Scottish Cervical CallRecall System SCCRS

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• Scottish Cervical Call/Recall System (SCCRS)
• Allan Wilson
• Advanced BMS Practitioner in Cervical Cytology
  and Lead BMS in Pathology NHS Lanarkshire

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Plan for today

• Background to SCCRS
• Overview of SCCRS
• Development of SCCRS
• Benefits
• Problems
• Lessons learned
• The way forward

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Background

• Project initiated in response to the report from
  the Quality Improvement Review published in June
  2000
• To review the quality of Call/Recall arrangements
  in Scotland
• To report on findings and implications
• To make recommendations

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Report conclusions

• The programme in Scotland very successful
• Demonstrated a 34 reduction in deaths and
  incidence
• Call recall arrangements safe but found to be
  fragmented and inconsistent
• Standardisation of call recall systems and
  processes required
• Development of a single national system

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Evolution of SCCRS

• Initially designed as a call recall system to
  replace OCCURS and CCS and GPass.
• Charlie Knox (SEHD Head of IMT) chaired the
  initial project board (2002).
• Project managed by Isobel Gavin supported by
  Gordon Shaw CMG (Secta)
• Software developers SchlumbergerSema (ATOS)
• Cytology Laboratories added in 2003
• Prototype available in December 2004

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Evolution of SCCRS

• Data migration from CCS, OCCURS and laboratory
  systems started in 2005 but was not complete
  until 2007
• Some labs struggled with data migration due to
  lack of CHI numbers
• Laboratory system specification in March 2005
• UAT during 2006 and 2007.

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SCCRS

• Single national system for
• Call recall including non-routine recall
• Colposcopy
• All smear/sample takers including Family planning
  and GP practices
• Cytology laboratories

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What does SCCRS do?

• Allows review of electronic lists of eligible
  women before invitations are sent out (RCL)
• Sends out invitations and reminders
• Electronic requesting
• Allows sample takers to access results
• Generates alerts for abnormal results
• Sends results to women
• Provides information for GMS contract

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SCCRS

• National parameters and protocols
• Access to authorised users of the programme
• Rapid electronic access to results
• Major reduction in duplication
• Monitoring and evaluation at national level

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What existed pre-SCCRS?

• Community
• CCS
• OCCURS
• GPass
• GP stand alone systems, e.g. Lothian
• Labs
• Various LIMS with cytology modules
• Colposcopy
• Various stand alone systems

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Information Governance issues

• Initial plan was for access to full histories
  from anywhere in Scotland
• GP concern undermined this principle
• GP practices can only access own patients
• Labs can access full histories
• What will happen with national Sexual Health
  system!!

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Main Benefits for Laboratories

• No need for a Laboratory Request Form move to
  online requests
• Accession number allocated by the central system
  (standardisation)
• Ability to screen and record throughout the
  entire screening process no requirement for
  batch entry
• Ability to move samples around Scotland
• Smear takers can enquire on the status of a
  sample within the lab

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Main Benefits for Laboratories

• Standardised laboratory reporting
• Turnaround Time/Average Reporting time
• Reporting Profile by Results
• Results by Opinion Role
• Sensitivity/Specificity
• Smear Biopsy Correlation

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Progress so far

• Went live on 28th May 2007
• By end of August approximately 6,000 users have
  logged onto SCCRS
• 122,129 smears reported
• As of 6th September, 87 of requests had been
  completed online
• Now down to only 2 paper requests
• Only five category A change requests
• 70 other change requests

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Problems

• Proxy users
• SCCRS is designed as a real time system!
• Must not be used prospectively or retrospectively
• Needs to be suitably resourced to ensure this
  (staff, training IT links, hardware)
• May involve a change of practice, e.g. occasional
  sample takers stopping taking samples.

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Problems

• Legacy data
• Access to biopsy data (?SCI store solution)
• Staff time for UAT
• Poor help desk support
• Mobius issues
• Labs devising their own work-arounds in absence
  of user group response
• Lack of Business Objects training

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Training issues

• Training for SCCRS was poorly delivered in many
  areas (particularly colposcopy).
• On-line training package was inflexible, complex
• Laboratory staff have experience in changing IT
  systems
• The impact of SCCRS was greater on clinical
  staff.
• Ensure clinical staff know where to go for
  support (not the lab!)

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Advantages

• Standardisation of practice
• Immediate results to sample takers
• National database
• Paper free system
• Considerable savings on clerical/admin resources

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Lessons learned.

• Comprehensive training for users
• Training must be fully resourced
• Paper free systems require entire systems to be
  re-engineered
• Consider all current uses of request forms and
  how/if you need to replace these functions.
• Labs have to learn to let go!

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Centralisation Inflexibility!

• Standardisation is essential for screening
  programmes.
• Possibly not the answer for laboratory systems,
  but..
• If you want to compare national data or feed into
  national databases

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Issue Reporting / Escalation Route
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SCCRS

• SCCRS is the most complex system within NHS
  Scotland
• 12,000 named users covering all aspects of the
  cervical screening programme in Scotland
• Trail-blazer for electronic requesting
• Lessons must be learned and applied to other
  systems in development.