboratory to publish some or all of its services to another ICE system, which means that you can share services across a region or individual hospital laboratories in a distributed system,” Blair summarised. “The reporting aspect means that users of one ICE system can see results from other services, no matter how they are configured.”

ICE in action

So, how does it work in practice? Blair gave two examples. In the first, two health boards want to consolidate some of their laboratory services, to make the most of expensive equipment and scarce clinical expertise.

Until recently, to do this, board A would have had to configure its LIMS and order comms systems to align with those of board B, and then keep everything in sync. But by using ICE, with its published services functionality, board B can publish a catalogue to board A, and board A’s clinicians can use it.

In the second example, one or more health boards want to set up a regional laboratory system on a hub and spoke model, in which one lab conducts specialist tests and others handle ‘hot’ work. To do this, all the labs implement a single instance of ICE and use it as both a catalogue and results repository.

“This allows for the customisation of not just one service but many services across a region, driving improved service optimisation for the labs, and delivering a higher quality of service,” Blair explained.

“Meanwhile, users get a longitudinal view of a patient’s diagnostic history, which reduces unnecessary testing, because all the results from the central repository can be presented at the time of the test. It also reduces time for the clinician, because they can easily locate and view this information, if it is there.”

The ICE diagnostic hub

If every health board in Scotland used ICE and used it to move from a regional to a national shared service model by publishing their labs’ catalogues to each other, the country would be a long way down the road to the vision set out by Craven.

But there is a final part of the picture, which is to bring in other tests as well. Blair explained that this can be done by integrating ICE with the systems used by other diagnostic areas, such as radiology and cardiology, using the ICE API. Users can then order tests and view results in the ICE diagnostic hub.

Blair argued that the case for doing this is that it’s not just pathology that is starting to operate on a regional or networked model. Many other services are moving in the same direction, which means that patient pathways increasingly span multiple specialities and locations.

If their information isn’t available to the clinicians in all those locations, there can be gaps in the record. The ICE diagnostic hub concept closes those gaps. “There are many benefits,” Blair said. “It takes less time for clinicians to find this information, it further reduces the need for repeat testing, it should mean a better diagnosis – first time. It also supports clinical audit and data analytics.”

Right test, right place right time… from anywhere

The webinar was shown examples of how the ICE diagnostic hub looks to users, who can rapidly configure its widgets to create patient, task and results lists to support their work, and then drill down into individual results or graph them over time.

Organisations that do not use the ICE diagnostic hub can use the ICE API to give their clinicians access through their electronic patient record. The event concluded with a rapid tour of some extensions and improvements that were made to ICE during the Covid-19 pandemic.

These include a stripped-down version of the ICE portal to enable care homes to order COVID tests in bulk, and a platform to enable staff to receive negative results by text; both of which are available for new and creative uses once the NHS in Scotland starts to recover.

The NHS in Scotland, as in other areas of the UK, has seen huge changes in its use of technology during the pandemic; and is now looking for ways to build on that momentum. In his introduction, Craven argued that new thinking on diagnostic technology needs to play its part. “Right test, right place, right time, from anywhere,” he said. “CliniSys | MIPS can help to make this possible.”

Clinisys in Scotland

If you would like a link to the recording of the event or would like to find our more then please contact us.