Black Country Pathology Services (BCPS) runs a state-of-the-art pathology hub in Wolverhampton and four essential services laboratories. In 2018, it chose the Clinisys WinPath Enterprise LIMS to improve communication, standardise working practices, and deliver efficiency and quality benefits.
WinPath Enterprise is now live at the hub and the ESL in Walsall, where BCPS operational manager Graham Danks says it is delivering more benefits than expected thanks to its close integration with testing equipment and medical records.
Lord Carter of Coles praised BCPS as “world class” when he visited the network and saw the LIMS in action. Danks says networks must pick the right IT partner
WinPath Enterprise realises Lord Carter’s vision for network pathology service at BCPS
“Black Country Pathology Services (BCPS) has used the Carter Report as our model, and we have done the whole thing: the building, the staff, the IT, the equipment. We chose Clinisys WinPath Enterprise, and our original plan was a big bang go live at the hub; but then things changed. During the pandemic we adapted our approach to keep moving forward. The LIMS has enabled us to do what we wanted to do. It has enabled our hub and spoke model of working and delivered savings. It is a roller coaster journey. You just have to hold on, and do it, and plan, plan, plan. But we have done it, and we have done it in a clinically safe way.” BCPS operational manager Graham Danks.
Black Country Pathology Services: one hub, four spokes, 22 million tests a year
Black Country Pathology Services (BCPS) is part of a major, national initiative to reorganise pathology services in England.
Following a landmark report by Lord Carter of Coles, NHS Improvement instituted a program to create 29 pathology networks to consolidate labs and standardise working practices.
The aims of the program are to make best use of scarce staff and resources, to improve efficiency and quality, and to make sure pathology can respond to the changing needs of the NHS while offering the latest tests and services.
BCPS was set up in 2018 to further these aims for its four partner trusts: The Dudley Group NHS Foundation Trust, The Royal Wolverhampton NHS Trust, Sandwell and West Birmingham NHS Trust, and Walsall Healthcare NHS Trust. It also serves 1,000 GPs.
It operates a central hub at New Cross Hospital, part of The Royal Wolverhampton NHS Trust and four essential services labs at acute hospitals in Birmingham, Dudley, Sandwell, and Walsall. The network is deploying Clinisys WinPath Enterprise at all five labs and all pathology disciplines.
In total, BCPS conducts 22 million tests per year for a core population of 1.5 million people; and it does so in a way that was described as “world class” by Lord Carter, when he visited the hub in 2021.
Putting a LIMS at the centre of a network
Black Country Pathology Services (BCPS) has taken the lessons of Lord Carter’s report to heart as it has developed its network and operating model.
To create the most efficient, highest quality service possible, it has designed and executed an extension to its state-of-the-art pathology building at New Cross Hospital in Wolverhampton, to enable it to handle a much larger volume of samples.
It has also invested in a single laboratory information system and plans to buy completely new equipment for the hub and its four essential services laboratories.
Operational manager Graham Danks says: “The Carter Report has been our model, and we have done the whole thing: the staff, the building, the IT, the equipment.
“The IT and the equipment are essential, because we want to build a virtual laboratory, so staff can go from Lab A to Lab B and see no difference in terms of the systems and equipment they use and the processes they follow to do things.”
In autumn 2018, BCPS decided to go with Clinisys as the provider of its single LIMS. It opted to take WinPath Enterprise as a hosted solution and deployed a wide area network to create the fast links needed for constant uptime and rapid access.
At the same time, it started to prepare for deployment, by drawing up a single Black Country catalogue for tests and services, coded using the national standard, SNOMED CT, and agreeing harmonised working processes with the different pathology disciplines.
“We put people in a room and gave them tea and biscuits and told them they couldn’t come out until they agreed,” Graham jokes. “However, it is an essential step. You standardise your working processes and then you execute them through the LIMS.”
The network planned for a ‘big bang’ go-live for WinPath Enterprise at the hub in Wolverhampton. But two things happened that forced a change of plan and a focus on its anatomic pathology and microbiology services.
First, BCPS won a major contract for human papilloma virus screening, as part of a national roll-out of HPV-first cervical cancer screening. And then the novel coronavirus arrived in the UK.
Running a pathology service during the pandemic felt like being amid the muck and bullets of a war zone – physically and emotionally draining. However, the legacy will be a very robust service going forward – and a laboratory network that knows how to work as a team.
Graham Danks talks to The Pathologist in February 2021
Delivering in adversity: Two years of Covid go-lives
Black Country Pathology Services (BCPS) was planning a big-bang go-live for Clinisys WinPath Enterprise when winning a HPV testing contract and the arrival of Covid-19 forced a rethink.
Nick Fudger, senior ICT program manager, says that to take up the HPV contract, the network had to build new testing facilities, TUPE-transfer in staff from the former contract holders, and link-in more than 1,000 sites doing point of care testing.
All of which made the implementation of the LIMS in anatomic pathology a priority. Nick says: “In the end, we went live with CellPath a year and a day after contract sign.
“That was at the hub [in Wolverhampton], closely followed by [the essential services lab in] Walsall.”
Just a few weeks later, the outbreak of the pandemic focused attention on microbiology. Nick says it became imperative to consolidate microbiology services at Wolverhampton and Walsall, because they had high-throughput Covid-19 test analyzers, so they became the next priority for go-live.
With the UK in lockdown, the implementation program adopted a remote working model and talked to Clinisys about a remote approach to user acceptance testing. In the face of considerable adversity, this delivered a second go-live in June.
“We made the new model work,” says Nick. “We went live with microbiology and shortly after that we went live with the whole of hematology. It was a notable achievement, and one that we have been able to build on, subsequently.”
Go-lives completed and planned
- Hub, anatomic pathology, 17 September 2019
- Wolverhampton, anatomic pathology, 19 November 2019
- Hub, microbiology, 14 July 2020
- Hub, hematology, 29 September 2020
- Wolverhampton, microbiology 3 December 2020
- Dudley, anatomic pathology, 4 May 2021
- Birmingham and Solihull GP microbiology, 29 September 2021
- Birmingham and Solihull microbiology and blood bank, 16 November 2021.
- Dudley, all disciplines, June 2022
- Birmingham and Solihull, final, September 2022
From the outset, we have recognized that a single LIMS is essential to support communication, standardization and harmonisation across our network. Our close working relationship with Clinisys enabled us to progress our plans during Covid-19, while focusing on microbiology and what was important to them.
Nick Fudger delivers an update on progress in a Clinisys press release, September 2020
Achieving the Carter vision
By September 2021, Black Country Pathology Services (BCPS) was nearing the end of its WinPath Enterprise roll-out at its central hub in Wolverhampton and its ‘hot’ lab in Walsall. It was also starting to see the benefits that it expected from a single laboratory information system.
Graham Danks says: “The big benefit has been that we have been able to use this technology to deliver that hub and spoke model of working. It has enabled us to achieve our vision of moving work from site to site, and that is working very well.
“We are also making the savings in terms of equipment and staffing that we anticipated in the original plan. We were expecting to save 10-15% per year, and the IT system enables us to do that, by standardising equipment and workflow.”
If Graham has one criticism, it is that Clinisys could help customers to get the most out of the powerful rules engine in WinPath Enterprise, which can be used to maximize savings by requiring operations to be carried out as efficiently as possible.
However, he is pleased with the other benefits that BCPS has derived from using a modern, interoperable LIMS. For example, the network has started to use some of the alerting functionality in WinPath to flag results that might need rapid or further review.
It has also been able to interface WinPath Enterprise to the three electronic patient records in use at its acute trusts, and to the wide variety of record systems used by community and specialist services, such as maternity and sexual health.
This makes it much easier for clinicians to view test results alongside a patient’s medical history when planning or delivering care. A separate project, using the Clinisys Integrated Clinical Environment or ICE, is supporting GPs, who can now order and receive test results electronically.
Lord Carter praises Black Country Pathology Services
Lord Carter of Coles praised Black Country Pathology Services (BCPS) during a visit to promote national pathology week in 2021. He was shown innovations such as barcoded tubes for laboratory samples, which allow information to be scanned into WinPath Enterprise, the full automation of the lab service, and the LIMS integration with local electronic patient record systems. “Deploying technology is the only way forward, and this is wonderful to see,” he said. “Trusts in other parts of the country have done it, but very few have done it as well as this.” Source: Royal Wolverhampton NHS Trust press release.
Top tips: drive hard and “plan, plan, plan”
Implementing a laboratory information system across a large network is a huge task. Black Country Pathology Services (BCPS) has been working on its deployment of WinPath Enterprise for three years.
Although the HPV contract and the coronavirus pandemic had an impact, Graham Danks says his first piece of advice to other networks would be to take the scale of the job seriously, and then to “plan, plan, plan.”
Some of this planning will be about sorting out infrastructure and interfacing systems. Nick Fudger says: “You need to get your systems ready up-front. You won’t be integrating your old order communications with your new LIMS, you will be doing a complete rebuild.”
However, most of this planning will be for the implementation of the LIMS itself. Graham says it’s vital to have someone to drive the process, to have clear milestones – or what he calls “white smoke events” – and to get the right people involved in low-level design, high-level design, and user acceptance testing.
“It has to be done by people who are doing their day jobs,” Graham says, “and there are never enough of them. People gave up their own time in writing test scripts and to ensure everything was in order. 260 scripts written, just to test blood chemistry is testament to their dedication.”
However, he stresses that the BCPS implementation became easier over time. When BCPS did its first go-live, it managed the project on a spreadsheet. When it did its second go-live, it had developed a central tool to give everybody involved full visibility of what had been done and what still needed to be done.
Clinisys is now using this with other networks. Nick says this is another lesson: a good relationship between network and supplier is vital. “The relationship with CliniSys | MIPS has been very good,” he says. “If we have a concern, we will raise it, and Clinisys will address it. It has some really good people on its team.”
Overall, Graham concludes, the deployment has been a success. “This was a big program, and there have been lots of things that have affected it, but we have done it, and we have done it in a clinically safe way,” he says.
His one regret? That because of Covid and the ongoing pressure on the NHS it has been difficult to sit down and celebrate that success “even though we all pulled together to make it happen.”