Clinisys Customer Summit 2024 – LIMS

The Clinisys Customer Summit 2024: responding to challenges, realising opportunities

Clinisys’ annual conference has become such a major event that it has been split in two. This time, it was Clinisys WinPath laboratory information system customers who gathered at The Belfry to discuss the major challenges facing pathology, and the role of technology in addressing them. Matthew Fouracre reports from a packed, but inspiring, two days.

Delegates to the Clinisys Customer Summit 2024 arrived at The Belfry to find it is expanding. The famous golf resort is adding 140 bedrooms and building what it describes as a “high spec, high-tech” ballroom with a capacity of more than 600 people.

Which is just as well, because the annual event has become so large that it has been split in two for a year. Clinisys WinPath customers packed the summit, while users of the ICE order communications and results reporting system will attend their own, dedicated event in the autumn.

Back at The Belfry, how to create the “high spec, high-tech” pathology services that will be needed to address future demand while meeting the expectations of staff and users was a key theme. Because, as Dr Bernie Croal, president of the Royal College of Pathologists, told a session on day one, healthcare and the laboratories that serve it are facing some big challenges.

An emerging crisis in pathology?

Dr Croal argued that most of these challenges are caused by “very limited” resources and capacity, which has led to “gridlock on pathways” and rising waiting lists and times, even in priority areas, such as A&E and cancer.

Pathology services have held up better than some, he suggested, but there is an “emerging crisis” caused by a shortage of money, rising demand, supply chain issues, and workforce shortages, which the RCPath has created a plan to address.

Technology, he went on, “will be part of the solution” – not because it will take jobs, but because it will help people to work more efficiently. Dr Croal noted that politicians are particularly interested in AI to smooth workflows and handle routine work.

However, he said, AI needs firm foundations, including functional laboratory information systems, good governance, and digital pathology. Plus, security – something that has acquired a new salience following the recent ransomware attack in London.

Security has moved front of mind

“We realise the process is a bit long, but we are doing a lot of work to make it easier,” he said. “And we will be pushing hard to make sure everybody is current, partly because we want you to have access to the latest and greatest features, and partly for security.”

Simpson warned cyber security assaults are a fact of modern computing life, and the best strategic response will be to get IT systems into the public cloud.

“Microsoft, Amazon, the other big cloud companies have tens of thousands of engineers looking for threats and responding to them,” he said. “Many of you are already hosted in the private cloud, in the Telefonica data centre, but our next job will be to get you into the public cloud, because it offers tremendous resilience and flexibility.”

Technology to address the challenges

In the meantime, Simpson said Clinisys continues to invest in Clinisys WinPath. He outlined some of the things the company is doing to make the system easier to deploy and use, such as a partnership with Stalis to make its Careview archive available to customers, and the Clinisys Automated Testing Solution, Cymetryc.

On day two, Kate Bryan from Stalis outlined how the ongoing Careview project is helping North West Anglia NHS Foundation Trust. Following a merger, it needed to move its laboratories off three legacy systems and onto Clinisys WinPath, and it wanted to minimise the amount of data migration involved.

To achieve this, legacy data is being moved into the archive, so that clinicians can access it whenever they need it from an in-context button in the LIMS.

Janine Bontoft, from the West Yorkshire Association of Acute Trusts, outlined how Cymetryc, which is delivered by American company STS, helped it to manage user acceptance testing with limited resources – a situation many laboratory managers will recognise.

Cymetryc provides test script writing support, runs test cases, and gives labs access to testing software. Kevin Hall, a LIMS replacement specialist, who also worked at North West Anglia, told another presentation that Cymetryc “felt like hard work, but was actually a life saver” because it freed up time to check its build matched its design documents.

Hall had other tips and tricks for delivering a successful implementation on schedule. These included: securing executive buy-in, finding adequate resources, avoiding “scope creep”, and working with willing helpers. “Don’t try to be a solo warrior,” he said.

Implementations and upgrades: top tips from the top networks

Delegates were able to pick up more implementation and upgrade tips from other leading pathology networks. Nick Fudger, from Black Country Pathology Services, talked about building an effective pathology IT team, advising his audience to “start where you are” and really understand your current architecture, before designing, building, and consolidating your future state.

Heather Clarke, from the University Hospitals of Derby and Burton NHS Foundation Trust, outlined the “good, the bad, and the ugly” of its LIMS implementation, which was “going so well” until the Covid-19 pandemic arrived in March 2020.

The project encountered some data migration and staff training challenges when it restarted; but still delivered a successful go-live in early 2022. Tamara Forster, from NHS Berkshire and Surrey Pathology Services, outlined how close partnership working and a relationship of trust with Clinisys had enabled it to successfully upgrade all four of its laboratories to Clinisys WinPath 7.24 this spring.

And Nigel Brown from Northumbria Healthcare NHS Foundation Trust, explained the “challenges and benefits” of moving to a modern LIMS in toxicology. The challenges: changing the drug screens and implementing electronic ordering. The benefits: more automation, better data, and – most importantly – happy customers.

Data drives innovation

In his keynote, Simpson also talked about some of the new functionality that is available to help Clinisys WinPath customers get the most out of their LIMS investment. The focus here was on giving laboratories better insight into their operations, for example via the VUE diagnostic console, which Simpson described as “one cockpit for the pathologist.”

He also talked about Clinisys’ support for the hot topic of digital pathology and getting ready for that coming world of AI. “The future will be about automation,” he said, “because studies show computers can already do [routine tasks such as cell counts] better than a pathologist. They ‘see’ things we just cannot see.” 

Some of these ideas were also discussed by early-adopters on day two. Marie Parsons, a consultant in the department of chemical pathology, talked about the introduction of clinical decision support at The Princess Alexandra Hospital NHS Trust.

It has been piloting software that reflects local and national protocols on re-testing within its ICE 7.1 system, to save money and improve the patient experience, by avoiding unnecessary phlebotomy appointments and bleeds.  

Karim Premji, from Nottingham University Hospitals NHS Trust, and Manx Baker, from Black Country Pathology Services, both talked about the rapid entry of samples into their operations, using Clinisys WinPath Auto-Reg.

Baker said the network now receives GP work from the entire Black Country into the hub laboratory and uses just 19 staff (previously 30) to cover the 24/7 shift.  The team are able to book all the samples in by midnight the same day whilst also taking calls and dealing with work from the acute Trust. How? Because a human can handle 48 orders per hour, while the Indexor can handle 357 using the WPE Auto-Reg functionality.

Data drives research – and changes lives

The day two agenda also covered some big topics, such the latest on laboratory accreditation, with an update on UKAS ISO 15189:2022 from John Ringrow of UKAS, and cyber security, with Mark Dimock from NHS England talking about how to protect critical systems without restricting clinical teams.

There were reflections on transfusion, with Dr Megan Rowley from Serious Hazards of Transfusion explaining how it is improving safety “bit by bit”, and antimicrobial resistance, with Dr Berit Muller-Pebody from the UK Health Security Agency, talking about the latest, five-year, UK plan.

But back on day one, delegates heard some inspiring examples of why all this matters so much and how the data pathology systems generate is being used to save and improve lives.

Fiona McRonald, NDRS genomics programme manager, talked about the National Disease Registration Service (NDRS), which is the part of the NHS responsible for collecting, linking and quality assuring data on cancer, congenital anomalies, and rare diseases. The addition of genomic information to NDRS data sets is having a wide ranging impact upon research and NHS patient care.

For example, she said NHS genomic lab data, collated by NDRS and linked to regional data on pollution, had contributed to a publication in Nature, in which scientists from the Francis Crick Institute were able to demonstrate an epidemiological link between air pollution and lung cancer in non-smokers. Laboratory work on post-mortem human lung tissue and transgenic mice demonstrated that lung cells containing age-related mutations in the EGFR gene were susceptible to malignant transformation if they were exposed to inhaled PM2.5 particulates.

National collection of germline genomic test data on cancer predisposition syndromes has enabled the NDRS to support the NHS clinical and molecular genetics community to interpret genetic “variants of uncertain significance”. By bringing together data and intelligence from labs around the country, NDRS is helping scientists to determine the cancer risks associated with each specific genetic variant. This enables genetic counsellors to give definitive information to patients previously living with uncertain findings from their genetic test, so that these patients can make informed decisions about screening, risk-reducing surgery and family planning.

Getting the required information from LIMS is not easy – and standardisation would help a lot. But McRonald said “lives are being changed, and we are making a difference on the ground, and that is because of the data that is coming in from you guys in the labs.”

Sarah Coupland, George Holt Chair of Pathology at the University of Liverpool and Registrar of RCPath, talked about the supra-regional eye cancer pathology service that supports the three specialist centres for rare eye conditions in England. The service conducts genetic testing on eye tumours, which has enabled clinicians to work out which patients are likely to see their eye cancer metastasise to the liver.

Although there is no treatment, she said there is high patient demand: “People want to know if they have a good melanoma or a bad melanoma, and whether they will live for another 25 years or two years.” Her hope is to build on the unique Ocular Oncology Biobank, and create a Digital multimodal Biorepository with digitised slides, ocular and radiological images, which will enable data mining by researchers, all with the aim of improving diagnosis and ultimately of patient survival. This template could be utilised by other Biobanks, and the multimodal data analysis applied onto other cancer types.

Helping the NHS family: relieving pressure, addressing prevention

The final two presentations, however, returned to the opening question of how healthcare and pathology services can tackle growing demand with limited resources.

Dr Martin Myers from Lancashire Teaching Hospitals NHS Foundation Trust argued that with “hospitals under pressure” and “ambulances backed up” there is a pressing need to move services into the community; while addressing the demand caused by an aging, unequal, and increasingly poor population.

Or, as he put it, the requirement is to: “One: shift pressure away from the front of the house; two: treat patients in their own bed, rather than a hospital bed where possible; three: reduce the disease burden.” His trust has developed initiatives where point of care testing can be used to avoid unnecessary admissions.

For example, it runs a Covid, flu, and RSV testing service for patients presenting at ED “so we can assess them with our rapid team and send them home with appropriate medication and advice. It is our intention to provide this service in Community Acute Respiratory Infection Hubs” It has developed a range of services to support out of hospital care, from heart failure monitoring, to keeping an eye on jaundiced babies, and from a “pee in the pot” remote POCT service for renal Patients, to a “lab in a bag” for virtual wards.

Dr Myers is also passionate about projects to pick-up people with heart failure in the community, to diagnose people with pre-diabetes, and to run health checks for people with learning disabilities. However, he said, these projects “need to be done properly” – “we need to make sure good pathology procedures are followed, that there is good governance” and “that results are recorded.” The Laboratory Anywhere Model must look at the strategic use of POCT in different Spaces, and different Times to address deprivation and ill health, prevention of illness, prevent existing illness getting worse, and to assist rapid decision making.

There is a debate over whether the results should be recorded in the LIMS, prior to reaching the electronic patient record or be sent direct to the electronic patient record systems. Dr Myers said Lancashire passes the POCT results through the Trust Interface Engine (TIE).  From there they can be diverted to any patient data base required. Dr Myers has opted for the EPR, as there should be a debate about whether the POCT results should be sent to other systems like EMIS, ICE, Patient Portal etc. Katy Heaney from Berkshire and Surrey Pathology Services, made a case for the LIMS, then onto EPR, arguing that this means POCT results can be subject to the same kinds of data management, rules and audits.

The future workforce: think tech

Meanwhile, Chris Sleight, Chief Officer from the Greater Manchester Diagnostics Network, gave an entertaining presentation about the six generations that have been born over the past hundred years and their attitudes to the use of technology.

Sociologists, he said, have identified six groups: the silent generation (born before the second word war, communicate face to face and by letter); the baby boomers (war babies, communicate face to face and by landline); Generation X (the “latchkey kids” of the 1980s who use email and invented text); Millennials (came of age around the year 2000 and are digital natives); Generation Z (influenced by the global financial crash, barely remember life before the internet); and Generation Alpha (today’s children and young teenagers, constantly streaming and social networking).

His point: laboratories today are staffed mostly by boomers and Generation X, but the Millennials, Gen Zs and Alphas coming into the workforce or getting ready to choose their careers have different experiences and expectations. They don’t just want to use technology, they expect to use it, or might not be able to imagine a workplace without it. Generation Alpha have no grasp of life without technology.

“To build a sustainable workforce, we not only need a workforce that meets the needs of our patients and population, but the aspirations of our workers,” he said. “That means digital solutions are important because the future workforce won’t just expect them but need them. That’s why we’re so pleased to be working with Clinisys as partners: we have the same aspirations about staying at the cutting edge of technology.”