Pandemic Pathology

We asked pathologists and laboratory medicine professionals to tell us how their professional and personal lives have changed during the COVID-19 pandemic.

Simon Hurst, Chief Commercial Officer at CliniSys Solutions, Chertsey, UK

Before the pandemic, our focus was to support the formation and delivery of pathology networks across NHS England as part of the national consolidation program (1). Having kept a close eye on the developing COVID-19 crisis since January, we decided – about three weeks before lockdown was announced – to ask our teams to fully implement remote working. The business had already adopted remote working tools, so it was easy for the teams to continue collaborating and delivering services to customers. Those who delivered services on customer sites have adapted, along with customers, to virtual deployment models.

At the same time, our immediate focus switched to the review and preparation of laboratory IT systems and services to support customers with their management of the crisis. Our systems support approximately half of all laboratories in the UK and handle 70–80 percent of laboratory investigation orders via our communication systems. A key part of our goal was to ensure that the government’s COVID-19 initiatives and local requirements could be seamlessly supported so that customers saw no change in service. To stay abreast of labs’ rapidly changing requirements, we collaborated closely with customers and key diagnostics advisors and kept up to date with daily briefings.

With about half of routine NHS laboratory volumes coming from primary care, pathology in general saw a dramatic reduction in samples overnight as lockdown was announced. With routine elective surgeries also canceled, some areas of pathology found their workloads significantly reduced. Not all departments saw the same effect, though – and microbiology and virology departments in particular became a pressure point.

The onslaught of new polymerase chain reaction (PCR) tests and reagents meant that we had to rapidly support the implementation of new techniques, instruments, and workflows. In short, we had to develop interfaces for novel lab analyzers and build new workflows and automated result texting solutions into our order communications and result reporting solution. The requirements frequently changed in line with evolving government demands – and between that and the flood of requests from customers and partners to support new IT solutions, we decided to set up a dedicated COVID-19 task force to address the pandemic’s unique needs. By adapting our usual processes and starting new projects at risk, we were able to massively accelerate our normal timelines. What would typically take three to six months was delivered in weeks – for instance, transitioning every NHS trust in England to the National Pathology Exchange (NPEx) to electronically transfer COVID-19 test requests and results.

Pathology and the pandemic

The pathology industry has a newfound agility, responding to requests and implementing go-lives remotely at lightning speed. In the coming months, healthcare IT suppliers will review how the sector can ensure that the NHS maintains this approach to innovation not just in exceptional circumstances, but routinely. Since the start of the pandemic, we have installed 47 new lab-to-lab interfaces, 71 PCR analyzer interfaces specifically for COVID-19 demands, 38 integrated point-of-care interfaces, system interoperability support for four Nightingale emergency hospitals, and support for multiple popup Intensive Treatment Units. The extraordinary speed of development and deployment has been evident at a more local level too; for instance, we created a solution that allows hospitals to text negative COVID-19 test results to NHS hospital staff.

In the past, innovation and speed of delivery have not always been aligned. In the rush to respond to the pandemic, some central decisions did not consider the end-to-end clinical digital pathway. The COVID-19 crisis has the potential to bring about effective, rational, long-term change – and it’s our job to ensure that happens. By investing in first-class NHS pathology services, we’ll be able to use and build on existing systems to support digital health.

With respect to future pandemics, we have to hope for the best, but plan for the worst by drawing on the lessons learned from this one. A strong option in the future could be a national model for pandemic testing that draws on our NHS pathology services and also on existing screening programs (such as human papillomavirus or bowel cancer) that were successfully centralized. We could also learn more about enhancing the IT management aspect of testing and reporting – can we increase testing capacity and reduce unnecessary labor-intensive activity? And if so, what improvements can we implement on a national scale?

The future of testing

An emerging focus for development is the environment in which clinical testing is performed – and the potential for patient choice. During the pandemic, primary care delivery has been transformed, with GP practices providing remote consultations by phone or video. Could this approach be further developed for patients who want to choose how and where their blood is drawn? Wouldn’t it be ideal to enrich the patient experience by giving them the ability to view their test results when they seek out health advice?

Going forward, we will see greater levels of home and community testing. Building on COVID-19 swab testing for antigens, other tests and screening programs will be ordered online and performed at convenient locations for patients. We currently do this for sexually transmitted infections; there’s no reason it couldn’t be extended to not just other infectious diseases, but also other common lab tests. The need for rapid IT solutions during the crisis has accelerated healthcare digitization. The NHS and its suppliers can look at what has been achieved and ask, “Why can’t we do this routinely?” As a result, the quality of standards will come under scrutiny. With careful review, we can determine which standards are necessary for safety – and which are only slowing us down.

To improve service delivery, we should consider centralizing data analytics to enable service remodeling and faster benchmarking. With the availability of larger national datasets in real time, we could provide an on-demand picture of trends in infection control rates, numbers of tests, positive results, demographic data, and more.

COVID-19 has fundamentally changed many aspects of our lives – and this is no less true in the laboratory. The speed of digital adoption is increasing. Is this the death of the paper-based system? Perhaps – and I, for one, am looking forward to what comes next.