Bowel Cancer Screening Programme Electronic Results Communication Frequently Asked Questions and Lesson Learned from pilots and roll out. Programme NPFIT Status Issued Version 3 Author NHS CFH Version Date 16/12/2010 The Bowel Cancer Screening System (BCSS) is now able to send out the results of the initial Faecal Occult Blood Test (FOBT) as an electronic message in a form that can be captured and saved on most GP Practice systems. FOBT result letters represent the vast majority of Bowel Cancer Screening Programme (BCSP) letters to practices. BCSS uses the same messaging standards and protocols used by the Pathology Messaging Implementation Programme (PMIP) service which is already in widespread use for sending pathology results to GP practices. Frequently Asked Questions FAQ1 Who should GP Practices contact if they have any difficulties with the results? Answer: For IT related technical difficulties such as result arriving at the wrong mail box on the GP Practice System then the GP Practices should go to their GP System of Choice (SoC) Systems Supplier on the grounds that most problems will be local issues with the GP Practice system that only the GPSoC Systems Supplier can resolve (pilot and roll out has so far proved this correct as the problems encountered have all been local configuration problems at the practice, all resolved by the GPSoC Systems Suppliers). GP Practices have support arrangements and thus established contacts with their GPSoC Systems suppliers. If the Supplier suspects that the problem lies with the BCSS system (server or Hub) then the GPSoC System Supplier will then contact the NHS CFH BCSS helpdesk (exeter.helpdesk@nhs.net). For business problems or questions concerning BCSS electronic messaging then the GP Practice should contact their BCSS Hub in the first instance. Please see FAQ2 for Hub contact details. FAQ2 Who does the Practice contact if they receive a result for a patient who isn t registered with them (this might occur occasionally)? Answer: Electronic messages are a straight replacement (or duplication) of the letters in that the BCSS IT system only sends the letter or electronic message to the GP Practice of the patient and it provides no facility to redirect the patient s letter or electronic message to another GP Practice. 1
However Bowel Cancer Screening Hub staff can print or reprint the original hardcopy letter corresponding to this electronic result. The Hub staff would have to print the letter and then manually send this letter to the appropriate GP Practice. Therefore the answer is that the appropriate Bowel Cancer Screening hub should be contacted. The BCSS Hub contact details are; Telephone for all Hubs - 0800 707 6060 E-mail London Hub Eastern Hub Southern Hub Midlands and North West Hub North East Hub Nlh-tr.bcsp@nhs.net lucy.peck@nhs.net neil.stubbs@nhs.net bowel.screening@uhcw.nhs.uk ian.ward@ghnt.nhs.uk FAQ3 What is the procedure if the lab has problems in sending out messages electronically e.g. the system fails? And how will they notify the practice? Answer: Firstly, this isn t a local lab, it s a single national point of service (NHS CfH Bureau supported). If any complete system outage is experienced, then messages will be queued and sent when the service is restored (communication of these results is not time critical like other PMIP lab results) If we have a failure with an individual GP practice (which we anticipate to be more likely from time to time) then the NHS CFH bureau will be immediately aware and will follow this up via the BCSS hub. The BCSS Hub or NHS CfH will then liaise with the GP Practice via their GPSoC Supplier. As a fallback, there is a facility within BCSS for the Hub to revert to printing hard copy letters of any failed messages and send these to the GP Practice. FAQ4 How frequently will results be sent out each day? Answer: At present the central server sends results to GP Practices once daily, overnight. Electronic communications are queued immediately the result is determined (normal, abnormal, no response etc). They are then batched up and sent by the BCSS system to the GP Practice overnight. If the GP Practice has requested a hard copy letter alongside the electronic communication, the corresponding letter is placed in a pre-prepared letter batch when the electronic communication has been sent. The Hub then determine when that letter batch is processed and sent on to Printers and thus GP Practices. Therefore electronic messages will be generated and sent every working day (assuming there are results to send) whereas the sending of hardcopy letters is 2
determined by the Hubs. With the exception of the abnormal letter some Hubs send letters to GP Practices on certain days of the week only. FAQ5 If new Read codes are added to the data set, how quickly will the laboratory add them to its system (generally this is done by path labs within a couple of weeks)? Answer: Again, this isn t a local laboratory system, this is the national Bowel Cancer Screening System (B CSS). We define our own results and have agreed the SNOMED and Read codes to be used for a National Bowel Cancer Screening FOBT. If we add any new Read codes in the future (following the NHS procedures for adding and implementing new Read codes), then we will agree a new code and implement that code in parallel with, and at the same time as introducing the new test itself. No new codes will be added other than ones that relate to our screening service, and at the behest of the national programme. There is currently no plan to implement any additional BCSS Read Codes or SNOMED codes. FAQ6 Is it clear where responsibilities lie for acting upon results? I ask this because usually a result goes back to the GP who has requested it and they then act upon it. If this is a copy of result and the Hub acts upon it, that needs to be clear in the message; or the GP must be aware that any message about bowel cancer screening will be the clinical responsibility of the Hub. I trust that I have understood the working of the screening service correctly. Answer: There are no changes in responsibilities for care with the introduction of this new electronic communication. Since 2006 GP practices have been sent hard copy letters containing these screening results, and understand they do not need to take any immediate direct action other than to record the result in the patient s notes for information and future reference. Where appropriate, the GP may wish to refer to and use the recorded results to support discussion with the patient at any subsequent consultation. Such discussion could be extremely effective in encouraging nonresponders to participate. The only change being introduced is that we are now sending the same results electronically. The electronic messages include a set of codes and descriptions which differentiate them from any other Read coded symptomatic test results received electronically. FAQ7 Please can you list the SNOMED and Read codes used by BCSS? Answer: The following Read codes identifies the investigation: 6866. Bowel cancer screening programme: faecal occult blood result (Term 30 description is BCS: FOB result) The 5 result Read codes are as follows: 6867. Bowel cancer screening programme faecal occult blood testing kit spoilt 686A. Bowel cancer screening programme faecal occult blood test normal 686B. Bowel cancer screening programme faecal occult blood test abnormal 3
686C. Bowel cancer screening programme faecal occult blood testing incomplete participation 9Ow2. No response to bowel cancer screening programme invitation The corresponding SNOMED codes are: 368481000000103 Bowel cancer screening programme: faecal occult blood result (observable entity) The 5 SNOMED codes listed below represent the 5 FOBT results that can be reported to the GP practice 375121000000106 Bowel cancer screening programme FOB test kit spoilt (finding) 375211000000108 Bowel cancer screening programme FOB test normal (finding) 375241000000109 Bowel cancer screening programme FOB test abnormal (finding) 384241000000100 Bowel cancer screening prog FOB tst incomplete participation (finding) 373251000000108 No response to bowel cancer screening programme invitation (finding) FAQ8 What is the format of the GP Practice DTS Address and EDI Sender/Recipient addresses? Answer: DTS address is commonly in the format GP Practice code + HC e.g. G12345HC although sometimes the Practice code part may be an old Practice code (merged Practice for instance) and the HC may also include HC1, HC2 or HC3. The EDI Sender/Recipient address is always a 15 digit numeric field where the last 5 digits are commonly (not always) 00005. FAQ9 Regarding the Bowel Cancer Screening Programme do we need to arrange for any firewall ports to be opened on the surgery network in order to receive BCSS Electronic results? Answer: The change that GP Practices must make to their GP systems is to load the GPSoC Supplier Software patch that allows them to receive BCSS messages correctly. (Note that the GPSoC Supplier needs to develop software to be able to receive and process the BCSS messages correctly. This will then be deployed to GP Practices when the system has been tested and approved.) Otherwise if the GP Practice already receives Pathology (PIMP) messages then no other change should be required to the GP system no extra firewall changes. FAQ10 Can historic results, sent before BCSS electronic results were implemented at that GP Practice and previously received by postal letter, now be resent electronically? 4
Answer: No. BCSS has no ability to resend results sent before electronic results were implemented at a particular GP Practice and there are no plans to develop that functionality. BCSS can resend results sent after electronic results were implemented at a particular GP Practice. These can be resent either electronically or by postal letter. FAQ11 What does the GP Practice or PCT do if the DTS address and / or EDI sender recipient address of the GP Practice system is changed? Reasons for such a change may include GP Practice merger or change of GPSoC GP System Supplier. Answer: The GP Practice or PCT must inform the appropriate BCSS Hub. For BCSS Hub contact details please see FAQ2 above. The BCSS Hub must then inform NHS CfH who will update the BCSS system. If NHS CfH is not informed of changes to GP Practice DTS address and EDI sender recipient address then BCSS electronic messaging to that GP Practice will fail. FAQ12 Is the electronic BCSS message addressed to an individual GP at the GP Practice? Answer: The BCSS system does not hold names of individual GPs so every electronic BCSS message is addressed to the Bowel Cancer Screening Administrator. This is the text that will be carried in place of the GP name. Lessons Learned from the Pilot Sites 1) Two pilot GP Practices requested that all BCSS messages were directed to the mailbox of one particular GP in the Practice instead of the general mailbox. These requests were dealt with by GPSoC System Supplier who in one case then set up a rule on the Practice s system to do this and the other case required a software upgrade to the GPSoC Supplier System. Please note that GP Practices requiring this must contact their GPSoC System Supplier as this is not possible from BCSS. 2) One pilot GP Practice asked if non-response result (i.e. one denoting that the patient had not responded to the screening invitation) could be handled by the GP practice system differently from the other BCSS result messages. The Practice was happy for the Read code to be added to the patient record, but didn t feel the result should appear on the list of pathology results for this patient. Such functionality is outside of the original requirement and would require additional software change by the GP Software Suppliers. The potential change will be discussed between NHS CFH and GPSoC System Supplier but for the 5
foreseeable future non response messages must be handled in the same manner as other BCSS messages. 6