Storyboard Entry Form 2015
Main author: Brent Varley
Email: [email protected]
Telephone: 02920502860
1. Storyboard title:
National Laboratory Information Management System (LIMS)
Replacement Project
2. Brief outline of context:
The Pathology Service across Wales undertakes around 50 million tests per
year all this work passes through different laboratory computer systems.
The Diagnostic Services Strategy “Getting Results” (WHC (2004) 061)
identified the dependency on an integrated information management and
technology infrastructure to support the delivery of modern diagnostic services
including NHS Pathology Services across Wales. As part of this strategy the
Pathology Modernisation Project was developed and one of the objectives
was to have a single solution for Wales and a further project was commenced
to procure and implement a new single laboratory system.
In 2010 there were 13 Laboratory Information Management Systems
supporting 18 main NHS Pathology Laboratories across Wales.
The key aims of the project were to enable standardisation of practice,
support improved clinical governance and introduce the capacity and flexibility
to meet future demand and new developments. The aspiration was that
pathology test results be made available from anywhere and anytime,
presented in an integrated way with agreed standardisation so they were
comparable across Wales.
The procurement was completed in June 2010 and the project to develop
and implement was commenced. The anticipated cost of the project is £28
million over the lifetime of the system.
3. Brief outline of problem:
Problems
Disparate computer
systems that proved
difficult to join together
Different lab use
different names for tests
and in some cases
different reference
ranges for results
Limited user group
influence on application
development to enhance
service delivery
Over reliance on a small
(and reducing) number
of suitably qualified and
experienced support
staff.
Proposed Solution
A single computer
system linked to all
laboratories across
Wales
Planned outcomes
High level of
standardisation of
system (Better Quality)
No need to train
pathology staff if they
move across labs in
Wales (Efficiency)
Standard reports
feeding into the Welsh
Clinical Portal (Better
Quality)
Improved access to all a
patients pathology
information when
making clinical reporting
decisions (Better
Patient Care)
Safer systems of work
for Laboratory Blood
Transfusion (Better
Quality)
High level
All results across Wales
standardisation
mean the same (Better
Everyone uses same
Patient Care)
names for tests etc
Support future delivery
Implement to national,
of national patient
UK or International
electronic records
standards where
(Efficiency)
possible
Better access to
statistics and
performance
Improve clinical
interpretations and
outcomes (Better
Patient Care)
Active and influential
Enhancements to future
user group/supplier
systems are developed
partnership approach to to Wales needs and
application development available to all
and support
(Efficiency and Quality)
Comprehensive and
System managed on an
responsive support
all Wales basis.
24x7x365
Continuity of service
delivered across Wales
for maintaining the
LIMS system
4. Assessment of problem and analysis of its causes:
Reported information suggests 70 to 80% of all diagnosis require
pathology tests to be undertaken; therefore all patients within Wales are
likely to have investigations undertaken at some point in their health care
pathway. The changing landscape of both primary and secondary care
services and need for new information flows through the use of national
systems (for example the Welsh Clinical Portal) required the capacity to
have more standardised information and reliable systems to deliver the
information to the point of need.
In 2010 there were 13 Laboratory Information Management Systems
supporting 18 main NHS Pathology Laboratories across Wales. There were
differences of practice including different test names, units of
measurement, reference ranges and processes. This meant that results
from one laboratory may not be easily compared with another. The
majority of systems in use were well over 10 years old and needed to be
changed.
Pathology strategies identified the need for an integrated laboratory
information management system across Wales to support service
development needs and facilitate strategic change. This would enable
standardisation of practice, support improved clinical governance and
introduce the capacity and flexibility to meet future demand and new
developments.
5. Strategy for change:
The project has had a very wide engagement process that was
implemented throughout the project. In the early stages national
workshops were held where representatives from all laboratories
contributed to outline approaches and design. A large number of service
champions and professional representatives were involved throughout the
procurement to decide on the final solution.
Subsequent to this standardisation groups were formed to work on all
areas of Pathology Services to undertake the necessary work to deliver a
single solution for Wales. Key stakeholders were also involved in the
numerous other working groups and governance processes required to
support the development of the project.
6. Measurement of improvement:
The project has been extremely complex and we have delivered some of
the system across all Health Boards (see table below):
Date
June 2012
October 2013
November 2013
Location
Hwyel Dda UHB
March 2014
Aneurin Bevan
UHB
Aneurin Bevan
UHB
Cardiff & Vale UHB
Betsi Cadwaladr
UHB
Betsi Cadwaladr
UHB
Cardiff & Vale UHB
Abertawe Bro
Morgannwg UHB
April 2014
June 2014
July 2014
September 2014
November 2014
January 2015
Cwm Taf UHB
Activity Milestone
Microbiology
Blood Sciences Go Live
Microbiology and Blood
Sciences Go Live
Microbiology Go Live
Blood Sciences Go Live
Microbiology Go Live
Serology Go Live
Microbiology, Blood Sciences
and Histology Go Live
Blood Sciences Go Live
Microbiology Go Live
The number of tests managed by the system is detailed below, indicating
at current levels 48 million tests per year are being processed:
7. Effects of changes:
The impact of the new LIMS is the Wales now has a much more
standardised service model with respect to the comparability of results
which will support new developments including an all Wales patient
information repository. Results can be more easily compared for patients
who have pathology tests undertaken across traditional Health Board
boundaries.
8. Lessons learnt:
The project was extremely complex with a significant level of activity in
many areas to ensure delivery of the solution. Key lessons learnt were:
Communications:
There was a very high level of Wales wide engagement at the early stages
of the project, this worked well and we were able to identify some key
champions.
The strategy and plan focused primarily on targeted communications via a
number of working groups/boards. While this channel of communication
had high value, it was not wide enough to reach grassroots staff. There is
a requirement to develop a more proactive approach, to identify key
messages for each stakeholder audience and maximise the channels for
communication to include face-to-face, online, social media, newsletters,
and events.
Resources:
On a project this size managing and maintaining resources has proved
difficult. As the system is highly service focussed and releasing staff from
their day jobs to undertake work on the new solution was difficult. A
dedicated team would have been preferable but would have a significant
cost.
Timescales:
The implementation of the software solution was dependent on service
standardisation and National agreements, the time and effort involved in
gaining National agreement was underestimated and resulted in the
timescales exceeding the agreed dates.
Laboratory Staff Relationship and Support:
A ‘one team‘ approach was taken and the 3 teams involved worked in
partnership to ensure any issues were resolved effectively and efficiently,
particularly during the implementation period, with the focus solely on
ensuring quality of service and service continuity.
9. Message for others:
This was a very complex project and a lot has been learned. We were told
it could not be done but we have delivered a working solution.
The project has over run the planned timescale for many different reasons
but we have persevered and are now starting to see some of the benefits
that were envisaged. We still have more work to do but we are
encouraged by what has been achieved to date.
10. Please summarise how your entry reflects the principles of
prudent healthcare:
We have implemented a new computer system that pulls together all the
laboratories across Wales into a single system. This allows all pathology
results to be held in one database.
This new infrastructure provides significant opportunities for reviewing
information and gaining evidence on the relationships between pathology
results we have never had before this could be used to improve clinical
reporting and outcomes. It will allow services to be modified to meet need
and development and contributes to the Wales vision of better access to
information across all Healthcare settings.
The standardisation of the way results are reported will support cross
boundary working and allow clinicians to better interpret results.
There is now a greater integration into the way IT is being delivered and
this includes major improvements in correctly identifying and recording
patient demographic details. This all contributes to ensuring we have
quality systems in place to make systems safer and for effective.
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