What is MedLIS?
In Ireland, more than 80 million laboratory tests are processed annually by 43 Health Services Executive (HSE) funded hospital laboratories. There are multiple laboratory information systems across the 43 hospitals with little or no inter-laboratory data sharing and electronic ordering of laboratory tests is very limited. Until recently, investment in healthcare ICT in Ireland has been completely inadequate and the majority of laboratory systems were originally installed between 1989 and 1999. Some of these systems have been maintained and upgraded but others are based on outmoded technology and are no longer capable of facilitating the requirements of modern laboratory medicine practice. The National MedLIS Programme will deliver a single national standardised laboratory information system replacing the multiple systems currently in use.
The strategic goal is: “To ensure patients’ healthcare providers have rapid 24-hour access to complete and up-to-date accurate laboratory data across all sites”. This means every result on a patient, irrespective of where the test was performed, should be viewable to healthcare providers who are entitled to legitimate access. Access to patient information will be in accordance with data protection guidelines and will be fully auditable.
The MedLIS programme will create an integrated nationwide laboratory information system that will improve the delivery of diagnostic laboratory medicine, healthcare quality, efficiency and outcomes for a population of 4.2 million. All major laboratory disciplines are included in the scope. Changes in hospital and HSE governance are expected during the lifetime of the MedLIS project and the project has been structured to accommodate these changes as far as possible and to allow for flexibility in this regard e.g. the number of laboratories may change. The success of the separate laboratory modernisation programme is dependent on having upgraded laboratory ICT. Dr Mary Keogan, National Clinical Pathology Programme Lead, recently described the MedLIS programme as the “chance of a lifetime” to implement changes on a standardised and national footing.
Project structure and governance
MedLIS is a designated eHealth priority project. We have found that the highest level of management support is required to drive large and complex national projects. The governance structure is designed to ensure all relevant stakeholders are represented on steering boards and within the project. The MedLIS Steering Board is chaired by Stephen Mulvany, Deputy Director General HSE & Chief Financial Officer, and the members include Senior HSE Management, Laboratory Managers, Faculty nominated Hospital Consultants (Lab & Non Lab), Laboratory Modernisation Programme, HSE Clinical Pathology Programme lead, General Practice IT, HSE ICT and HSE procurement. The project is one of the first ICT projects to be clinically led. Dr Miriam Griffin, Consultant Histopathologist and Cytopathologist is Programme Manager and Clinical Director.
The National Project Team, who are entrusted with day-to-day delivery of the project, are the key to the project’s success and consist of senior scientists and biochemists, all nominated and approved by the national Laboratory Managers group. Their standing within the scientist and laboratory community and ability to facilitate the necessary consultations to allow consensus on national and local standards is integral to the success of the project. The project team also includes ICT specialists, essential for all the complex integration, networking and messaging requirements which underpin modern technology and ensure smooth information transfer across numerous internal clinical and external national information systems. These team lead out on multiple workstreams.
Roll-out to hospitals will be in five phases with multiple hospitals going live in each phase. The project is in phase one and is currently finalising the national standard build with a view to integration testing over the coming months. The first phase is the longest and incorporates a pilot group of hospitals, with subsequent ‘go lives’ in those hospitals prioritised as having the greatest need for replacement information systems. Order Communications for GPs and external users will be rolled out in parallel with their local hospitals. It is expected that the project will be complete in Q1 2020. Despite initial project delays, the project does not intend to decrease the scope as the business benefits will only be met if there is full uptake of the multiple clinical, logistic and outreach solutions.
The scope of the MedLIS project incorporates all of the 43 HSE-funded hospital laboratories in the health system. Private hospital laboratories are out of scope. Order Communications modules involve all clinical users i.e. every healthcare provider that requests or reviews laboratory tests in hospitals and in the community setting e.g. GPs, nursing homes, healthcare clinics. There are an estimated 10,000-plus users in phase one of the project, made up of over 1,100 laboratory-based users and 9,000 hospital doctors, nurses, GPs, etc. Cerner consider the MedLIS project to be the largest of its kind in Europe.
What’s included in MedLIS?
Cerner’s Millennium Pathnet, Powerchart Orders and Powerchart Ambulatory form the basis of MedLIS and contracts were signed in September 2015. The deployment model is a single national system based on a central single instance of the software and database. This model will facilitate a single national laboratory record and end-to-end connectivity, thereby ensuring that clinicians have real-time access to the full laboratory diagnostic data on each patient irrespective of where the patient is located and where the patient’s tests were carried out.
The first stage of the project is to produce a national standard system, so that there will be only minor local configuration changes required after the first phase. The project team discipline leads have been supported in this gargantuan task by over 80 consultant and scientist subject matter experts from across the country. This wide consultation process has resulted in consensus on many issues. The availability of the National Laboratory Medicine Catalogue was very helpful as a guide. However, some perennial thorny problems continue to be worked on e.g. what constitutes a “profile” still hasn’t been resolved in some cases. But the MedLIS team believe that the provision of a national system with national standard information will pave the way for these to be eventually put in place and there is a clear imperative on the Irish laboratory community to provide harmonisation, where possible. MedLIS are committed to continue working in conjunction with the HSE National Clinical Pathology Programme to achieve this.
A major MedLIS innovation is the inclusion of Order Communications, resulting and reporting for all users within hospitals and for the wider community of laboratory test users, particularly GPs. This is hugely significant and will greatly facilitate the roll-out of positive patient identification for laboratory specimens. The scope of the project is truly national as it will impact every patient, doctor, nurse and other healthcare provider who requires laboratory test data. Electronic order communications will also allow us to jump ahead with implementation of nationally approved care sets and rules-based demand management guidelines available at the point of ordering. Patients’ healthcare providers will have 24/7 access to the patients’ complete and up-to-date laboratory electronic records across all sites. This will be available on fixed and mobile devices in line with clinical need and data protection requirements.
Laboratory core and specialist functionality with decision logic support capability is provided through the PathNet suite of applications with ancillary functions provided through additional modules. There is a full audit trail. Legacy data will be stored in a central database with context sensitive access from MedLIS. There will be 24/7/365 support, data back-up and a robust disaster recovery solution. MedLIS includes an Outreach communications and logistics module to facilitate other relevant healthcare providers e.g. GPs, offsite clinics and nursing homes. MedLIS will have a comprehensive helpdesk and information structure with a first line helpdesk dedicated to laboratory users, Application Managed Services as well as an online eService portal and an online resource hosting eLearning solutions specific to the MedLIS programme. There is a comprehensive integrated report writer. MedLIS expects to implement a single sign-on module that will allow rapid access to the MedLIS system for laboratory users. We hope to work with other eHealth projects to provide patient access to their own data via a secure patient portal.
What are the expected benefits?
The successful implementation of the new National Medical Laboratory Information System across the laboratories will deliver significant benefits for both the patient and the organisations concerned, with potential for exchequer benefits. These include improved quality of patient care, timeliness of service (faster turnaround of laboratory results), security and availability of patient information, standardisation and support for accreditation, ability to support increasing workload, and reduced incidence of unnecessary repeat tests and risk of litigation. There will be a national standard build agreed as part of the project with a high (over 80%) standardisation across all sites. The successful system will allow for laboratory information to be shared with relevant healthcare providers in line with clinical need and data protection requirements. Access to this information will be governed by a robust control system that will ensure access is only available for legitimate reasons.
- Single national electronic laboratory record
- Greater access to patient laboratory results
- Reduction in laboratory test duplication
- Faster throughput in laboratories with Analyser ready labels for specimens
- Reduction in manual data entry and associated with sample and test result handling
- Reduced maintenance costs
- Modernisation with integration of national care sets and usage guidelines
- Robust database security and back up eliminating loss of patient data
- Improved management through the production of integrated standardized management information reports
- Integrated reports incorporating molecular diagnostics
Dr Miriam Griffin
Consultant Histopathologist & Cytopathologist
National Clinical Director & Project Manager MedLIS Programme