Clinisys Customer Summit 2024 – ICE
Clinisys’ second big customer summit of the year saw more than 150 people gather at the Belfry to hear about the roadmap for its order communications and results reporting system, innovative use-cases, and why it all matters. Matthew Fouracre reports.
As the health and care system becomes both more complex and more integrated, IT that can smooth workflows and share vital patient information across organisations becomes ever more important.
So, it was no surprise that more than 150 customers of Clinisys’ order communications and results reporting system, ICE, gathered at the Belfry this autumn for a customer summit. After all, ICE underpins today’s healthcare and looks set to play a big role in the joined-up, technology-supported health and care system of the future.
Healthcare changes and Clinisys responds
The busy day and a half started with an introduction from Clinisys Vice President Support for UK, Ireland and Europe, Darren Solomon. He outlined some of the many reasons for the changing environment in which pathology, diagnostics and its suppliers operate.
These include: the huge demand pressure that the whole of healthcare is under and the formation of pathology networks “which are all at different levels of maturity.” Also, a tough cyber security and a changing technology environment, in which older operating systems and browsers are being retired.
Against this background, Solomon said Clinisys’ role is to develop products “that meet your needs”, embrace new thinking, and are easy to deploy and upgrade.
“We know we are another provider asking you to upgrade, but it really is essential, so we are working on upgradability,” he said. “I don’t know if that’s a word, but let’s go with it.”
New interface engine, new UI
Upgradability matters because ICE really is one of the NHS’ core IT systems. Around 75% of GPs and 120 trusts and health boards use ICE to order and report tests for more than 40 million patients every year. However, there are many “flavours” of ICE in place. And there’s a big jump from all of them to the latest product versions: ICE 8 or ICE 2024.
“One of the things we have done is to rebuild the interface engine (that allows ICE to interface with, or ‘talk to’, other systems),” said Glyn Hughes, senior product manager. “We have stripped out a load of legacy code, which makes it much lighter and faster.”
Also, connections are no-longer hard coded. New ICE uses application programming interfaces or APIs to exchange information with other systems, so integrations can be managed by the customer as workflows change or new providers come on stream.
The bigger change for ICE’s half a million clinical users will be a move to a new user-interface, the ICE native UI. This will replace ICE Desktop, that was built for Internet Explorer browser, which Microsoft ended most support in June 2022.
The good news is that the native UI will work on modern, internet technology, run on different web browsers, and gives users a more consistent look and feel. “We are pleased to say that around 20% of customers are in testing mode,” Hughes said. “To everybody else I would say: get it into testing, play with it, break it, let us know what works for you and what doesn’t.”
Preparing for the Pathology Messaging Service
It’s not just technology that changes over time. In the early days of healthcare computing, the NHS in England adopted the Read Codes to provide a standard vocabulary for recording patient information and procedures in IT systems.
Later, it moved to an international coding system, SNOMED CT. GP providers made the switch, however the data flow from laboratory information management systems (LIMS) to general practice continues to be sent as PMIP EDIFACT, governed by the NHS 003 Pathology Messaging Standard. ‘Middleware’ like Clinisys Labcomm has for twenty years provided a reliable mechanism for supporting the data flow.
Karim Nashar, a terminology specialist at NHS England, said unfortunately the reliance on PMIP EDIFACT and Read codes is fundamentally limited. Read Codes were developed in the 1980s, they don’t cover any new patient lab tests since NHS England stopped maintaining them in 2016 to support medical developments. We could issue an emergency SNOMED CT release with new codes in a matter of days.
“During Covid, we couldn’t send Covid test results to GPs, and we had to find a work-around,” he explained. “Building on our experiences we are actively working on measures to ensure this doesn’t happen in the future”.
The first step will be to update the messaging standard that systems like ICE use (from a UN trade standard called EDIFACT to the global, health specific, Fast Healthcare Interoperability Resources or FHIR) which can handle SNOMED CT coding.
And the second will be to encourage LIMS providers to adopt SNOMED CT. Karim argued that just the first step will benefit laboratories because they will be able to access and analyse much more SNOMED CT coded data, then the second step would entail labs accessing more accurate SNOMED CT representations of patient testing encouraging better data quality, and national consistency in lab test reporting using a common language. In his presentation, Hughes said Clinisys is developing new middleware to support the Pathology Messaging Service. Although, he added, the Clinisys Hub will eventually be able to ingest, transform, integrate, and re-export data for many kinds of integration and research projects.
In his presentation, Hughes said Clinisys is developing new middleware to support the Pathology Messaging Service. Although, he added, the Clinisys Hub will eventually be able to ingest, transform, integrate, and re-export data for many kinds of integration and research projects.
Many flavours of ICE to support information sharing
This kind of ‘under the bonnet’ development is far from the only response that Clinisys and its ICE team are making to the changing healthcare environment.
Solomon said one trend is Regional ICE, or the deployment of one instance of ICE across a pathology network that will almost certainly be running or deploying a single LIMS, such as Clinisys WinPath.
“The benefits are that it is easier for clinicians to access results from across the network, and for the network to run a single testing catalogue,” he said. ICE is already being deployed at four pathology networks on this basis.
A well-established option for sharing results is to use ICE OpenNet to enable the users of one instance of ICE to see results from another instance of ICE. Solomon said this is being updated in line with the wider rewrite of the system and will adopt the new UI.
Then, there is ICE Gateway, which responds to the needs of community and mental health providers that work across network boundaries by enabling them to see a consolidated view of results from numerous ICEs.
Better for patients, better for clinicians
Dr Rizwan Malik, a radiologist and imaging IT leader, told the final session on day one that however it is done, sharing results is essential.
Reflecting on a project to create a regional hub to share imaging outputs, he said this led to less repeat testing, which is more efficient and better for patients because “it reduces the number of times people have to come in to be scanned – or stabbed.”
He also argued it helps to create smoother workflows and better load balancing, by allowing tests to be sent to sites and clinicians with the expertise and capacity to conduct them, and it is better for clinicians, because it supports flexible working.
“I am more than happy to do a few hours’ reporting in the evening, if I can do it from home, and I don’t have to drive into a breeze-block office to do it,” he said. And he’s not alone. Malik’s region has been able to do more work in house and send less to contractors – “keeping money in the organisation.”
Clinical decision support, works
Another aid to improving the efficiency and quality of pathology services is to make sure clinicians are ordering the right tests. On day two, Steve Herman, medical director of MedCurrent, outlined the case for building clinical decision support into systems like ICE.
CDS is well established in radiology, where NHS England designated a portion of the £250 million funding of the Digital Diagnostics Capability Programme to roll-out the iRefer tool recommended by national reports and the Getting It Right First Time programme.
It is less common in pathology, but Herman outlined the results of a pilot at Princess Alexandra NHS Foundation Trust, which has used MedCurrent to make Royal College of Pathologists guidance on repeat testing available to clinicians.
Using the system for just seven tests saved £47,000 in five months; and stopped a lot of unnecessary bleeding for often old, frail patients. “The NHS is looking for technology to streamline workflows and improve efficiency,” Herman pointed out. “I believe we have shown CDS can shorten waiting times in radiology and save money for pathology.”
Top tips for testing and security
Any IT system needs to be properly deployed, though. Also on day two, Janine Bontoft, programme director at Clinisys, gave the conference her top tips for testing, gained from years of experience in deploying ICE, LIMS, blood tracking, and other systems in the NHS.
Her first tip: don’t just focus on “functional testing” aka “does it do what it is meant to do?” and instead ask “is it behaving as we would expect it to behave out in the real world?” And, linked to that, make sure the people who will be using a new system or upgrade are the ones testing it – “don’t assume the workflow is what is written on paper.”
Bontoft also demonstrated a tool that she found invaluable. Cymetryc allows test scripts to be loaded and assigned to testers, who can pass or fail them, leave comments, and assign tasks to colleagues, IT teams, and suppliers. The whole process can be tracked on dashboards and exported as reports.
In today’s world, systems must also be secure. But Mark Dimock, NHS England’s cyber security lead for the East of England, said a risk-based approach is needed. Yes, he told the conference, the National Cyber Security Centre has identified a host of cyber security risks.
There’s cyber espionage, attacks on critical infrastructure, threats to the supply chain, ransomware (in which hackers lock systems and demand cash to unlock them) and phishing (in which hackers use pop-ups and emails to try and con users into handing over valuable personal information).
And yes, the NHS and its staff are under constant assault. But “the only way to be completely secure is to turn off the computer and put it in a box and bury it” and that’s just not practical. So, network managers need to think through their risks, log them on a risk register, and have documented procedures in place to address them.
Also, he said, returning to an earlier theme, run up to date systems and patch them. “I know that if you have a big upgrade – a new ICE, or whatever – it can be disruptive, but you need to make sure you are running the most safe and secure systems that you can,” Dimock said.
Why it all matters – ‘think myeloma’
Rebuilding one of the NHS’ core systems, finding innovative ways to improve information sharing, adding-in CDS, thinking about security. The Clinisys ICE customer summit had a busy agenda.
But in the middle of it, Brogan Ashley, head of research at Myeloma UK, reminded everybody of why pathology and the technology that supports it matters so much. Myeloma is a blood cancer that arises in the bone marrow, she said, that mainly affects older people – although a quarter of those diagnosed are still working.
It is hard to diagnose, because the symptoms are non-specific and GPs rarely see it – many people are diagnosed in A&E after suffering a potentially life-changing event, such as a broken back. But a package of diagnostic tests is available and can be built into ICE.
“The key thing is to enable people to ‘think myeloma’,” she said, “and to give clinicians the tools they need to easily order the correct batch of tests to make a diagnosis. We are working with some sites who’ve seen great results, and we are working with Clinisys to make it easy to implement.”
