Northern Ireland CoreLIMS and Blood Production and Tracking
An ambitious programme to implement a single laboratory information system at five health and social care trusts and the Northern Ireland Blood Transfusion Service has laid the groundwork for the first, national, vein-to-vein tracking programme in the UK.
Organisations involved
Health and Social Care Northern Ireland: the publicly funded healthcare system in the region.
The Department of Health: an executive department of the Northern Ireland government: has overall responsibility for health and social care services.
Digital Health & Care, Northern Ireland: the data and technology lead for the health and social care system in Northern Ireland.
The Business Services Organisation (BSO): a non-departmental public body that provides services to the Department of Health and health and social care trusts.
BSO is leading on the Northern Ireland Pathology Information Management System or NIPIMS programme, which consists of CoreLIMS (the roll-out of a single LIMS) and BPaT (the Blood Production and Tracking project).
The Northern Ireland Blood Transfusion Service: an independent special agency responsible for collecting, testing, and issuing blood and blood products to hospitals, from its headquarters in Belfast. It also provides antenatal testing and reference laboratory testing for the region.
Health and social care trusts: Northern Ireland has six health and social care trusts that provide hospitals and other services. Five cover regions (Belfast, Northern, South Eastern, Southern, and Western) and the sixth is the ambulance service.
The challenge
The Infected Blood Inquiry recommended the introduction of ‘vein-to-vein’ tracking to improve the oversight of blood stocks, demand and outcomes for patients. In 2022, the then Northern Ireland Health Minister, Robin Swann, committed Northern Ireland to establishing the first system in Europe by 2027.
The solution
The Northern Ireland Blood Production and Tracking project, or BPaT, is on course, but it is a complex project that has only been made possible by prior investment in pathology transformation and technology coupled with the willingness of suppliers to address integration challenges.
Key developments include the roll-out of a single laboratory information system, Clinisys™ WinPath, to five territorial health and social care trusts as well as the Northern Ireland Blood Transfusion Service, alongside other regional IT programmes. This implementation has been overseen by the Business Services Organisation’s CoreLIMS project.
The outcomes
Clinisys WinPath is live at three trusts and the NIBTS, and its roll-out is due to be completed by May 2025. The CoreLIMS project is already delivering benefits by supporting standardised ways of working at Northern Ireland’s laboratories and improving the visibility of results.
The BPaT programme is implementing the additional blood production and tracking technology required and integrating it with the LIMS and other systems. When complete, it will deliver modern, online donor communications and visibility of blood and blood products across the region. This will make it easier to respond to incidents and gain new insights into outcomes.
Ambitious plans
“The Infected Blood Inquiry recommended end-to-end digital tracking from donor to patient to outcome. What we have been able to do is design a system to meet these requirements. The benefits for our patients and clinicians will be significant.”
Karin Jackson, Chief Executive of the NIBTS and Senior Responsible Owner for CoreLIMS and BPaT
Northern Ireland has ambitious plans for health and social care, including its laboratory services. Health and Social Care Northern Ireland has established a pathology transformation programme to regionalise pathology services, encourage standardisation, and provide better facilities and career opportunities for staff.
To underpin this work, it has been implementing a single laboratory information system (Clinisys WinPath) at five territorial health and social care trusts and the Northern Ireland Blood Transfusion Service.
The implementation of the LIMS has been co-ordinated by BSO with other IT projects that comprise the encompass programme to create a single, digital health record for every citizen. These include: the roll-out of the Northern Ireland Digital Identity Service, the implementation of the EPIC electronic patient record, and a regional Northern Ireland Picture Archiving and Communication System (NIPACS+).
Despite the complex chronology and integrations required, the first go-lives for the CoreLIMS project were delivered in 2023, with the NIBTS going live the following year, and the entire project due to be complete in May 2025.
CoreLIMS has also laid the groundwork for the Northern Ireland Blood Production and Tracking or BPaT project, which is looking to introduce digital ‘vein-to-vein’ tracking for blood and blood components across the country. Being able to electronically trace blood and blood products from donors to recipients is a key recommendation of the Infected Blood Inquiry final report.
However, vein-to-vein tracking is immensely complex, and it is only Northern Ireland’s commitment to service transformation, its investment in IT, and the willingness of its suppliers to deliver the integrations required that has put the region on course to achieve it.
A critical service: the context of blood transfusion in Northern Ireland
Northern Ireland’s pathology services cost around £100 million to deliver each year, employ more than 1,100 staff, and carry out more than 40 million diagnostic tests annually.
These tests are conducted at laboratories run by the region’s five territorial health and social care trusts, while blood transfusion services, reference laboratory and antenatal testing are provided by the Northern Ireland Blood Transfusion Service.
The NIBTS is an independent, special agency of the Department of Health. It operates two mobile teams and runs around 800 donation sessions annually from its headquarters at Belfast City Hospital and in community settings throughout the region.
All donations are rigorously tested to determine their ABO and Rhesus blood group and screened for irregular antibodies. Donations are also screened for a number of communicable diseases, including Hepatitis and HIV, to ensure they are safe for transfusion.
The BPaT solution allows each donation to be logged into the NIBTS blood production system, where its progress is tracked through the testing and processing laboratories. From here, it is issued to the hospital trusts, which track the rest of its journey through to the patient.
Every week, around 500 people in Northern Ireland require a blood transfusion. Blood components such as red cells, platelets and plasma are used to treat patients with cancer and blood disorders, trauma as well as women accessing maternity services.
The challenge
“This transformational project will help us drive improvements in the blood production and transfusion process. For the benefit of patients and staff, I look forward to BPaT becoming fully live across the entire region.”
Northern Ireland Health Minister Robin Swann, 15 May 2024.
Vein-to-vein tracking: a first in Europe
During the 1970s and 1980s, thousands of UK patients contracted HIV, hepatitis viruses, or both from contaminated blood or blood products. In 2017, a public inquiry was announced into what had gone wrong, chaired by Sir Brian Langstaff.
When the inquiry reported in 2024, one of its recommendations was that digital ‘vein-to-vein’ tracking should be established, “to allow oversight of blood stocks, demand and outcomes for patients receiving transfusions.”
In May 2024, the then Northern Ireland Health Minister, Robin Swann, launched the Blood Production and Tracking project to establish the first vein-to-vein tracking system in Europe by 2027.
When it is completed, BPaT will enable blood donors to book their donation appointment online via a donor web portal, and enable blood to be tracked from donation to the Northern Ireland Blood Transfusion Service blood centre, from the centre to hospitals, and to transfusion administration to patients. This will allow for full, electronic visibility of the blood stock inventory across Northern Ireland, facilitating greater sharing and more efficient use of this vital resource. It will also make it easier to recall products and provide new insights into outcomes.
The solution
“The BPaT project is impressive because of the number of suppliers involved, and the number of systems that all need to handshake and pass information to each other. It is an interoperability masterclass. That is why this has not been done before. It’s hard, and everybody involved has to be committed to it.”
Paul Mcanuff, blood transfusion domain lead, Clinisys™.
Built on investment in modernisation and IT
The Blood Production and Tracking project is immensely complex and is only possible because of the significant investment that Northern Ireland has made in service transformation and technology, and the willingness of suppliers to tackle the interoperability required.
Service modernisation: Northern Ireland has big ambitions for health and social care, and the services that support them. Significant reports (“The future of Pathology services in NI” in 2006 and “Proposals to improve pathology services consultation” in 2016) called for modernisation of pathology services, supported by a consolidated laboratory information system.
To move forward, the Northern Ireland Pathology Network established a Pathology Foundational Keystone project, which brings together a range of stakeholders who shape and deliver pathology services in the region. The project supported standardisation and harmonisation by agreeing test names, units of measurement, reference ranges and processing parameters.
“We had eleven labs that were all doing the same tests in different ways, so we streamlined all that before we went out to tender for a new system,” says Melissa Cochrane, Head of Programme Delivery at Business Service Organisation.
“The decisions made and consensus reached were invaluable. Whenever we talk to other pathology networks in the UK, we always say: ‘do the standardisation first’.”
A single laboratory information system: With the Pathology Foundational Keystone project in hand, attention focused on technology. Northern Ireland’s laboratories were sitting on a ‘burning platform’ of legacy IT systems that were going out of support, while the NIBTS was using a 15-year-old system that had been developed in-house and was also coming to end of life.
In March 2020, the Business Services Organisation initiated a procurement process for a single, regional, laboratory information system, which came to be known as CoreLIMS.
“That was a big year, because of the Covid-19 pandemic,” says Melissa Cochrane. “We had not done a procurement by Teams before, but it really worked for us because more people could join remotely and get involved.
“We were heavily involved in the roll out of the Covid-19 testing, running the procurement, and writing the BPaT business case, so it was a very busy time for everybody involved.” The following year, Clinisys™ was chosen to provide the latest version of its WinPath Enterprise LIMS to the CoreLIMS project.
National IT programmes: The single LIMS roll-out is not the only technology programme underway in Northern Ireland. Digital Health and Care Northern Ireland is also leading the encompass programme to create a single, digital care record for every citizen.
The key dependencies of this programme include: the introduction of the Northern Ireland Digital Identity Service as a unique identifier for patients within the health and social care system; the roll-out of a single imaging system (the Northern Ireland Picture Archiving and Communications System, or NIPACS), and the deployment of the EPIC electronic patient record and patient portal.
The encompass programme has had a significant impact on CoreLIMS. Melissa Cochrane says: “This has been a complex roll-out. There are numerous systems to go-live at each trust, these systems have complex integration dependencies so they need to go live in order – NIDIS, then CoreLIMS and NIPACS+, then EPIC – and Covid compressed the timescale available to do all of this.”
CoreLIMS roll-out: There was also significant political interest in getting to the first go-live, which took place at Belfast Health and Social Care Trust in November 2023. Melissa Cochrane says: “We went live with Clinisys in Belfast and then we went live with encompass three days later.
“None of us got any sleep, and it was very, very intense. But we got-live, and the go-live was very successful.” South Eastern Health and Social Care Trust went live with both Clinisys WinPath and encompass later the same week.
Six months later, in June 2024, the NIBTS migrated away from its 15-year-old system to Clinisys WinPath, while Belfast and South Eastern went live with their blood transfusion modules.
Then, a year after the first go-lives, Northern Health and Social Care Trust went-live with the LIMS, alongside the national cytology screening service in Belfast. This leaves just two trusts to go-live this year (2025): Southern and Western.
October 2021
Clinisys announces that it will provide the latest version of its WinPath Enterprise LIMS to the Northern Ireland Pathology Information System project, which covers both CoreLIMS and The Blood Production and Tracking project (news release).
November 2021
The Department of Health issues a policy statement, announcing a regional management structure for pathology services in Northern Ireland, supported by the CoreLIMS and BPaT projects.
November 2023
Belfast Health and Social Care Trust and South Eastern Health and Social Care Trust go-live with the core components of Clinisys WinPath (press release).
May 2024
Health Minister Robin Swann launches the BPaT project as “the first of its kind in the UK and Europe.”
June 2024
The Northern Ireland Blood Transfusion Service migrates from its in-house LIMS to Clinisys WinPath (press release), and Belfast and Southern go-live with their blood transfusion modules
November 2024
Northern Health and Social Care Trust goes live, alongside the cervical cytology screening service, to complete the third phase of CoreLIMS (press release).
Blood Production and Tracking
Meanwhile, the business case for BPaT was approved in 2021, after which a tender was published for the technology required, which was won by MAK-System and its subcontractor Accuscience.
MAK-System will configure and implement a fit for purpose blood production system (eProgesa) at NIBTS. This will include an online portal for donors, where they can book an appointment and fill in a donor healthcheck questionnaire as well as a stock and demand management system. T
This will be integrated with the Clinisys WinPath LIMS at the NIBTS blood bank in Belfast, so blood can be traced from donation to testing, processing, and inventory. Hospitals will then use the Hospital Web Based Ordering module to order blood and Accuscience will replace their mix of computerised and paper-based blood tracking with its BloodTrack software. This will include an option for remote release fridges and associated kiosks.
The plan is for BloodTrack to be interfaced with the hospital LIMS and the EPIC electronic patient record, which staff will use to order blood and blood components and transfuse patients. Once a transfusion is complete, a message will be sent back to the LIMS to “close the loop”, ensuring cold chain integrity and inventory is updated.
Patrick Breen, Programme Manager for both BPaT and primary care order comms programmes, says: “Because we have one LIMS for the region, we can implement a regional blood production and tracking solution – but that does not mean it has been easy!
“It has been anything but! It has taken considerable effort to address the integration challenges involved, but we have worked through them. We are presenting this to clinicians as the gold-standard, and what other healthcare systems should be aspiring to.”
The outcomes
“Paper notes are cumbersome, and that makes it slow to track blood from the donor to the patient or back. Digital enables us to understand what is happening at every point, more efficiently. We will not just be able to track the blood, we will have the full clinical picture.”
Patrick Breen, programme manager for BPaT and primary care order comms.
CoreLIMS delivers benefits, with Blood Production and Tracking to come
The Northern Ireland Pathology Information System programme is already delivering benefits to health and social care trusts and those who rely on their services.
Benefits of CoreLIMS: The roll-out of a single LIMS to the Northern Ireland Blood Transfusion Service and hospital laboratories is encouraging further standardisation. “Standardisation is something that we have been working on for a long time, and the new system is really supporting that,” says Karin Jackson.
“Everybody is on the same analyser platform. Everybody is using the same LIMS. It is encouraging everybody to work in the same way, which makes things much safer and faster.” The integration of the LIMS with the encompass programme also means that clinicians in hospitals have more information about the tests that have been conducted for their patients.
However, the biggest single benefit of the programme to date is that test results are visible across the region, which should improve continuity of care, and reduce the number of repeat tests that are carried out.
For example, if a patient is seen in Derry/Londonderry, and referred for specialist treatment in Belfast, clinicians in Belfast will be able to see and act on the results taken at the referring hospital.
In the blood transfusion context, the NIBTS can see the results of tests carried out at hospitals, and hospitals can see the results of tests carried out at the blood centre, which should reduce the number of times that individual patients need to be bled and speed up the transfusion process.
“Patients in Northern Ireland move around the system, so from the point of view of the patient, the visibility of tests is one of the biggest bonuses,” says Matt Gillespie, Head of Testing at the NIBTS.
“It means fewer appointments. Fewer needles. And better safety, because if they give a blood sample in Derry/Londonderry, and then they go to Belfast, the antibodies are already identified. We only need to conduct one more test. Or, if the patient needs an emergency transfusion, their history and historic blood group is available, and they can be given the right blood.”
Benefits of BPaT: The implementation of the regional Clinisys WinPath at both the NIBTS and hospitals is also providing greater visibility of blood stocks across Northern Ireland. This should make it easier to transfer blood and blood components between sites to meet patient needs and reduce waste by making it easier to see expiration dates of blood components.
Melissa Cochrane says: “Because we have one LIMS system, we know where all our blood and blood components are at any given time. That will allow us to use them much more effectively”.
Business case benefits of BPaT
- More effective donor management and stakeholder communications: by creating a modern, online communications and booking option.
- Enhanced stock management and demand management: by providing the capability to access real-time stock and demand data.
- Increased real-time surveillance of control points and transactions: by creating the ability to view transactions in real-time, identify errors and report incidents more quickly.
- Improved safety: through improved auditability and traceability to react to issues, such as recalls.
Full, digital tracking will also make it much easier to recall blood and blood components, if testing identifies an issue or to investigate patient safety incidents.
If a patient suffers an adverse incident, then the combination of the testing information in the LIMS, and the operational data in EPIC, will make it much easier to work out whether the blood, or the way it was administered, or a clinical issue lay behind that.
Laying the foundations for further transformation: Northern Ireland’s investment in pathology transformation, backed by a single LIMS, linked to other IT programmes, has laid the foundations for further technology developments.
These include the roll-out of digital histopathology, the introduction of ambient dictation and automated notetaking, and the use of AI in clinical decision support. Another big project in hand is primary care order communications.
As things stand, GPs in Northern Ireland order tests for their patients using paper forms. So, a working group was established to find out what they would want from a digital system.
Patrick Breen says: “A paper-based system is slow. It can also pose a risk to patients, because errors can occur when information is manually transcribed from the forms into the laboratory information system.
“An electronic digital solution should deliver significant efficiency and safety benefits.” The BSO is currently drafting a business case for a commercial primary care order communications and results reporting system that will integrate with the LIMS and with GP clinical information systems.
Status
Significant programmes, delivered at pace
Northern Ireland’s national IT programmes, including CoreLIMS and Blood Production and Tracking have been enormous pieces of work: but the progress and benefits delivered to date have been impressive.
Melissa Cochrane sums up: “We are fully live with the Northern Ireland Digital Identity Service, which links all our IT systems and records together. We are fully live with the NIPACS+ radiology system. We are live with encompass at three out of five trusts, and we have Clinisys WinPath live at the same trusts and at the Northern Ireland Blood Transfusion Service.
“We are rolling out BPaT and working on primary care order comms. And all of these systems are helping to drive standardisation and transformational change across Northern Ireland. There is always more that we want to do, but what we have achieved is making a real difference to services, to clinicians and – most importantly – to patients.”
Northern Ireland’s blood transfusion service migrates to Clinisys WinPath
Northern Ireland’s CoreLIMS programme has achieved another significant milestone by migrating the Northern Ireland Blood Transfusion Service (NIBTS) away from its 15-year-old laboratory information system and onto Clinisys WinPath.
Northern Ireland’s laboratory services reach another IT milestone
The transformation of pathology services across Northern Ireland has achieved another milestone, with the completion of phase three of the CoreLIMS programme to deploy Clinisys WinPath to all five health and social care trusts and the blood transfusion service.
Leeds blood transfusion service live with Clinisys WinPath
Leeds Teaching Hospitals NHS Trust successfully updates its pathology laboratory information system, supporting a new digital way of working which will ultimately support innovation across West Yorkshire.
