CliniSys has been working with one of NHS England and Improvement’s regions on a diagnostics hub to give clinicians access to diagnostic test results across modalities, no matter where in the region they are carried out. This kind of approach to removing the barriers and enabling systems to be truly integrated is the theme in the Department of Health & Social Care’s recent Working together to improve health and social care white paper. And that could just be the start of a national diagnostic repository… Darren Ransley and Darren Solomon explain.
The NHS in England has been split into eight regions to create space for innovative thinking about how to transform health and care at scale. CliniSys has been working with one region on a diagnostic hub: a single point of access for clinicians to view test results of all kinds, no matter where they were conducted.
The intention is to start with pathology results, using the technology embedded in the Integrated Clinical Environment, or ICE. But the diagnostic hub has huge potential. Initial modelling suggests it will easily save its first region a million a year by avoiding the need for hospitals to repeat simple blood tests.
After that, the more test results the hub contains, the greater its potential impact on trusts, clinicians and patients. Sales director Darren Ransley and ICE product director Darren Solomon explain.
Where did the idea for the diagnostic hub come from?
Darren Ransley: “We have been talking to the diagnostic lead of one of NHS England and Improvement’s regions. He challenged us to think about “the art of the possible”, using the systems in which the region has invested already.
“We developed the concept of a central diagnostic hub that would take results from across the region and give clinicians a holistic view to support patient care. The intention is to start with pathology results, and then move on to other areas: radiology, cardiology, endoscopy…”
How will it work?
Darren Solomon: “The CliniSys Integrated Clinical Environment, or ICE, already has a feature called ICE OpenNet that enables one instance of ICE to share results with another. ICE OpenNet is great, but because you are making calls from one trust system to another, you couldn’t use it across a whole region. It would be too network intensive.
“The diagnostic hub will get that chatter under control. It will have an ICE underneath it that all the other ICEs can talk to. It will be hosted in the cloud, handle all the processing, and create the region-wide view that Darren has just been talking about.”
What about trusts that don’t use ICE?
Darren Solomon: “Trusts that don’t use ICE can still integrate with the diagnostic hub by using the ICE application programming interface. Essentially, we will publish a specification and an API to enable any system to send us properly formatted messages.
“When it comes to viewing results, a lot of electronic patient record systems allow third-party applications to launch in context, so trusts can let clinicians view results that way. Or they can render our information for display within their system.
“At CliniSys, we believe the future for major healthcare IT systems is interoperability and our vision is to be very open. We will publish the ICE API and then it is up to trusts and their vendors to display in context or do the work to render it.”
How does ICE OpenNet help clinicians at the moment?
Darren Ransley: “ICE OpenNet is a very simple concept. It means that clinicians working in trust A can see results from trust B and vice-versa. So, if a patient presents in trust A, and they’ve already had bloods done in trust B, their clinician can take a look at the results.
“That way, they avoid the need for taking more blood which can cause delay and further patient anxiety and discomfort. Or, if they decide to order the test again, they have a baseline against which to compare the result.”
And how would they benefit from the diagnostic hub?
Darren Ransley: “We can see this potentially being incredibly useful to services like NHS 111 and emergency departments. If I was a call handler in NHS 111, and I had access to all of a caller’s results, I’d be in a much better position to advise a patient.
“A&E is a bit different, because they take bloods immediately. But access to prior results would give clinicians a reference point. They could look back and say: ‘Ok, I can see this is your baseline, and it’s always a little high, so we won’t worry too much about this reading’. Or: ‘You’ve dropped a lot, and we need to do something about that’.”
Will this generate savings?
Darren Ransley: “As part of our thinking around the diagnostic hub, we had a look at how trusts across the region that we are working with are using ICE OpenNet. We found that in just one conurbation, with three major acute centres, there were more than 58,000 OpenNet connections in a single month.
“By making some assumptions about the kind of tests results that clinicians were likely to be looking for, we were able to calculate that each trust was saving about £70,000 a Month or around a £1 million a year, just from not running those tests again. Scaled up, that suggests the diagnostic hub should save the region about £5 million a year. So, it’s a great investment in getting a lot more out of technology that already exists.”
Would it work in other regions, though?
Darren Ransley: “We already have other regions interested in the diagnostic hub concept. We’re having quite detailed discussions with a second region in which ICE is much less prevalent. It would need to do more of the integration using the ICE API; but it can still see the benefits.”
What is the vision for the future?
Darren Solomon: “We want to get this working well in one region. But then we would love to get it working in all eight regions. If we could do that, we could also create a national diagnostic repository, by linking the hubs together.
“What we want to provide is a full picture for the clinician, wherever they are working, and at whatever point on the patient pathway. The more diagnostic data we can route into the hub, the more benefit for the patient there will be.”
If you would like to find our more about our approach to creating Diagnostics Hubs, then please contact us.