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Keeping Path Links on track

Biomedical News – October LIMS feature

By Patrick Mitchell-Jones, Product Manager, iSOFT Laboratory Systems

For the successful integration of pathology services across the whole of Lincolnshire, Path Links realised that effective sample tracking would need to go hand in hand with a single patient master index, held within a single, multi-site pathology IT system. By working closely with iSOFT, Path Links has achieved its key strategic goal of allowing samples to be booked in at any of its five sites for analysis in whichever laboratory is best placed to perform the tests requested, whilst maintaining a track of the sample's whereabouts.

Established in 1998, and representing a collaboration between two Lincolnshire Trusts (the Northern Lincolnshire and Goole Hospitals NHS Trust and the United Lincolnshire Hospitals NHS Trust), comprising five District General Hospitals (Scunthorpe, Grimsby, Lincoln, Boston and Grantham), Path Links provides pathology services to the 1,000,000 population of Greater Lincolnshire, the second largest county in the UK. In April 2001, a single management structure was introduced – representing a service configuration model accepted by both the National Pathology Modernisation Board and the Royal College of Pathologists.

In February, as a prelude to fully integrating its pathology services, Path Links placed the largest ever UK contract for an integrated pathology LIMS with iSOFT to implement its i.Laboratory solution. John Hutton Minister of Health switched on the Cytology system at Lincoln in June. The rest of Cellular Pathology is being rolled out in phases across all Path Links hospital sites over the following three months. It is anticipated that sample tracking will be switched on in October 2002.

The requirements for the sample tracking system were drawn up by a team of representatives representing each of the Directorate within Path Links. These were then given to iSOFT to incorporate into the implementation and to suggest a way forward that met Path Links' business needs. Basically, in addition to having to track samples entered on the system by each of the five hospitals, the system had to cope with three potential testing scenarios:

All the requested tests could be completed on the originating site ('All done here')
Some of the tests could be completed but some would have to be undertaken elsewhere, which could be outside of the Path Links enterprise in the case of specialist requests ('Some done here')
All the requested tests would have to be completed elsewhere ('Not done here')

For simplicity, iSOFT divided the testing facilities into domains (see figure 1), some of which included more than one location. They then created scope for managers to view the work lists within each of the domains, which could represent a hospital, department or an individual laboratory, to give them the visibility they needed to monitor sample processing.

As regards samples, facilities were provided to manage these singly or in batches, such as all histological sections relating to a certain sample, where it would be impractical to label each slide.

Within the batch management programme on each site, a dispatch list is created for each 'not done here' sample indicating where it needs to be directed. If it needs to leave the enterprise, details of the sample and the requests will be sent from i.Laboratory using the industry standard HL7 Lab-to-Lab links, soon to be implemented.

For 'some done here' samples, the option exists within i.Laboratory to either split the sample for parallel processing on two, or more sites, or conduct the requests that can be completed on site, and send the sample off for serial processing. In each case, having both a single patient master index and a single multi-site IT platform, allows for the receiving laboratory to process the sample by simply scanning the bar code, which identifies its new location; all the work requested on the sample has already been entered by the receiving laboratory.

The single, multi-disciplinary IT system also makes it a simple task to combine the results as they are generated and authorised and make them available to the requesting clinicians through enquiry, which may be web based, and GPs through (Pathology Messaging Implementation Project (PMIP) reporting.

Tracking the sample remains the responsibility of the originating laboratory. Staff set a time limit in which they expect the sample to arrive and be logged in at the receiving site. Should this be exceeded, a warning flag is generated. Once the sample has been 'logged-in', the sample tracking system will know of its new location.

Running within sample tracking is a rack management system. This not only allows every rack to be tracked, but can also create an audit report detailing where each sample, rack, batch or organism has been, when it was there and who sent it.

Staff within the five sites are now interfacing with their new pathology LIMS and its sample tracking system via totally new Windows-based prompt screens. To prepare them for the change, Path Links appointed a specific Training Manager and set-up a dedicated Training Suite, and this has streamlined the roll-out of i.Laboratory.

According to John O'Hara, the Path Links IM&T Project Manager, "Having a single IT system was always seen as imperative for the success of the Path Links, and this view has been more than proven. iSOFT's ability to implement single i.Laboratory systems across multi-site configurations was a key factor in our choice of supplier but, at the time, we only had a commitment from them to develop the required sample tracking facilities and other essential functionality. Within four months, they had developed all the necessary software and we can now accurately track the progress of samples anywhere within the enterprise."

Furthermore, the new LIMS, which was funded from the government's Pathology Modernisation Fund, represents a fundamental part of Path Link's EPR strategy and will facilitate the introduction of Pathology messaging to the new PMIP standards and formats, which come into force at the end of December 2002.

In successfully creating and implementing a single multi-site IT platform, Path Links and iSOFT have built a robust model which other Trusts that are considering going the 'managed network' route to pathology modernisation can now follow with confidence.