Scottish Pathology Network (SPAN) Progress Report Oct 2008 SPAN
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
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 5 1 1 2 1 1 2 1 1
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.
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
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
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 2003 10% 5.8% 5% 0% Overall Clinically Significant 0.5% 0.7% Benign to Malignant
E Health Pathalba Project Image sharing Development of synoptic reporting and links to SCI NCDDP
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
Pathalba Rapid review of Difficult colorectal polyps (integral to Bowel Screening QA) Lymphomas (accessing specialist pathology in local setting) Pathology EQA
Local/regional/national Multi Disciplinary Team Pathologist Monklands Pathologist Dundee Research/Education Database
SPAN Statistics Biopsy Activity 01 April 2007-31 March 2008 Region Requests Specimens Paraffin Blocks H&E Special Stains ICC Blank slides Molecular Pathology Ayrshire & Arran 20540 28550 56242 85855 10580 18262 0 0 Dumfries & Galloway 9851 12547 19614 33345 3641 11566 19502 0 Fife 18946 28384 49403 74776 5198 13384 844 0 Forth Valley 15571 23105 41276 45601 5989 5207 1400 Glasgow 66937 93799 215395 333809 27241 80860 97877 8748 Grampian 32992 46820 84713 84071 5335 27311 89420 0 Highland 15710 25204 37494 38062 2177 14120 45523 79 Lanarkshire 27408 34347 88785 123171 7878 29168 18911 0 Lothian 58337 90464 157271 178525 20719 57088 6068 0 Tayside 28467 40811 93832 123550 8800 30707 1897 Clyde Division 19086 26026 56753 98340 6760 10335 60637 Scotland 313845 450057 900778 1219105 104318 298008 342079 8827
Statistics Histopathology Biopsy Activity 1999-2008 1400000 1200000 1000000 800000 600000 1999 2008 400000 200000 0 Requests Specimens Blocks
Other examples of Redesign? Cervical Cytology and the likely impact to laboratory delivery
Cervical Cytology Laboratory Review Commissioned by Scottish Govt. Steering Group 1 st Meeting May 2007 5 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.
Cervical Cytology Laboratory Review Drivers Effect of technology including Imager Manpower planning Declining coverage Effect of HPV Vaccination Effect of HPV testing
Smears Processed 2002-2012?.. 500000 450000 471121 400000 350000 300000 250000 200000 150000 100000 401749 373000 373000 335700 298400? 50000 0 2002 2007 2008 2012
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
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
THINPREP PLATFORM Preparation ThinPrep 2000 Screening Image Processor Jane Doe 1234567 05/12/97 Review Scope ThinPrep 3000
Quality ThinPrep Plus Imaging increases the sensitivity of cytology Publication Increase in HSIL with ThinPrep Plus Imaging Roberts et al 2006 22% Miller et al 2007 42% Lozano et al 2006 38% Davey et al 2007 15% Chivukula et al 2007 13%
Feasibility Study - Oct 2008 Feasibility Cohorts: 3: Aberdeen R.I. 11 5: Ninewells 11: Raigmore 5 3 4. Glasgow RI 7: Southern General 10: Inverclyde 10 4 7
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
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
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
Poster Nov 08 Networks Meeting