Future Lab: Who should manage pathology IT systems

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Future Lab Who should manage pathology IT
systems

• Dr Rick Jones
• Yorkshire Centre for Health Informatics
• University of Leeds
• Leeds Teaching Hospitals Trust
• http//www.ychi.leeds.ac.uk

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Friendly Rivalry

• Lunch
• Building CPD Community
• Looking outside the box
• Sharing knowledge

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Outline

• Pathology Context
• What is in Pathology IT
• Options for management
• Debate?

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Current Context (in England)

• Foundation Trusts
• SHA/PCT reorganisation (again!)
• Independent sector
• GP commissioning
• Payment by results
• All threats to traditional Pathology Model

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Moores Law beyond
2x _at_ 6-12 months
Log
Network Bandwidth
2x _at_ 18-24 months
Performance/ Price
1995
Now
2005
2010
Time
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Point of Care Testing

• Technology is putting testing closer to the
  patient
• Results
• Lower quality
• Higher convenience
• Serious risk of loss of data integrity

What happens outside pathology is increasingly
important
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Pathology is a Knowledge Business

• Clinical Advisory Service
• Clinical Audit
• Direct Clinical Service to Patients
• Laboratory Processing
• Training and Education
• Research and Development
• Near Patient Testing

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Laboratory Medicine
Data INFORMATION KNOWLEDGE
Policy RD Audit
Clinical Services
Specimen Analysis
Improved Patient Care
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Results Delivery
Is it useful? Regular
users 5,500 New records each day
6,000 Page impressions per day 35,000 Page
impressions per month 1m
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Information Delivery
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Clinical RiskHelp - which patient?
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Architecture
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Threats Challenges

• Traditional areas of control slipping away
• Order Comms clinical system activity
• Results access indirect via clinical interface
• POCT tests outside the laboratory
• Disease registers
• Systems purchases without our involvement
• Internal systems unfit for new business
  environment
• Payment by Results
• GP commissioning / Specialist commissioning
• Competition

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Specialist applications where there are gaps in
the LIMS

• Screening
• Population-based activity must be integrated
• Tele-histopathology
• Very large images
• No DICOM equivalent yet
• Transplantation immunology
• Donor / recipient data models needed
• Clinical Genetics
• Patient is a pedigree
• Major consent and disclosure issues
• Market too small for commercial development
• Lab to Lab Communications
• Needed to support tertiary referral

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Software Portfolio of a Typical Lab

• LIMS
• Excel spreadsheets galore
• Access databases
• Email / Office functions
• Local bespoke systems
• PMIP
• Request systems
• Blood Track
• Etc, etc

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Is this an appropriate architecture
ExecutiveDecision Support
Management Systems Finance, Personnel, Statistics
Office Automation FunctionsWP, email, WWW
Operational SystemsLIS, POCT Network, Analytical
sub-systems
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Pathology IT Architecture

• Layer Description Clinical Functions Management
  Functions Information
• 4 Executive Decision Support Performance
  Monitoring Knowledge
• Systems Planning
• Quality Management
• 3 Intermediate Ward Requesting RD
  Support Aggregate information
• Systems Clinical Reporting Workload Statistics
• Supplies / Contracting
• Quality Assurance
• 2 Operational Reporting Analytical Control
  Operational Data
• Systems POCT Networks Word Processing
  e.g. LIMS Web Browsing
• 1 Network Servers / PCs / Printers / E-mail
  / Infrastructure
• voice image management

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System Management

• Part of the problem is that there is no natural
  focus of IT management control in many of the
  emerging networks.
• Hence NPfIT does not have a coherent body with
  which to engage at national or local level.
• This was recognised in Pathology Modernisation
  Guidance.

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Pathology Systems Management

• All pathology services should have a Pathology
  Systems Information Strategy Group which aims to
  develop system capacity that, is capable of
  meeting the internal and external needs of the
  service.
• Has this been acted on?

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Pathology Systems Information Strategy Group

• This group must be formally represented at the
  highest level of management of the network.
• Is IT represented at Board level?
• What should be the terms of reference?

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Information system management

• The IT Strategy Group will establish a
  broad-based IT plan for the network that
  addresses its current and developmental business
  needs.
• This plan will be of necessity a multi-year plan
  which sets clear priorities, deliverables and
  milestones.
• It will be essential to develop appropriate links
  between this group and teams responsible for
  electronic record development in Trusts and LSP
  communities.
• Do we have such plans? 

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Where do we go?

• Pathology IT needs to be more cohesive
• Vision needs to be beyond the LIMS
• Need to engage at appropriate level
• ? SHA
• ? Network
• Business management increasingly important
• POCT major challenge

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Who should manage Pathology IT?

• Internal
• What is the organisation?
• Do we have the qualifications?
• Trust
• Is that the business owner?
• A local shared service
• Who is the supplier?
• Outsourced
• To whom iSoft??

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What skill set is needed?

• Information System Managers
• LIMS managers
• Network support
• IT support PC / Printers /Devices
• Business managers
• How much can we depend on suppliers?

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Workforce - Training Levels

• Skill Level Competencies Examples Job
  Functions
• Basic EDCL Data access AC
• and data entry Technical
• Intermediate Application use Word
  Processing Supervisory staff
• Spreadsheets Scientific leaders
• Databases AC
• Advanced Application use Statistical
  analysis Scientific Leaders
• Modelling RD
• Web site design Management
• Specialist IS development Specialist
  applications System managers
• Bespoke systems IT Support
• Decision support systems
• Management Application

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Next Steps

• Professionalism
• Sharing information
• Influence lobby
• Building evidence base
• Publish work
• theses
• research outputs

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Key Challenges

• Ensuring business models drive the systems and
  not the converse
• Keeping pace with the rate of change in
  diagnostics point of care testing, genetics
• Supporting integration between pathology and
  clinical services at the patient level

Simply replacing LIMS systemsis not the real
agenda
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Further Reading

• Information management and informatics need for
  a modern pathology service. Jones O'Connor.
  Annals of Clinical Biochemistry, 2004, 41
  183-191.
• Available in PDF from
• http//www.acb.org.uk/annalsindex.htm

Price, St John Hicks, AACCPress, 2004.
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Latest Initiatives

• Sir Muir Gray Position paper on Path Needs
  copy available at http//www.jiscmail.ac.uk/lists
  /ACB-CLIN-CHEM-GEN.html
• look for me in June Archive
• New SIG Group being set up at CfH site
  http//www.informatics.nhs.uk/index.html
• This will concentrate on Clinical interface
  issues and diagnostic decision making

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Latest Initiatives

• Do once and share activity developing across
  UK to share best practice avoid reinvention of
  wheels
• Email Jem Rashbass at the RCPath if you want to
  get involved.
• CPD4IT www.cpd4it.org.uk
• May become de facto contact conduit for CfH
• Regular meetings
• 10th November Glasgow - General update
• 5th December Leeds Order Comms