Content, Feature Content, Interview

Interview Series: CliniSys explain how Integrated Clinical Environments can join up healthcare

For the latest edition of our Interview Series, we speak with Darren Solomon, Support and ICE [Integrated Clinical Environments] Strategy Director for CliniSys and the company’s Marketing Manager, Matthew Fouracre.

Here, they talk us through how interoperable networks, such as ICE OpenNet, can help NHS organisations link up locally, and regionally, to securely share patient data between hospitals and other healthcare sites.

The solution is currently assisting nine trusts across the North East – Gateshead, Newcastle, Northumbria, South Tyneside, Sun­derland, Durham, North Cumbria, North Tees and South Tees – acting as a ‘virtual laboratory’ to help speed up the results process, track patients and tests, reduce admin time for staff, improve ease of ordering and provide a full diagnostic picture for clinicians.

Tell us about yourselves and your roles at CliniSys

Darren: I’m the Support and ICE Strategy Director. I have two hats – I run the department that supports all our customers and care settings with our products, but I also head up the strategy for our ICE order comms business. I’ve been here for two-and-a-half years now and I’ve worked in healthcare IT for a decade. We’ve got a good range of expertise at CliniSys – from the labs, biomedical sciences – including a cross-section of domains with leads from healthcare backgrounds, and we also balance that with IT professionals, as well.

Matthew: I’ve been working for CliniSys for 22 years across a range of disciplines, given my lab subject matter expertise. I started on the service desk and now manage marketing for the UK. We primarily come from a pathology background – one of our core product suites is Pathology LIMS (Laboratory Information Management System) – and that product is installed in over 60 per cent of NHS trusts across the UK. To augment that, we also have our order comms solution – the ICE system.

What does the CliniSys ICE system offer?

Darren: Over 74 per cent of primary care GPs order tests using ICE and 35 per cent of acute trusts use ICE on the wards. We see ICE as the order comms solution for all settings, across all diagnostics. We started with pathology ordering, and now have users from radiology, endoscopy, and cardiology. From a workflow perspective, at its base level, if you go to your GP and they want to order some blood tests, they will launch ICE, and order some tests, and those tests get routed through to our WinPath LIMS system, and then the results come back into ICE.

What’s amazing is how paper-heavy the NHS remains. For example, a sample will turn up at a lab with a handwritten form that will say what test it is and what patient it’s for. The lab will have to then manually book it in but can’t always read what it is. This causes delay, especially when there is still a large amount of paper referrals and tests that come through.

What we provide with our solutions is an electronic end-to-end workflow, so when a sample arrives at the lab, lab staff simply scan it in and marry it up with the electronic order which has already been received. That’s critical for when you get the result back. If you can’t marry samples and orders together, where can the result go? The issue you get with paper and handwritten requests is that the result doesn’t always flow back, meaning medical professionals have to chase the lab and it delays the patient care if it’s an abnormal result. With our ICE electronic order comms, we close the loops quicker so the results get back to the caregiver and the patients can be treated or informed in a more efficient manner.

Matthew: The NHS has a paper-lite strategy. Using our solutions to aid, the NHS and individual trusts getting to that nirvana of paperless [are] also providing governance and traceability. We’re proud that we have solutions to manage the flow of the specimen from the patient’s bedside, all the way through to the diagnostics.

Darren: Another part of why electronic order comms is within our product, and why we have a level of decision support, is that we try to avoid unnecessary or repeat testing by guiding the user through their decision process.

For example, for radiology there’s a national standard on how to order which test and when, so we integrate our product with iRefer – which guides clinicians through to the right test.

There is also the situation with not having access to relevant patient information to see if a test has already been done, avoiding repetition, delay and cost. That is where ICE OpenNet can help. OpenNet is part of ICE and lets users connect securely to other local ICE systems to share data and present a complete clinical history.

Tell us about your work with North East NHS trusts

Darren: The North East is a great example. Nine NHS trusts all use ICE and all have OpenNet connections to each other. For example, if there is a patient in one particular hospital, a clinician can see whether that patient has had any tests done in any other hospitals in the area, at the click of a button. What it means is, if that patient was treated and had a blood test, maybe there’s no need to order a test again because the result is there. That’s the benefit that ICE provides – the ability to share. Because we have so many ICE systems in the UK, we are able to share data across all of them without additional software purchases or expensive technical upgrades.

What we are now looking at is the potential of connecting a whole region together, so you’re looking at 17 or 18 trusts all having an ICE system that allows them to share data across an entire region. Allied to that, we’re also looking at how that can be offered to the ambulance services and the 111 services, because then when a patient is referred, they can see any results and tests.

Matthew: All our solutions and services focus on patient care – the right results at the right time, which is vital. In addition, there’s the cost saving element, where the cost of unnecessarily repeat tests are removed, saving on resources, materials, logistics, the testing and so on.

So, in summary, it’s that ability to provide clinical decision support to try and aid the right testing, to avoid duplication and repeat testing when unnecessary.

Darren: We have seen in the news recently the impact that the shortage of certain blood tubes is having on the NHS. To address the issue we can add specific rules to ICE that make users aware that a specific test comes with a specific container and whether the user is certain they want to order it.

CliniSys is a provider that’s willing to share data and willing to work with others to integrate. ICE stands for Integrated Clinical Environment – and it’s through the integrated piece that we’ve made our name and we’ll work with as many departments, laboratory systems and EPRs as needed.

If vendors don’t work together then it makes it very hard for the clinicians to be able to share data with each other. We believe it’s our duty and commitment as a supplier to be willing to have those conversations and do that integration work right across healthcare.

How does that fit with Integrated Care Systems (ICSs)?

Darren: What’s interesting with ICSs, is how they align [or not] with pathology and radiology networks. The challenge is when a group of healthcare organisations want to share a service but there are boundaries of those services, then different boundaries of NHS trusts and then different boundaries of ICSs.

The way they work right now is through lots of paper. So, one of the things we are exploring is the ability for trusts to use ICE to connect to any laboratory system and how we can help in the whole community. As areas start interacting with each other a lot more, suppliers like ourselves can really help to connect the dots.

We’ve talked to one community trust about enabling them to connect to four other NHS trusts from a single location. We can allow them to view the results of their patients across a far wider area. We’re going to expand that much more over the next 12 months and help facilitate electronic ordering and give them a view beyond their ICSs, into other trusts and pathology networks.

One of the initiatives the [UK] Government is developing are community diagnostic hubs and bringing services closer to patients for easier and quicker access. The idea behind it is that, with the pandemic impacting routine treatments, you try to avoid that happening in the future by taking care away from secondary care and into the community. It’s early days but it’s all about how we enable the healthcare system to continue in a pandemic and the challenge is always about joining it all together, closer to patients. ICE can definitely have a role to play within this initiative and given the market coverage the solution being used in many communities so can be easily integrated.

Matthew: Sharing information in diagnostics is actually pretty rare with a lot of information in silos. A solution, such as ICE, becomes a powerful tool to bridge the gap between those silos, and join all that vital information into a single area of diagnostic information and patient history for the clinician. We really feel like we’re making big steps in the right direction, connecting healthcare.

Tell us about your work with the Black County Pathology Services

Darren: It’s an interesting project. We were approached by them about their care homes and some of their private customers. Whenever they were ordering COVID tests, they were receiving paper and spreadsheets, and in the lab, they were having to use extra staff to process these items.

In response, we developed the ICE Portal and it’s currently being rolled out in the Black Country. What it will do is allow care homes and other customers to order COVID tests, electronically. It’s a web portal, so it can be accessed on a mobile phone, tablet or PC and be used to order tests for 50 residents in a minute or so, and the results come back to them as well.

COVID is just the start of where we think we can take the ICE Portal – we’re looking at long-term condition management and monitoring, result entering, and how we go beyond COVID into those types of workflows.

The portal is important because there’s a lot of unconnected care settings that still exist. The ICE Portal connects order and results communication together with ICSs and can help support the Shared Care Records. At CliniSys, we’re very open to sharing our data and enabling integration. We are very lucky because we can connect into other ICEs – they can ‘talk’ to each other and it’s massively valuable.

Are you expecting a national view of this information one day?

Darren: The challenge is that doing anything nationally is always very complicated. We’re not looking to replace anything or force anyone to rip out what they’ve got. All we’re saying is – because most trusts have an ICE system – it works out of the box. We’re willing to allow primary, secondary and community healthcare settings to simply connect using our APIs to securely share healthcare orders and results across many care settings.

Where we have those pockets of regional strength, we want to try and help and deliver more back to those trusts. The North East already has nine trusts completely connected – so any doctor can view results for their patients across the entire region, without leaving the workflow that they’re in. We want our systems to flow instinctively for caregivers.

We integrate with all the GP systems, we integrate with all the laboratory systems, we integrate with radiology information systems – so we’ve done a huge amount already. It’s about the value of sharing data between different care systems. We want to be the order comms for all care settings – not just primary or secondary.

In three- or four-years’ time, things will be very different across health and social care, with everything much more connected and integrated. It’s the art of the possible, using solutions such as ICE, and the commitment to connect, and connect some more. We need to learn from this pandemic to ensure that if and when we encounter a situation like this in the future, that we can continue to deliver the required care to everyone who needs it. Leading on from that we have a responsibility as suppliers to the NHS, to enable the NHS to do what it does best, by providing innovative and integrated solutions.

To find out more about CliniSys, visit