Eliminating siloes of diagnostic data

A recent webinar explored how North East and North Cumbria is implementing a ‘global ICE’ using Clinisys ICE Network, and the benefits that regions, clinicians and – most importantly – patients can expect from moving towards an integrated diagnostic data strategy.  

 

North East and North Cumbria has the largest geographical area of any integrated care system in the country and covers some of its most remote areas. As Chris Charlton, transformation and delivery manager, told an HSJ webinar, there’s “lots of sheep, lots of grass.”

The area’s hospital services tend to be located in its bigger towns and cities, so patients often have to travel for diagnosis, treatment, and specialist services. This means clinicians need patient information to be available across the ICS. But, at the moment, it is often held in siloed IT systems.

For example, Chris told the webinar the ICS has nine instances of Clinisys ICE. Each of these handle order communications and results reporting for a specific hospital. But one instance can’t share information with another: “Each ICE deployment is a silo of data.”

Making the silo problem real: the chemotherapy challenge

Chris gave a concrete example of the problems this can cause. A patient might be diagnosed with cancer in Carlisle but be referred to Newcastle for chemotherapy. Checks need to be carried out to make sure a course of drugs is suitable for them.

But, as things stand, clinicians in Newcastle can’t raise a test request on their instance of ICE. They have to ask a GP in Carlisle to order the test: and then it is the GP who is responsible for follow up, when it is the clinician who needs to know the result is back.

Sometimes, this information doesn’t get through. “There are lots of issues for patients who travel to Newcastle only to find out they are unsuitable for chemotherapy,” Chris said. “It’s a waste of a journey, and it may be a waste of expensive drugs.”

To solve this kind of issue, the ICS has made the development of a global order communications solution one of the workstreams of its digital, data and technology strategy, and is working on a project to deploy ICE Network to achieve this.

Many flavours of ICE

Glyn Hughes, senior product manager, ICE, stressed that Clinisys ICE is a system that was “born and bred in the NHS” but now has the backing of a “truly global” company behind it.

He told the webinar the system has received considerable investment in recent years, with better interoperability, a new interface “that a clinician has described to me as ‘truly transformative’,” and new tools such as demand management.

At the same time, new ICE products have been developed to overcome the silo problem. The best known is ICE OpenNet, which is widely used across the NHS to enable clinicians using one instance of ICE to see results in another.

There is ICE Gateway, which enables clinicians using one instance of ICE to order tests in another. As Glyn put it: “Where ICE OpenNet breaks down siloes for results, ICE Gateway does the same for orders.”

A further development is ICE Hub, an online portal aimed at mental health, community and other services that may need to work with numerous order comms systems. Then there is ICE Network, or global ICE, which is what North East and North Cumbria is using.

“It is a single, harmonised view for ICE requests, whether those are for pathology, radiology, or cardiology,” Glyn said (in fact, he joked later, ICE could be used to order anything – even sausages). “It simplifies the whole ordering landscape.”

Integration, standardisation, harmonisation

Implementing such a big and complex system is not simple, though. At the start of the webinar, Chris outlined some of the challenges his ICS has faced – not with the system, but with the IT and laboratory environment it is going into.

One issue has been making sure orders and results are linked to the right patient. The different hospital trusts in the region use different patient administration systems. And they handle demographic information in different ways – some allow hyphens in surnames, for instance, and some don’t – “which makes it challenging to use their data.”

The project is going to use NHS Number and date of birth to get around this problem. Another issue has been how to control access. As things stand, clinicians may have access codes for more than one instance of ICE, so it’s not possible to look across them and work out whether two clinicians are placing orders, or one clinician using two codes.

The project is looking at using professional registration numbers to overcome this problem. Yet there are further hurdles. Sites placing orders need to be accurately identified; but the project has found GP practices logged on ICE under old names.

Every order going into a laboratory needs to be accurately identified, but labs on different instances of ICE may be using the same accession numbers. The project wants to standardise pathology lists using SNOMED CT, but some of its descriptions are too long for ICE to handle…

The pay-off: patient value, improved efficiency, better resilience

Chris was confident these challenges will be overcome, and that it will be worth it. In a question-and-answer session, he was asked how the cost of this kind of project can be justified when the NHS is under so much pressure.

In response he argued there are at least three justifications; patient value, improved efficiency, and better resilience. Patient value will come from integrating the global ICE with the BadgerNet maternity system, which will make results available to maternity teams, and the Great North Care Record, which is used by community and social care services.

Greater efficiency should come from making test results to more users, reducing the need for costly repeat testing. And greater resilience will come from making it easier to transfer testing work from one centre to another, to cope with planned downtime, or in the face of disaster.

“There is a massive business continuity improvement,” he said. “You can change the service provider relatively easily for GPs and clinicians. You can move the samples relatively easily with this in place.”

Plus, of course, it will transform the experience of those patients who need to travel from Carlisle to Newcastle for chemotherapy. This idea clearly inspired those watching the webinar.

Solving the chemo challenge, and the maternity challenge, and dialysis…

One commented that the same would apply to maternity: “pregnant women can be monitored in the community, and then sent into hospital for birth, and all the data will be available at any hospital they end up in.” The same, she added, would apply to sickle cell patients, or those needing dialysis.

In fact, the webinar demonstrated, any patients who need to travel between sites and services that use siloed IT systems will benefit from their region moving towards an integrated diagnostic strategy and using it to drive standardisation and best practice.

“By breaking down traditional organisational boundaries, we can create a more holistic view of the patient journey,” Glyn argued, “and, at the same time, we can reduce duplication, improve outcomes, and deliver a much better clinical and patient experience.”