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Homerton improves GP test access

28 April 2011   Shanna Crispin

Homerton University Hospital NHS Foundation Trust has contracted CliniSys for the implementation of its CyberLab.

About 40% of the trust’s lab test requests come from the 44 GP practices within NHS City and Hackney, and at the moment they all lodge requests on paper. CyberLab will enable the GPs to make the requests electronically through the web.

Homerton’s pathology IT manager, John Gooch, said this will vastly improve the lab’s efficiency.

“It takes between 30 seconds and a minute to log a paper request into the LIMS [laboratory information management system] – electronic requests take five seconds,” he said.

“Sometimes, on really bad days, when we’ve got poor attendance in the lab, [paper requests] can delay the process by a couple of hours. If [the requests were] electronic it wouldn’t be of that sort of level.”

The CyberLab software is currently being installed. Gooch said he hopes to pilot the system with one or two GP practices during the summer, with the first practice actually going live in late summer or early autumn.

The trust is then planning to continue to transfer one practice per week to the electronic system – aiming to have all converted by mid-2012. This would mean that 90-95% of the lab’s requests would then be made electronically.

Homerton has paid for CyberLab and has received no financial support for the improvements from the primary care trust.

“We’ve wanted this for probably about three years now,” Gooch said. “In the end I actually persuaded the trust that it was in our best interests, so we’re happy to pay for it all.”

He added that the system will help to secure the lab’s income as the healthcare sector moves into a more competitive phase.

CliniSys’ chief executive officer Fiona Pearson said the system gives GPs a better quality service.

“There’s quite a big change in the relationships between GPs and laboratories, and that’s where we are starting to see these types of systems, because it helps the laboratory deliver a better service to GPs.”

Following the GPs’ conversion to electronic requesting, mental health will be the only services to still lodge paper requests with the Homerton’s pathology service.

 

 

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Last updated: 28 April 2011 17:07

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alano58 182 weeks ago

We introduced a system of electronic test requesting several years ago in Lincolnshire using the DART OCS software product from PlumTree. We had no problem engaging with GP practices once they saw how efficient it was. The system is universal across all pathology departments & is integrated with all accredited GP clinical systems to enable safe patient identification & demographics pre-population of test requests.

The solution includes decision support (tick one box for suspected diabetes chooses the required tests); printing of bar-coded labels for the sample bottles; a redesigned bag with printing on the reverse; mandated use of NHS number for patient identification; and GP access to the database, including non-GP requests, searchable only by NHS number. Data is transferred to the lab via N3, they swipe the bar-code at the lab end to confirm patient & test request details.

The number of tests rejected for handwriting errors (the most common reason for rejection) has virtually reduced to zero, and far fewer tests are having to be repeated because someone inadvertently forgot to tick a test request on the form. Apart from some teething troubles with our standard GP printers (we added an extra bin) the solution has been trouble-free. We will look to expand this into radiology test requesting later this year.


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Conflict of interest?

just_instantiate 182 weeks ago

It is interesting that GP ordering projects are usually (always?) driven from the acute end. This is hardly surprising given the relative availability of resource and the nature of the products available on the market. However, it seems to me that this is a very effective way of locking GPs in to a particular lab. Obviously that's in the interests of the acute provider, but is it really what the GPs want? ... and is it in the overall interests of NHS efficiency? I wonder if in the long term the underlying design pattern might make it more difficult to implement thorough-going reconfiguration of pathology services.


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Pays ye' money and takes your "Choice"!

Nick Tordoff 182 weeks ago

Most of these projects have been funded by the Acute Trusts in order to make internal savings. If the GP Commissioners/DH want to fund a different model in order to achieve a market in path lab services, they will have to put their hands in their pockets.

But beware! Choose and Book started of a a well scoped deliverable electronic booking system. The retro-fitting of a policy on patient choice to the software delayed its effective implementation by years.


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Paying the piper ...

just_instantiate 182 weeks ago

Quite - if the acutes are paying they call the tune. Doesn't mean it's necessarily the best thing for the NHS though. A parallel is the various service companies providing transport, cleaning etc to the NHS. These often come with a "free" ordering application, that being web-based and remotely hosted doesn't even need any local infrastructure. However, they do come at a cost in terms of lock-in and architectural inflexibility.

Your comparison with Choose and Book is well made, but surely the point that it would have been a much more successful project without the political overload supports my (implicit) contention that a network architecture would be a feasible (and I believe, superior) alternative to a point-to-point one. That the term "referral" only reflects the fact that doctors don't like being ordered to do things, reminds us that Choose and Book actually is an ordering system. As such, it could probably have been developed as a universal platform by which GPs could order any service from an acute - or rather, that any NHS organisation could order from any other.


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Have the GPs been consulted?

Mary Hawking 183 weeks ago

Any change in process like this does require the involvement of the GPs: speaking from local experience, it can take longer to complete a lab request online than on paper: you still need a form if phlebotomy is involved, and the form may not print (we've been told it is a N3 problem - and insoluble!).

The thing that got GPs in my area involved was the ability to see resultsof investigations ordered by other people.

This isn't just a hospital IT system savings situation: it involves the whole pathway.

What is the benefit for GPs and practice staff?


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I can't imagine they would do this without consultation

+ve Informatics 182 weeks ago

Having implemented a similar system but using Indigo4 in a previous life consultation with the GPs is critical to realising the benefits for the labs and the GP staff. Our system also included providing printers for the surgeries so the need to write labels was also removed - and that is a great benefit to the GP staff. There were no N3 issues as this was controlled at the GP system end.

As far as I can recall all saw benefits and embraced the system.

Just a shame the MH Trust won't/can't electronically order and receive.


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5 Secs fo a GP to request a test and print bottle labels....

Chris Frith 183 weeks ago

....then the commissioners and users would be interested.

Good first step (already achieved by Anglia ICE I believe) but good to see they have competition. Hopefully BT will be asked to improve the efficiency of the (Not so) New NHS Network (N3) too?

Chris Frith

EMIS user and GP Hereford


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Is N3 the problem?

Phil Grayson (TPP) 182 weeks ago

I find it hard to believe that the problem lies with N3 as they run a tight ship and are quick to rectify any faults within their control. The issues you describe could be caused by a local network issue but I suspect the problem is with the application you're using.

Regardless of where the problem lies, any application vendor worth their salt should be able to thoroughly diagnose the fault and work with N3 or the local networks teams to resolve it.

You're the N3 customer, not the application vendor. If the fault has been reported to N3, I would strongly suggest asking for a reference number to get both sides of the story.


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