Integrated care systems are tasked with joining up health and care. Making sure that tests can be ordered digitally and that results can be shared between sites and care teams is an important element of their agenda. Darren Ransley, senior vice president of global sales at Clinisys, outlines how the Integrated Clinical Environment, or ICE, can help.
The 42 integrated care systems that started work in July have a remit to connect many different health and care providers to support joined-up care and generate the data required for population health management.
Ordering tests and making sure the results get back to the clinicians and patients who need them, is an important part of the integration picture. NHS England estimates that 95% of clinical pathways rely on efficient, timely, and cost-effective pathology services.
ICS leaders should be thinking about how they can move services from paper orders to digital requesting, make results available to professionals wherever they are working, and create data feeds for shared care record and analytics platforms.
These tasks are complicated by the development of national networks for pathology, radiology, cancer and other diseases. These networks have an important role in standardising procedures to deliver more efficient, higher quality care, but they rarely align with ICS or, indeed, other NHS boundaries.
Which means that ICS digital leaders who want to digitise and integrate order communications and results reporting may find themselves working with two or three different networks – as well as multiple acute trusts, GP practices, community services, and care settings such as prisons.
ICE: built for integration
Pathology networks have their own communications and integration challenges and are addressing them by implementing single laboratory information systems. Clinisys is helping to lead this development: 18 of the 29 pathology networks in England use our LIMS.
Radiology networks are making similar investments in picture archiving and communications systems. However, this leaves the challenge of ordering tests and returning results to provider sites across the NHS.
Our integrated clinical environment already addresses this challenge for many professionals. ICE, as it is better known, is used by 75% of GPs, as well as 40% of acute hospital departments and wards, to order tests of all kinds. However, as its name implies, ICE is about more than “order comms” for GPs and acute clinicians.
It is built to integrate with other systems, so it can be used to solve wider order comms and results reporting challenges. For example, if community services are still placing orders on paper, ICE can be integrated into their electronic record system to digitise the process. ICE is web-based, so it can be used wherever there is internet, 4G or 5G connectivity, and it has just undergone a major user-interface upgrade.
For larger, more complex community and mental health providers, working with patients who cross those care boundaries, Clinisys has developed ICE Gateway. This enables clinicians to see results, wherever tests were conducted, and select the order communications system in the right area for any tests or investigations their patients need.
ICE OpenNet: built for sharing data
Clinisys has also developed ICE OpenNet to connect one instance of ICE to another. This enables requesters using one instance of ICE to check whether a test they are about to order has been conducted and reported on another instance of ICE.
Again, this is already used by many GPs and acute clinicians, but it has wider application. For example, if a prison health centre is ordering a lot of tests, giving its doctors access to the instance of ICE used by local GPs may reduce costs – by reducing unnecessary repeat testing – and improve patient care – by providing a baseline for reference.
However, integration doesn’t have to stop at this point. Clinisys can also build an interface to bring together numerous instances of ICE. We are working on a project to do this for a community trust in the South of England, whose patients use labs at a number of local acute trusts.
This solution is vendor agnostic, in that it allows users of ICE and other order communications software to view results across the region. By having access to all the systems in use locally, requesters will be able to send patients to the best and most convenient service for them, and still surface results to support their care.
We are also working with a very large pathology network in the North of England to create an ICE repository, which will go a step further again by laying the foundation for a single data feed of diagnostic results into the local shared care record.
As well as enriching the SCR, this will improve the security and resilience of pathology services. If one laboratory in the area is unavailable or under pressure, then ICE’s can be configured to send requests to another lab, which will then report them in the normal way.
Strategic thinking helps systems and patients
Putting patients at the centre of the healthcare system, and ‘joining up’ that system to support clinicians in delivering of their care is a key reason for the creation of ICSs. Yet ICSs are at very different stages on their journey towards integrated care, supported by integrated systems.
So, ICS leaders that want to explore the benefits of digital diagnostic test ordering and integrated results reporting should start by mapping what they have now.
ICE will almost certainly be familiar to their GPs and hospital clinicians. But is it being used consistently for both requesting and reporting? And is it being used as widely as it could be across pathology, radiology, and other diagnostic services?
Are there other parts of the system that need to implement digital requesting? Or that would benefit from an ICE OpenNet installation to let requesters see results from one instance of ICE in another? Does the shared care record need a single results feed to support pathway redesign and analytic services?
These are the conversations that ICS and digital leaders should be having because there are significant cost savings to be made. One group of hospitals, spanning multiple pathology networks, in the South of England has implemented ICE OpenNet and is seeing its hospital requesters use it 60,000 times per month.
If each of those uses avoids a repeat test, the installation will be generating savings of around £75,000 a month – or £1 million a year. But, more importantly, it will be improving patient care. At the start of every request there is a patient, and that patient might be a frail, elderly woman for whom having blood taken is a major event.
Nobody wants to repeat bleed patients for tests that might not be necessary if their care teams just had access to the results of tests that have already been conducted. Digital, integrated order communications and results reporting can help to stop it happening.