Scottish Pathology Network (SPAN) Progress Report Oct 2008

Transcription

1 Scottish Pathology Network (SPAN) Progress Report Oct 2008 SPAN

2 SPAN Pathology configuration in Scotland Operation of the network Context (diagnostics in Scotland) Common challenges Concerted responses 2 examples of function Electronic image sharing Review of provision of cervical cancer screening

3 Current Pathology Structure Lothian R.I.E WGH Lanarkshire Wishaw Monklands Grampian. Glasgow & Clyde 1 G.R.I. SGH WGH Inverclyde Cyto RAH Paisley Histo Tayside Ayrshire & Arran Forth Valley Fife Highland Dumfries and Galloway

4 SPAN Representative of all NHS Boards Linked to Health Dept Scottish Cancer Group Centre for communication /Website Steering Group Other groups GI Group Head Biomedical Scientist Group Benchmarking Group Lymphoma Group Etc.

5 Diagnostics in Scotland (Better Health Better Care) Diagnostics Steering Group Emerging imaging network Emerging laboratory medicine network 18 Week RTT Molecular Diagnostics A major issue for cancer Her-2 in breast cancer K-ras in bowel and lung cancer Links with cancer and other networks

6 Specialisation Loved by user clinicians (dermatologists, haematologists, renal etc) Mixed views in Pathology (and a mixed picture across Scotland) MDT working A big workload issue Specialist EQA a requirement in some areas (breast screening) coming in others (bowel screening) Solutions Limited specialisation Devolving specialist work Networking (North and East lymphoma group) Moving to regional clinical teams with rationalisation/development of MDT meetings

7 Specialisation in Coventry: Skin Cases Reviewed at MDM: Overall Discrepancy Rate and Clinical Significance (%) 30% 25% 27.3% 20% 15% 14.1% 12.5% Pre Aug 2003 Post Aug % 5.8% 5% 0% Overall Clinically Significant 0.5% 0.7% Benign to Malignant

8 E Health Pathalba Project Image sharing Development of synoptic reporting and links to SCI NCDDP

9 Pathalba Project Plan Phase 1 Camera access for digital images across Scotland 90 installations Delivered 2007 Phase 2 Assessment of electronic structured reporting Assessment of high resolution slide scanning use

10 Pathalba Rapid review of Difficult colorectal polyps (integral to Bowel Screening QA) Lymphomas (accessing specialist pathology in local setting) Pathology EQA

11 Local/regional/national Multi Disciplinary Team Pathologist Monklands Pathologist Dundee Research/Education Database

12 SPAN Statistics Biopsy Activity 01 April March 2008 Region Requests Specimens Paraffin Blocks H&E Special Stains ICC Blank slides Molecular Pathology Ayrshire & Arran Dumfries & Galloway Fife Forth Valley Glasgow Grampian Highland Lanarkshire Lothian Tayside Clyde Division Scotland

13 Statistics Histopathology Biopsy Activity Requests Specimens Blocks

14 Other examples of Redesign? Cervical Cytology and the likely impact to laboratory delivery

15 Cervical Cytology Laboratory Review Commissioned by Scottish Govt. Steering Group 1 st Meeting May Meetings to October 2008 Chair John Burns Remit To oversee the review of provision of laboratory services for the Cervical Cancer Screening Programme and to provide a report with recommendations for the future to NHS Scotland and the Scottish Government.

16 Cervical Cytology Laboratory Review Drivers Effect of technology including Imager Manpower planning Declining coverage Effect of HPV Vaccination Effect of HPV testing

17 Smears Processed ? ?

18 Cervical Cytology Laboratory Review Decision to look in depth at the national options for delivery Tribal Consultants Appointed May 2008 Benefit criteria identified Options Status Quo through single/multicentre, networking etc Due to report 2009

19 Cervical Cytology Option Appraisal Process (Tribal) Develop Benefit Criteria Assure, Rank & Weight Benefit Criteria Agree and Define Options Score Options Against Criteria 4 Focus Groups Aug / Sept 2008 Review Group October 2008 Review Group Nov to Jan 2009 Review Group & Focus Groups Representative(s) February 2009 Full Option Appraisal

20 THINPREP PLATFORM Preparation ThinPrep 2000 Screening Image Processor Jane Doe /12/97 Review Scope ThinPrep 3000

21 Quality ThinPrep Plus Imaging increases the sensitivity of cytology Publication Increase in HSIL with ThinPrep Plus Imaging Roberts et al % Miller et al % Lozano et al % Davey et al % Chivukula et al %

22 Feasibility Study - Oct 2008 Feasibility Cohorts: 3: Aberdeen R.I. 11 5: Ninewells 11: Raigmore Glasgow RI 7: Southern General 10: Inverclyde

23 Imager Feasibility Study Workflow GP/Clinic Sources Lab 1 Viewer (V) Recorded in SCCRS Stained, labelled etc. Lab 1 (V) Slides and CD received Slides screened with viewer, reported GP/Clinic Sources Lab 2 Imager and Viewer (I&V) Recorded in SCCRS Stained, labelled etc Lab 2 (I&V) Own slides imaged Lab 1 & 3 Slides Imaged & Returned Lab 2 (V) Slides screened with viewer, reported Final reports issued through SCCRS Outcomes reviewed by Feasibility Steering Group GP/Clinic Sources Lab 3 Viewer (V) Recorded in SCCRS Stained, Labelled etc Lab 3 (V) Slides and CD Received Slides screened with viewer, reported

24 Imager Feasibility Project Timelines Stage Timeline Scoping of Feasibility Study December 2007 OJEU for procurement of Imaging System March 2008 Project Manager Specification/AFC Grading/Advert May 2008 Project Initiation Document May 2008 Contract Award for Imager Feasibility Study June 2008 Detailed specification of protocols June 2008 Project Manager Appointment June 2008 Staining machine delivery, stain conversion and validation Jun - Aug 2008 Imager delivery and placement Aug Sep 2008 Review of initial process October 2008 Completion of practical element March/April 2009 Delivery of draft report to Feasibility group May 2009 Final report to review group June/July 2009

25 Where next? Continue current work Admin base, Steering group website etc. E Health Pathalba, NCDDP, Genetics E Health Cervical review and feasibility study. Work with national initiatives 18 week RTT Encourage and help - Imaging develop emerging MDN s Clinical Biochemistry Microbiology Molecular pathology Implementation of cervical review outcomes

26 Poster Nov 08 Networks Meeting