The purpose of this consultation is to gain feedback on a proposed new standard for the way that information for pathology test requests, results and reports should be structured, recorded and shared.

Background

Pathology services are fundamental to healthcare, providing diagnosis, monitoring treatment and disease progression/development. Pathology tests are the laboratory examination of samples of bodily fluids, cells and tissue for diagnostic or forensic purposes. The tests are usually analysed and reported by laboratory scientists and physicians.

Currently there is little consistency in how information is shared across pathology. This adversely impacts communications between laboratories and clinicians and can have patient safety implications. The code systems (identifiers & names of tests) used in pathology are outdated and no longer suitable to hold the quality and quantity of the healthcare information required for current best practice. A range of different coding schemes are used in General Practice, in hospitals and laboratories making it difficult to share and interpret the information consistently. In addition, there are issues in how units of measurements (e.g. milligrams, centimetres, etc) are associated with results, giving rise to safety risks with results from different laboratories not being easily comparable.

This consultation is part of the work of the Professional Record Standards Body (PRSB) to assure the standard and the approach being taken. The consultation is aimed at patients whose samples may be tested and who may wish to access their own results, clinicians who request and use pathology test results for treatment of their patients, and for laboratory scientists and physicians who perform the tests and report on their findings.

Development and assurance of the standard

A proposed new pathology testing standard has been drafted by NHS Digital for PRSB assurance, consisting of an information model that defines the structure and content of information that should be held for pathology tests.

In future the terminology that will be used to record individual test codes within the model will be SNOMED CT (an internationally recognised clinical health terminology). In due course this will supersede all coding systems currently used for pathology tests in England. This new standard based on SNOMED CT is initially being tested based on blood sciences (incorporating chemical pathology, haematology and immunology). A team of pathologists and terminology experts have mapped the top 350 codes for blood tests to the new SNOMED codes to test the effectiveness of the new model. These initial codes and the approach for creating them have been shared with leading NHS trusts and hospitals as part of the development process. Other disciplines and types of pathology test will be tested in due course. It is assumed that the model and approach will work equally well with other categories of pathology test.

NHS Digital has already conducted an extensive consultation on the units of measure associated with pathology tests. Due to the complex nature of the standard being created and expertise required, this information model is being assured by a group of expert clinical informaticians.

However, for those who wish to see the detail there is high level diagram supporting the information model. Technical details about the code lists, units of measure and other aspects of the standard are available here.

What is different about the new standard?

The new standard enables the requestor to unambiguously specify the test being requested and consistently communicate the results/reports in all clinical setting (e.g. primary care, secondary care or labs). This will also enable more accurate reporting of abnormal as against normal results and more relevant interpretation in reports. Ensuring results are available in all clinical settings will reduce the need for repeating a test that already been performed elsewhere. This new standard will be based on international standards (SNOMED CT and HL7 FHIR), which ensures that we follow international guidance.

Using a standard coding structure (SNOMED CT) for pathology tests and being able to code the clinical need, also using SNOMED, will allow systems to insert relevant information automatically from the coded record e.g. the target HbA1c blood sugar level for diabetics agreed between the patient and their doctor. Using a standardised coding structure for all elements of the request-result cycle will enable enhanced clinical decision support. This approach is also being used in other healthcare settings as part of the move towards using SNOMED for all aspects of healthcare information.

Grouped results could be reported together (e.g. glucose tolerance tests), enabling doctors and patients to understand the sequence of results more clearly as they can then be displayed in a series, or as a graph.

The new standard will also enable non-numerical value results to be standardised and received as coded information (e.g. the presence or absence of an antigen).

Received test results will be more easily linked to the test request to enable better reconciliation. The new standard also enables the requester to specify the clinical need as well as the required tests, e.g. “clinical need: Primary biliary cholangitis, test request: Liver function tests” and supporting information so the laboratory can determine and perform the appropriate tests, lessening the need for re-ordering to ensure the appropriate test is done or if further tests are required.

The standard includes the opportunity for inclusion of commentary on the results and information for patients through links to supporting information to support sharing of accessible and understandable information with patients on their own test results.

Tell us your views

Whether you are a patient or carer, a clinician requesting tests and receiving results or a lab receiving test requests and sending results, your input is very important to us. We would like to invite you to participate in this consultation which aims to:

• inform our work;
• provide your views on the suitability and completeness of the proposed standard to meet your needs (and its generalisability to other types of pathology test)
• provide feedback on whether you think the proposed approach is safe and implementable

Please answer the survey questions by 21 March 2019.

If you have any further comments on the standard or other aspects of our work, please contact us via support@theprsb.org