ServiceBrochure

About X-Lab

CONTENTS

Introduction

What is NPEx?

How it works

Benefits

Future enhancements

Case study

LIMS connected

Deployment

Ways to stay engaged

About THIS and X-Lab

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“The chance to improve the quality of the work we produce should never be missed and the real benefit of getting results back to the clinician and the patient faster is invaluable in terms of the service we offer to our users. Although there is a short-term requirement for time and resources to be invested into the project, the long-term benefits of improved quality and significant cost savings will more than make up for this.”

Robin LytheSenior Biomedical Scientist CMFT

IntroductionThe challenge of laboratory communications

Though the majority of core laboratory services are highly automated and computerised, the referral of samples between pathology service centres is still either by email, fax, paper or driven by restricted point-to-point links.

Front line care has a high dependency on diagnostics with 80%+ of patient pathways relying on a diagnosis provided by Laboratory Medicine services. It is not unusual to see health & care diagnostic services under increasing pressure to save cost while simultaneously improving quality, productivity and coping with increased demand from clinical services. To meet this challenge providers of pathology services, whether public or private, require robust and scalable digital solutions that will enable increased efficiencies across clinical networks that span regions and countries.

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We are expecting to see growth in the volume of lab-to-lab communications with the consolidation of specialist services, the rapid growth in point of care / direct to consumer testing and the opening up of the marketplace for laboratory services.

The National Pathology Exchange (NPEx) serves as an enabler for addressing the above challenges by offering a service for the delivery of digital requesting and reporting at scale, across regional and countrywide clinical networks.

What is NPEx?About the product NPEx is the UK NHS’s national

solution to the challenge of connecting all pathology laboratories together. It is unlike any other lab-to-lab system in the world due to its scale and success.

There are over 50% of English Hospital Trusts and Scottish Health Boards in the UK connected or developing connections to NPEx.

The system was designed so that every single laboratory can send and receive lab tests and results to every other laboratory whether NHS or private, across the whole country. The service is also enabling digital requesting and reporting capability for the Channel Islands, direct to consumer & external QA (EQA) testing. The map above provides a visual

representation of laboratories connected or connecting to NPEx and those still using paper.

An interactive map can be found at: www.npex.nhs.uk.

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What is NPEx?Connected

Connecting

Still on paper

How it worksThe NPEx Process

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The NPEx service functions like a telephone exchange, by connecting pathology laboratory systems to a central hub located within a secure NHS datacentre so that requests and results flow electronically to and from any laboratory/services, which is also connected.

At a technical level NPEx establishes a direct interface between laboratory systems and the national hub, creating a streamlined paperless process. The digital service uses a messaging engine, which converts local codes to a standard messaging structure and SNOMED-CT coding standards, this enables inter-operability between Laboratory Information Management Systems (LIMS).

How does NPEx work? The process:

Test requested on hospital or

GP order system

Picking list and delivery notes printed from

NPEx

Barcode confirmssample arrival

Tests performed

Results sentimmediately

Results receivedimmediately

Request details transmitted

to receiving LIMS

Results confirmed

Sample sent

Request detailstransmitted to sending LIMS

BenefitsAdvantages of using the NPEx system

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NPEx presently enables requesting and reporting for the following disciplines:

Laboratory medicine disciplines supported

Cost savings for reducing data entry,

handling faxes/emails and posting

paper

Improved efficiency, quality, and patient

safety due to reduction in errors

2.5x improvement in test turnaround time

Business intelligence enabling better

management decisions

Improved cost efficiency enabled

through a centralised reporting

facility

A national solution for connecting LIMS

systems together

Haematology Biochemistry

Bacteriology

Serology Immunology

Virology

Due to the lack of standardisation for pathology test requesting and reporting in some laboratory medicine disciplines, results are returned as free text where the relevant LIMS suppliers cannot receive structured messages. For example free text is used for reporting of Cellular Pathology results. We work collaboratively with NHS Digital, the Royal College of Pathologists, international bodies and NHS laboratory customers to develop standards including the National Laboratory Medicine Catalogue (NLMC).

More details of our work developing the NLMC are available at:

www.rcpath.org/profession/pathology-informatics/national-laboratory-medicine-catalogue.html

Developments in NLMC

Future enhancementsWhat is the NPEx team working on?

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NPEx has the ability to operate in a similar way to a stock exchange for pathology tests, where managers can review price, quality and performance data to decide which laboratories to send work to, ensuring they receive the most cost effective and efficient service for their patients and host organisation.

Challenges we are focussed on addressing include:

• 100% coverage of the UK NHS and other UK diagnostics services (including private labs)

• Full coverage of all Laboratory medicine disciplines (over and above those listed in the previous section)

• Increase the ability of NPEx to support emerging disciplines, e.g. genetic testing

• Full support for integrating with digital Point of Care Testing (POCT) cloud solutions

• Provide NPEx solutions to key European markets (Republic of

Ireland, France, Sweden)

• Demonstrate international NHS leadership in digital laboratory medicine

• Adding file attachment functionality

• The NPEx Genetics offer

The key objectives

Case Study

CHALLENGES OF USING PAPER

Putting NPEx to the test

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As a specialist referral centre themselves, the Immunology Department at Central Manchester University Hospitals NHS Foundation Trust (CMFT) send approx. 1,100 test requests away per annum, which is less than 1% of the total work they do. When Oxford Immunology (John Radcliffe) subscribed to NPEx, we engaged CMFT to use NPEx for referring tests to enable improved turnaround time and eliminate transcribing errors. Enabling these two laboratories to communicate using NPEx involved a number of challenges.

The only way for CMFT to send requests away and receive the results back from Oxford, was by paper via the post. This process caused many difficulties for CMFT. These challenges included:

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CMFT’s median turnaround time for all referred tests was 15 days

Results entered incorrectly when they were recieved at CMFT

Amended reports required to highlight correct and incorrect information

Lost samples, requiring patients to be re-bled, wasting time and increasing risk

Lost post, or post sent to the wrong location due to human error

Clinical transcription errors causing potentially incorrect or delayed treatment

IMPLEMENTATION

IMPROVEMENTS

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Building a workingrelationship with members of the OxfordLab Medicine team

Enabling message translationfrom Manchester AMP toOxford HL7

Setting up newtests in NPEx

Completing testing

Ensuringuser confidence

in using the service

Checkinginformation is

presented clearly

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Improved qualityof test information

Improved accuracy

Paperless reporting Clear audit trail logging

Easy for CMFT managers to use

Test requests and results no longer

get lost

Reduced staff cost Same day reporting

The full case study can be found at: www.npex.nhs.uk

LIMSconnected

HL7 interfaces are enabled with the following laboratory

system providers

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Clinisys Winpath

Clinisys Labcentre

iSOFTTelepath

iSOFTApex

Omnilab

TechnidataRoche Swisslab

Sunquest Fordman

Meditech

EPIC

InterSystems

Cerner PathNet

NHS BT Hematos

DeploymentGetting you connected to NPEx

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Deploying the LIMS interface and setting up NPEx for a pathology service is achieved through a project with six milestones. The key is communication, which is facilitated by NPEx through a dedicated Project Manager.

In order to minimise project management overhead, but retain sufficient control, the project is organised into several activities. For simplicity, these are treated as work packages within a single project stage.

Typically, NPEx assumes that a deployment project will be completed in 3-4 months from project initiation through the process of:

• Contract & kick off

• VPN setup & testing

• Configuration and training

• Pipe clean testing

• User acceptance training

• Go live and testing•

The deployment process

Ways ofengagement

How to stay in contact

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01484 355420

@thisnhs

contact-us@this.nhs.uk

Oak HouseWoodvale Office ParkWoodvale RoadBrighouseHD6 4AB

www.npex.nhs.uk

About X-Lab and THIS

The partners behind the product

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About X-Lab

X-Lab has been established for 10 years as an innovative e-health systems development organisation that specialises in building highly scalable solutions at the leading edge of healthcare technology.

About THIS

The Health Informatics Service (THIS) hosted by Calderdale and Huddersfield NHS Foundation Trust (CHFT) is a large well-established supplier of Information Management and Technology (IM&T) services. A comprehensive range of high quality customer focused IM&T services is offered. This includes front and back office technical services, information governance, information management and analytical services in conjunction with a project, programme management and training capability, including many specialist products.

X-Lab and THIS partnership

THIS has a commercial NHS partnership and long standing collaboration with X-Lab Ltd for the provision of NPEx lab-to-lab messaging services to over 50% of NHS pathology services throughout the UK.

You can email “contact-us@this.nhs.uk” to access the:

Quarterly Newsletter User Forum

Annual User Group Regional workshops and roadshows

“NHS Blood and Transplant’s experience so far of using NPEx has been to assist in enabling EDI, our current activities, and our plans for the future. The ambitious pilot we planned a few years back had to be significantly rescoped, but the proof of concept we finally created, that connected our own LIMS to a test Labcentre system was an important milestone. One thing we certainly proved was the need for a standard to cover blood transfusion results.”

Ian BrittonSpecialist Services IT Systems ManagerNHS Blood and Transplant Service

“Using NPEx to automate the electronic return of EQA data is proving to be a very exciting venture and we look forward to live trials this Autumn. The announcement of the collaborative project between ourselves at Birmingham Quality UK NEQAS and X-Lab was clearly well received, participants recognising the benefits and time-savings they could achieve.”

Andrew RobinsSenior Analyst ProgrammerUK NEQAS

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www.npex.nhs.uk01484 355420

contact-us@this.nhs.uk

@thisnhs

www.linkedin.com/company/the-health-informatics-service