Highland NHS Board 5 February 2013 Item 5.6 REPLACEMENT OF LABORATORY INFORMATION MANAGEMENT SYSTEM WITHIN NHS HIGHLAND Report by Alex Javed, Service Manager Laboratories and Radiology on behalf Deborah Jones, Chief Operating Officer The Board is asked to: Agree the need for replacement of the current legacy Patient Administration Systems with a modern Laboratory Information System. Consider the more detailed content of the associated Business Case. Agree to the procurement of a new multi-laboratory LIMS to replace the GE Ultra product used in Pathology and LRS Medipath used in Blood Sciences and Microbiology. Agree immediate commencement of the procurement process associated with replacement of the LIMS to ensure implementation is achievable before the expiry of the GE Ultra Centricity system and associated loss of service provision for Pathology. Agree the required local funding to allow the implementation to commence in line with the schedule in the associated business case. 1 BACKGROUND AND SUMMARY The business case supporting the replacement of the NHS Highland Laboratory Information Management Systems (LIMS) was presented at the December 2012 Asset Management Group meeting, following its ratification by the ehealth Strategy Group on 30 October 2012. The business case provides the rationale and benefits for replacing the current two LIMS with the preferred option of a unified system for all NHS Highland laboratory disciplines, this being one of the pillars of the ehealth strategy alongside replacement of the Patient Management and Radiology Information Systems in delivering an end to end IT solution for laboratory diagnostics. Cost savings related to reduction in WTE associated with booking in samples and delivering paper reports equate to 257K over the three year implementation timescale. The extensive product sourcing and procurement lead-in times coupled with the obsolescence of GE Ultra from 2016 necessitates the approval of this business case within FY 12/13. NHS Highland is therefore requested to accept the above recommendation which will enable progress towards commencing the replacement of the LIMS before the expiry of the GE Ultra Centricity system and associated loss of service provision for Pathology. 2 REPLACEMENT OF THE CURRENT SYSTEMS WITH A MODERN, UNIFIED LIMS The Laboratory Services within NHS Highland consist of a number of specialised laboratories encompassing the disciplines of Blood Sciences (Biochemistry and Haematology), Blood Transfusion, Microbiology (culture, molecular, serology [including the Scottish Toxoplasma Reference Laboratory and Specialist Service for Lyme borreliosis]) and Pathology (Histology, Mortuary, Cytology and Cytogenetics). NHS Highland has, owing to its geography, a larger number of laboratories than would be normal in a more densely populated area. Accordingly, there are four physical locations, all of which are vital components of the organisation in which these laboratories are sited Raigmore, Belford, Caithness General and Lorn and Islands Hospitals in Inverness, Fort William, Wick and Oban respectively.
Blood transfusion is the responsibility of the respective laboratories on each of these sites with the exception of Raigmore Hospital and is therefore within the specification of the current and future LIMS. The associated business case considers the LIMS requirements of the first three sites, though is designed to accommodate the needs of the Lorn and Islands Hospital within Argyll and Bute, should that become a requirement. The existing LIMS within the three sites are: LRS Medipath (Blood Sciences Laboratory and Microbiology) GE Ultra Centricity Laboratory (Pathology) The Medipath system was procured nearly twenty years ago, is supported by an Australian based company (LRS) and the Western Isles Health Board is its only other Northern Hemisphere customer. There is no formal development programme for the version installed within NHSH, meaning that requirements of users have to be met by individual customised alterations to the software. This limits the extension of functionality to that required of a modern LIMS, and management information tools are limited in range and function data extraction is cumbersome, time-consuming and not sufficient to support the requirements of audit, workload analysis, quality management and demand management/control. Critically, Medipath does not fully support electronic ordering, which is a key requirement of requestors and laboratories, as well as being central to the benefits associated with the upcoming Patient Management System. Electronic resulting from Medipath is of a form that does not fully meet users needs. The GE Ultra Centricity system was implemented in February 2009, but in July 2010 GE announced that it would be undertaking no further development work on the Ultra product, and that its customers must withdraw the system from operational use by July 23 2013. However, because NHSH had signed a 7 year support contract support for NHSH only would be extended to February 2016 with the rest of the World no longer being supported from July 2013. Without a supported LIMS in place the Pathology service of NHS Highland would no longer be able to function and service would cease and it is essential that this situation be avoided. There is therefore an opportunity to redress the shortfall in functionality of the Medipath system used in Microbiology at Raigmore Hospital and Blood Sciences in Raigmore, Caithness General and Belford Hospitals at the same time as replacing the Pathology system and the recommendation is that a single supplier be commissioned to provide a multi-laboratory, multi-site solution. This would meet both the clinical requirements and additionally would enhance the management tools available (such as demand management and measurement of KPIs) and facilitate the implementation of associated critical systems, particularly order comms and electronic resulting to both internal and external users. Recurrent revenue savings associated with electronic requesting and electronic results transmission to users would arise from reduction in staff resource needed for booking in samples and printing out and despatching reports. Indicative costs for procurement and implementation are shown below, based NHS Lanarkshire s proposal. Although broadly equivalent in terms of laboratory services and multi-site delivery to a mix of primary and secondary care, it is not representative of the geography or specific operational requirements of NHS Highland and the costs are therefore provided for illustrative purposes only. Entering a joint procurement exercise with NHS Western Isles would reduce the capital and revenue commitment required from NHSH by approximately 10%, in line with the Partnership Agreement between the two organisations. Revenue savings associated with the implementation are shown below. These are predominantly comprised of reduction in headcount of Medical Laboratory Assistants (MLAs) and A&C staff, both in the laboratory and wider hospital setting (the latter involved in delivering paper reports to requesting clinicians), the exact amounts being dependent on 2
which laboratories go live first; Blood Sciences has a current establishment of 8.5WTE MLAs, Microbiology 10.29WTE, Pathology 2.6WTE therefore greater revenue savings will accrue if Medipath were to be replaced before Ultra. Non-pay savings associated with reduced printing costs are also included. Costs Procure new 2013/14 2014/15 2015/16 2016/17 LIMS System commitment commitment commitment commitment for all Laboratories Capital (excluding VAT) Purchase and interfacing of 500K 250K 250K multi-lab system Interfacing to ehealth 50K 50K systems Hardware costs 150K 100K 25K 25K Capital charges 42K 21K 20K 1K Total Capital 742K 371K 345K 26K Revenue Software, hardware support 170K 60K 60K 50K and licence Legal costs 10K 10K Implementation costs 60K 30K 30K Data transfer from current 40K 20K 20K systems Total Revenue Costs 280K 70K 110K 100K TOTAL 1022K 441K 455K 126K Revenue Savings Cumulative (4 (recurrent) years) Laboratory staff (MLAs) 161K 23K 46K 92K A&C staff (lab) 27K 5K 11K 11K A&C staff (Raigmore) 44K 11K 22K 22K Printing costs 25K 5K 10K 10K Total Revenue Savings 257K 44K 89K 135K Additional to the revenue savings identified above, estimations presented in Appendix D of the business case shows that nearly 4000 working days per year are spent within NHSH Primary Care simply transferring data from laboratory results into separate systems. This equates to 17.8 WTE involved in supporting the current inadequacies in the LIMS-Docman data transfer. Any savings in primary care associated with implementation of the LIMS project would not offset the associated capital and revenue commitments but would reduce the overall cost per reportable laboratory test. 3 CONTRIBUTION TO BOARD OBJECTIVES The laboratory systems are integral to the diagnostic process, which in turn is a key component of determining the direction of the patient pathway. As such, the results of investigations need to be communicated accurately, swiftly and efficiently to aid clinical decision-making and this replacement programme is integral to the Board objectives: Highland Quality Approach: the LIMS replacement programme supports a reduction in waste, harm and variation. 3
Improvement and Change: in conjunction with the forthcoming Patient Management System the LIMS will be a key enabler in promoting demonstrable quality improvements. Engaging Effectively: views and needs of service users are encompassed within the business case and the specification of the LIMS solution. Delivering Safe and Effective Services: removal of the reliance on manual transcription and paper reports will reduce errors and support clinicians in delivering the correct treatment in a timely manner. Delivering Efficient Services: cost savings associated with reducing manual involvement in multiple processes will reduce the overall, holistic cost of each diagnostic report, removing non value adding processes. 4 GOVERNANCE IMPLICATIONS The business case impacts most notably on the following governance aspects: Clinical Governance: preventing errors and delays associated with manual transcription (both in the laboratory and in primary care) involves the use of a large amount of staff resource, which will be greatly reduced when a true end to end electronic service can be instigated within all laboratories Financial Impact: in addition to the resource savings noted above, an analysis of primary care processes showed that nearly 4000 working days per year are spent transferring data from laboratory results into separate systems. The governance implications of this are both clinical and financial while the associated staff resource is unlikely to be dedicated solely to these tasks by removing them it would allow pressures on that resource to be reduced Staff Governance: There are significant implications for staff, both clinical and nonclinical. The implementation of a new LIMS, in conjunction with the new Patient Management System, will aid in the reconfiguration of service design and clinical work-flows. The formal project management process includes ensuring staff involvement in, and knowledge of, the streamlined processes which will result. 5 RISK ASSESSMENT The requirement for LIMS replacement is on the risk register and has been discussed at Asset Management Group in October and December 2012 following on from its inclusion into the ehealth five year plan for capital investment, based on identified need. The implementation of the LIMS will be undertaken using formal Project Management techniques, based on Projects in a Controlled Environment (PRINCE2) and LEAN Principles. This approach ensures a continual process of risk assessment involving the maintenance of formal Risk Registers and audit trails around risk mitigation. 6 PLANNING FOR FAIRNESS No issues have been identified with this process, and none are anticipated. LIMS implementation will require reconfiguration of individual laboratory and secondary care delivery elements. This reconfiguration process will be subject to formal impact assessment as an inherent element of the project management process. 4
7 ENGAGEMENT AND COMMUNICATION Stakeholder engagement has taken place extensively within Primary Care (survey results included within the appendices of the business case) and with other service users, as well as internal stakeholders such as clinical leads and other end users. The business case has been presented at the ehealth Strategy Group and Asset Management Group and, following on from Board approval to commence the procurement process, all stakeholders will be invited to contribute to development of the operational specification of the LIMS. Approval of the Business Case will result in the establishment of a Procurement and Implementation Board which will include representatives of all stakeholders. Engagement and communication will be an inherent and formal element of this structure. In addition, communication with staff at all levels of the organisation will be through cascade from senior management, staff briefings and the joint staff governance approach along with the NHS Highland Communications Department. Alex Javed Service Manager Laboratories and Radiology Medicine and Diagnostics Division 25 January 2013 5