1. The Benefits of Using NPEX & The Vision for Sending and Receiving Pathology Tests Nationally Keith Burrill Pathology IT Systems Manager University Hospital Southampton

2. Background – possible options UHS major teaching hospital on the South Coast UHS variety of work processed for numerous organisations, includes channel islands and some private and foreign, as well as local ‘networks’. UHS also refers some work for testing Options appraisal: Paper reporting / courier delivery – general move away from this Fax ~ VIOP, Governance arrangements – only option for some clients Email – Advanced Encryption Standard (AES) 256 bit / PDF reporting – or NHS mail within the NHS Client collection reporting system, PDF, NBTS, Cardiff NPEx lab to lab links

3. NPEx Option Only option to provide electronic referral and reporting (incl. HL7) Eliminates transcription errors, reduces turnaround Initial primer funding from Pathology Modernisation monies (OJEU) Required investment and User Acceptance Test (UAT) across LIMS vendors, sites and NPEx Project delivery Data Share / IG requirement Virtual Private Network (VPN) & SSL certificate over N3 National Laboratory Medicines Catalogue (NLMC) UAT – test NPEx and test LIMS accounts Test pack & test scenarios e.g. unsolicited results, comment reporting Referral and reporting function UAT again post changeover to live

4. LAB A Create referral order Refer sample and form. Receive result(s) LAB B Receipt sample Analyse sample Report result(s) Referral processes costsRecipient process costs Staff time etc Indicate test is send awaySample receipt Prepare request form for send awayIssues with patient identification Issues with identification of test(s) requested Cost of monitoring transportationIssues with location and consultant identification Reporting costs Receipt of results Referred result reporting TAT - electronic vs. paper based Enter results into LIMS Reporting TAT - electronic vs. paper based Benefits of automation Web Server NPEx

5. Design elements Problem 1 - Sample and test codes not standardised between labs Solution NPEx provides facility to map investigations between labs to SNOMED CT/NLMC Investigation constituent test s are further mapped to SNOMED CT/NLMC All above without impacting local LIMS coding Problem 2 – Laboratory sample numbers may not be unique across laboratories Local sample numbers despatched to NPEx on creation of request - triggered by request item/ test being booked in, then despatched The received sample number is used as Order Number, the solution is to make the Order ID unique to Trust by employing National Administrative Code (NAC) On reporting both numbers stored in same message to ensure pairing and can be tracked in NPEx Quick Search window by either party

6. Shipment example

7. Southampton Lab system receipt

8. NPEx clients and Case Study Southampton (Clinisys Labcentre) Swindon (Clinisys Winpath) Live switchover March 2013 Paper, fax, LIMS access, migrated to NPEx Currently Immunology and Clinical Chemistry Salisbury (iLabTP) Live Switchover March 2013 Implemented Immunology, UAT Clinical Chemistry Hampshire Hospitals (Clinisys Winpath) – Basingstoke and Winchester UAT both Trusts operating both functions, referral, processing Triggered Oxford joining NPEx?

9. NPEx and Non-NPEx referrals

10. Stats March 2013 – Jan 2014 NPEx specimens (from previous slide) Salisbury 7,813 Swindon 14,993 NPEx investigations Salisbury 12,697 Swindon 25,887 Unique investigations traded Immunology 130 Chemistry 80 Acetyl choline receptor Ab78 Adrenal antibodies6 Almond49 Alt.ve Haemolytic Complement1 Animal danders8 Anti B2 Glycoprotein 192 Anti Cardiolipin Ab944 Antibody Titre1 Anti-Neutrophil cytoplasmic Ab1119 Apple allergen3 Aspergillus fumigatus139 Avocado1 Baker's yeast2 Banana allergen7 Bee venom3 Beef allergen1

11. Clinical Biochemistry, examples 11-Deoxycortisol2 17-OH-progesterone7 24 HR CORTISOL15 25-OH-vitamin D2 & D3249 A1AT Phenotype11 ACTH7 Adrenalin1 Aldosterone23 Aldosterone/Renin Ratio18 ALP isoenzymes1 Alpha-1-antitrypsin17 Aluminium1 Androstenedione4 Arsenic whole blood1 Beta-2-Transferrin1 CA 19.997 CA15331 Cadmium whole blood1 Caeruloplasmin15

12. Next steps National System – Link to Manchester Network referral to Southampton, specialist tests e.g. Cobalt Poole are interested… Complete Clinical Chemistry implementation with Salisbury Labcentre upgrades enabling Microbiology and Cell Path UAT with NPEx Connect to other Labs Via NPEx?

13. Summary: NPEx Benefits and Vision NPEx Implemented, operational and supported. Has been well received by our clients Justified by local network volume & benefits delivered which enables… Further connectivity as is a Single National System. Does not require re-registration on local servers – as current for likes of PMIP, or local GP requesting & reporting deployed solutions. Thank you for listening, and thanks in particular to all parties whom have worked with us during these NPEx implementations