NIPACS, Northern Ireland
The NIPACS+ Programme, commissioned by DHCNI, in Northern Ireland represents a pioneering effort to bring digital innovation to the field of pathology in the region, which performs around 40 million diagnostic tests each year. The Programme was delivered by Business Services Organisation, Directorate of Digital, and this case study explores the journey from initial challenges to successful implementation, highlighting the strategic planning, collaborative efforts, and technological advancements that made it possible. By integrating Sectra Digital Pathology, NIPACS+ has streamlined workflows and enhanced collaboration between pathologists in the region, enabling them to seamlessly execute all tasks within a single application—including case allocation and reporting.
The traditional glass workflows used in pathology laboratories are labor intensive and the prevailing assumption is that there is a natural ceiling when it comes to optimizing end-to-end workflows. Pathologists in Northern Ireland relied heavily on physical slides, which posed several challenges. Dr. Clinton Boyd, Clinical Lead Pathologist at the Belfast Trust, recalls that the traditional process was cumbersome and limited their ability to work efficiently. They needed a solution to streamline the workflow and improve their diagnostic capabilities.
Dr. Boyd explains that the inefficiency of the old workflow was a major barrier. Manual handling of glass slides not only took considerable time but also increased the risk of errors and slide damage. Storage was another significant issue. Large volumes of slides required substantial physical space, which made retrieval difficult and slow.
Limited access to physical slides also restricted opportunities for consultation and second opinions. “Sharing physical slides across sites for second opinions presented logistical issues. It slowed us down and delayed critical diagnoses or discussions of patients at multidisciplinary meetings,” says Dr. Paul Kelly, Pathologist and co-clinical lead for the initiative at Belfast Health and Social Care Trust’s Royal Victoria Hospital.
In 2018, Stephen Hillocks, Senior Project Manager, joined the NIPACS team with a mandate to introduce the digital pathology project. His early efforts focused on drafting the necessary addendums to the existing NIPACS business case, which included provisioning for the additional technology partners necessary for the project.
By June 2020, Laura Molloy, Senior Project Manager, had joined the effort to oversee the implementation phase. Her role was crucial in transitioning from planning to execution. “We started with a strong foundation and a clear vision of integrating digital pathology seamlessly into our existing systems,” she says.
I think the fact that you can move to the radiology and pathology images together is a massive thing and that’s one of the big benefits that our pathologists always talk about. Being able to bring in those two ologies on one system was absolutely fantastic
The deployment of digital pathology was fraught with challenges. Molloy described the process as “incredibly complex,” involving multiple integrations. It also faced considerable resistance from some stakeholders, who really didn’t want to change.
The project was managed like a change project, since technical integration created significant hurdles. The team had to deploy 16 WSI scanners and integrate them with an outdated lab system. “Some of our sites couldn’t produce barcodes, requiring a separate project to address this issue,” she notes.
Additionally, resistance from certain individuals within the system added to the complexity. To address this, Hillocks initiated activities such as roadshows and a regional symposium to try to get people on board and win hearts and minds. “I think it was extra difficult for us, because we did not have lessons learned from similar projects and no other site to reference to ‘go look how well this is working here,’” says Molloy.
What they did have, however, was some key advocates for the digital pathology project. “We had really good champions for digital pathology located at various sites, including experts in biomedical science, pathology and clinical administration,” explains Molloy. Their role was to promote the project locally, working closely with their colleagues to address concerns and build support. “They helped fight the good fight,” she adds.
The collaboration with Sectra was also instrumental in overcoming these challenges. “Sectra’s flexibility and willingness to adapt to our specific workflow needs were critical. They were always responsive and willing to make necessary adjustments,” Hillocks emphasizes. “It was those good relationships that were formed that really helped us in the end,” adds Molloy.
Sectra’s flexibility and willingness to adapt to our specific workflow needs were critical. They were always responsive and willing to make necessary adjustments
It was those good relationships that were formed that really helped us in the end
Dr. Boyd points out that while the digital images were “good enough” compared with traditional microscopy, the real advantages lay in improved workflows and collaborative opportunities. “The quality of MDT (multidisciplinary team) reviews has improved because the images are immediately available,” he says, underscoring the enhanced efficiency in diagnosis and teaching.
Dr. Kelly shares an example: “Just this morning, I received a message from a pathologist in another lab in Northern Ireland asking for my opinion on a case. I was able to look at it and provide my thoughts within minutes. In the past, he would have had to send the package to me, perhaps send more tissue samples and additional stains, and receive an answer weeks later. Now, we can do it in two or three minutes. That’s what really matters for the patient.”
Both Dr. Boyd and Dr. Kelly highlight the non-quantifiable benefits of digital pathology, such as improved teaching tools and the ability to consult with colleagues quickly. “It takes about 10% of the time to prepare pathology lectures now compared with before,” Dr. Boyd notes.
Moreover, the flexibility offered by digital pathology has encouraged senior pathologists to continue part-time, thereby maintaining indispensable expertise within the system. “Digital pathology has allowed more senior pathologists to stay on part-time, which means we retain their valuable experience,” Dr. Kelly says.
Robbie Wilson, Discipline Manager for the Institute of Pathology at the Belfast Health and Social Care Trust, says that digitizing the pathology workflow has led to significant improvements in time management and operational efficiency, with a live overview dashboard of all cases and reporting status. “Granular information across specialties is completely changing our turnaround time analysis, with the potential to set more accurate expectations for clinicians and patients in terms of when they will get results. We can more easily identify and flag routine and urgent cases,” he says.
Just this morning, I received a message from a pathologist in another lab in Northern Ireland asking for my opinion on a case. I was able to look at it and provide my thoughts within minutes. In the past, he would have had to send the package to me, perhaps send more tissue samples and additional stains, and receive an answer weeks later. Now, we can do it in two or three minutes. That’s what really matters for the patient
Granular information across specialties is completely changing our turnaround time analysis, with the potential to set more accurate expectations for clinicians and patients in terms of when they will get results. We can more easily identify and flag routine and urgent cases
Dr. Kelly had often told the Sectra development team that their system wasn’t customizable enough. As a result of those discussions, there is a new update coming up this autumn with three new layout options, directly addressing his feedback. He was pleasantly surprised: “They really listened to us and made the changes. I didn’t expect such a big company to respond so effectively.”
“We have seen a demo recently, and it looks good,” adds Dr. Boyd. He then explains that the difference is that in digital pathology, unlike radiology with its static images, the process starts with base images and further tests might be added later, creating new images before reporting a case.
“We often have to make requests for further work within some sort of system, not necessarily within PACS, but we add in why I require additional tests A, B and C, which converts into the hands of the biomedical scientists and then they perform the tests. Then the sections are created, and scans are uploaded in the Sectra PACS. So obviously you’d want to have everything in one system if you possibly could. And Sectra are working hard to create the ability for us to have one integrated system that can do everything, so the pathologist never has to switch between different systems. Unlike many commercial companies, Sectra really listened to us and created an integrated system that meets the needs of pathologists.”
When asked about the lessons learned and recommendations for those considering moving to digital pathology, Molloy and Hillocks mention the importance of including skeptics in the project team. Molloy emphasizes: “Including skeptics ensures they feel involved and reduces the chances of encountering resistance later on.”
Additionally, Hillocks highlights the need for comprehensive representation from all impacted areas to address potential issues proactively. “We had a small team to start, which was overwhelming. Having a representative from each impacted area would have been beneficial,” he says.
From a pathologist’s perspective, Dr. Boyd adds: “Digital isn’t going away for all the quality reasons we talked about before. So, if you’re starting off in your career or even halfway through, you need to get on board because you’re going to be forced at some point to report in digital pathology. So, you might as well get in now and try to influence things.”
Looking forward, Dr. Kelly believes in the potential of AI to enhance pathology workflows. He sees a place for AI in triaging workloads by applying algorithms to identify higher-risk cases needing urgent reporting. This approach would go beyond merely prioritizing cases labeled as urgent and extend to all cases within certain specialties, streamlining the process by highlighting those cases that require quicker attention.
Dr. Kelly advocates for an automated system to assign cases to pathologists based on specific parameters, improving overall efficiency and workflow. He also emphasizes the importance of integrating multiple AI systems into one comprehensive system to reduce complexity. “Reducing integrations means fewer people are needed to maintain the system,” he points out. “While there is a risk in relying entirely on an IT system, ensuring its robustness can mitigate this, ultimately simplifying our processes and improving reliability.”
The NIPACS+ digital pathology project is a game-changer, proving just how much strategic IT can reshape clinical work. Thanks to ongoing teamwork and flexibility, the future of digital pathology looks set to deliver better precision, efficiency, and patient care. “We’ve done it now, and we’re immensely pleased with the results. There’s definitely no going back,” Dr. Boyd concludes, echoing the excitement of everyone who’s been part of this transformative project.
We’ve done it now, and we’re immensely pleased with the results. There’s definitely no going back
About Business Services Organisation (BSO)
The Business Services Organisation was established to provide a broad range of regional business support functions and specialist professional services to the health and social care sector in Northern Ireland. Part of this business support includes the management of Health and Social Care Programmes and Projects such as NIPACS+ and Digital Pathology.
About NIPACS+
Northern Ireland has six HSC Trusts, five of which produce imaging: the Belfast, South Eastern, Western, Southern and Northern Trusts. These Trusts provide a wide range of integrated health and social care services for a population of 1.9 million covering a geographical area of 14,000km2 Imaging Services are vital in the provision of modern healthcare in Northern Ireland. There are more than 2 million radiology examinations carried out by HSCNI annually.
The original Northern Ireland Picture Archiving and Communications System (NIPACS) contract was awarded to Sectra UK Ltd in 2008. This solution includes a RIS, PACS and VNA. It currently stores and provides access on a single enterprise solution to the following specialty types: radiology, digital pathology, cardiology, dental, obstetrics, endoscopy, ophthalmology and medical photography.
