EXCLUSIVE - Robust and secure delivery of medical results – ICT innovation at NSW Health Pathology
What is your role as CIO of NSW Pathology?
My primary operational responsibilities include providing IT infrastructure and support for approximately 4,500 users and more than 60 laboratories. Our IT strategic plan is formed in direct response to our business plan.
How well integrated is NSW pathology with the overall healthcare system?
NSW pathology is tightly integrated into the health system in New South Wales. For example, NSW Health Pathology receives electronic orders from hospitals and we send electronic results into patient medical record systems. Most of this integration is via point to point interfaces, though we are driving new integration via an enterprise service bus capability.
More than 70% of patient treatment decisions are made through pathology. NSW Health pathology conduct over 61 million test activities each year. A lot of this testing is related to primary diagnoses. The clinicians in hospitals must have reliable access to pathology results in order to deliver necessary care to patients.
We also perform testing for private hospitals, for the primary care sector (General Practitioners) and for Specialists. That means we have to support many more destinations for the data because there are many distinct medical practices. We use a mixture of direct interfaces and data broker systems to provide that integration.
Can you tell us about ICT-related projects you are working on?
We have a large project roadmap with more than 50 projects. The main ones are around laboratory systems, billing systems and around what we call middleware (not middleware in the sense of IT), which consists of discipline-specific systems which exist between the laboratory instrument and the laboratory information system.
We are also working to provide pathology results to doctors on their mobile phones and tablets particularly outside of the hospital context.
As a subsidiary of NSW Health, we must work with both state-wide systems and a diverse set of Hospital-based systems across the organisation. NSW Health provides a platform for integration between those systems, and that platform is key to our ICT strategy.
Many of our projects require enhanced levels of integration, and sometimes integration outside of the NSW Health boundaries. We are providing a platform to complement the state integration platform, in order to enhance and build upon its functionality and extend Pathology’s integration capabilities.
Which upcoming ICT technologies in your view will have a transformative effect on healthcare?
We are a very technology rich business, with a lot of automation already in place. Even so, there is a lot of new innovation and even technology disruption going on.
Cloud is definitely a key area. We are leveraging cloud services for several projects. It changes the way we can deploy applications, and allows us to take a 2-speed approach to our IT. We can go beyond the large laboratory based systems that are critical for ongoing business, to provide add-on services more rapidly.
Cloud enables a new approach to projects, for example we can rapidly prove concepts with a “succeed or fail-fast” approach - quickly trying new things, and learning from them - regardless of success or failure. This is in contrast with the earlier situation where you make very large investments into adding functionality to core systems and then you find out you have to make even bigger investments to get it working.
What is your approach to data privacy and security?
We are the custodians of the data, not the owners. The patients own their data. The data must be accessible to their caregivers in the medical system.
All our data is subject to the State Records Act and the Health Records and Information Privacy Act and a number of other regulations. We have a whole compliance program ensuring that our storage and processing of data is compliant with those policies and acts.
Sometimes, the rules might be dealing with a general problem and not specifically our problem, like when technology moves ahead of the rules. This can result in ambiguities. For example, the rules around data retention in genomics, what you should keep and how long you should keep it can be complicated.
The whole genomics process is very data intensive. The initial sequencing on an instrument generates a large image. The image is digitally processed to create a genomics sequence and then those genomics sequences are stitched together by an algorithm in software. We then analyse the data to identify clinical information. At every stage in that process, there’s data generated. We have to take a position on how we classify that data. For example, we have to classify a large amount of data as working data, because it is not feasible to store it long-term. We are very careful, and must follow strict rules about how treat each type of data.
In some cases other business requirements like quality management might conflict with policies. For instance, we shouldn’t keep working data under the State Records Act but we sometimes need that data for quality checks on our instruments.
Aside from the privacy issues, we must ensure patient safety. Much of the risk is around patient identification and specimen chain of custody. Patients could be incorrectly diagnosed, and some errors in pathology data could have catastrophic consequences. We have many levels of automated and manual checking to minimise any chance of these errors occurring. Technology is a key component here – for example we make use of barcoding and scanning to ensure the right test is performed on the right specimen and the result sent to the right place.
So, there are a lot of checks and balances around our data, around how we store it. High risk processes may be data-driven and paper-driven in parallel to ensure that we avoid mistakes.
Can you talk about some technology areas in pathology and health which are witnessing significant growth?
We are seeing 300% rise in genomics testing, maybe even higher. It is admittedly off a small base but heavy investment will be required to keep up with the demands of the technology.
Normally, you would go through a process where the specimen is processed and examined by a trained team of scientists and doctors to make a diagnosis. In genomics in order to process that specimen, you need to bring data from sources outside of your business – for example, reference data from the web and other sources.
Genomics is all about analytics and algorithmic processing, taking reference data, getting knowledge from multiple sources, figuring out what that variation might mean and then putting together a diagnosis. It is a different way of providing care.
Another area is in miniaturization, which underpins point-of-care testing technologies. We operate one of the world’s largest point-of-care device networks across 175 emergency departments in NSW. The capabilities of these handheld instruments is growing every day, and we are seeing more and more demand for the service – both from within the hospital sector and outside, including mobile uses of the technology. This all must be delivered with appropriate management of the systems, sourcing of reagents, user training and quality controls. The results that are generated must also be handled like any other Pathology results and be available in the appropriate clinical systems.
Then there is telemedicine. A big opportunity for telemedicine in pathology is around the support of surgery. A pathologist might need to consult during surgery in a hospital. It is not always easy to have a pathologist on standby. To take an example, a surgeon might need us to check the surgical margin, to make sure that they excised the whole of a tumour. That service could be delivered via a telemedicine approach. We have a trial platform being installed right now, and are about to start designing and conducting some studies.