NPEx: A National Scale Solution for the COVID-19 Crisis

NHS England and Improvement and NHS X have issued a ‘National Adoption Directive’ which mandates that all English NHS Trusts are to use NPEx to electronically transfer send-away test requests and results for COVID-19. The directive, which means all English NHS Trusts currently without an NPEx connection will implement in an intensive two-week national scale project, will see NPEx coverage in England soar from 75% to 100%. Alongside onboarding 47 new NHS Trusts, the project instructs all laboratories which are connected to NPEx to ensure they are ‘Live’ for digital referring and/or reporting for COVID-19 through NPEx.

During a ‘Digital Responses to Covid-19 Briefing and Q&A With NHSX’, hosted by Digital Health News, Dr Simon Eccles, who is the Chief Clinical Information Officer for Health and Care (a role which spans across the Department for Health and Social Care and NHS England and Improvement) and the deputy CEO of NHSX, stated that:
‘We need a centralised system. And what we need is the absolute clarity on the interoperability of this. […] We are mandating NPEx, the National Pathology Exchange system, for every lab doing COVID tests in the fastest possible time frame in order to gain that degree of interoperability.’

As part of the mandate, the NPEx team will be reporting directly to the NHS to aid their response to the COVID-19 outbreak in England. Having 100% of English NHS laboratories using the system will allow NPEx to record test volumes; the positive/negative breakdown of these volumes; information about overall requests and reports to measure testing lags; and individual laboratory level data to provide insight into capacity. NPEx as a ‘centralised hub’ opens access to capacity through interoperability. This intelligence is the result of a robust infrastructure which will endure beyond the COVID-19 crisis and continue to provide national and laboratory-level benefits for a full range of diagnostic disciplines.

At a laboratory level, NPEx uplifts capacity by removing unnecessary manual processes, and the associated risk of transcription errors, from referrals and reports. This, in turn, allows staff to focus on testing capacity which will enable volume increases. NPEx’s automated, digital workflow also reduces the time it takes to refer a test and receive the result which minimises turnaround times and ensures clinicians have access to results in less than 24 hours of them being generated. Fast, accurate and efficiently returned results will help stem the spread of the virus if patients are able to enforce isolation measures more quickly and allow healthy people to return to work sooner.

NPEx is a key enabler for the government’s drive to provide COVID-19 testing for frontline NHS workers. The NPEx team are working alongside Amazon, Deloitte, Thermo Fisher Scientific, Boots, Royal Mail, Randox, the Wellcome Trust and top UK universities to provide an integrated solution for frontline and key-worker testing home and drive-through testing. NPEx manages the clinical reporting of these tests by securely and accurately tracking their arrival at the laboratory, linking them into the NPEx central record, and ensuring results can flow onto the reporting bodies quickly. When the results have been generated, they are sent through NPEx to the NHS Business Services Authority who text results to frontline workers. This programme of work has the potential to save the UK £9.4 million per day in unnecessary sick pay for the estimated 100,000 people who are self- isolating with symptoms who are negative for COVID-19.

After just a week’s engagement with NHSX, the NPEx team had the project moving at speed to deliver each work package. A regular NPEx deployment takes around two to six months, however the project aims to have the unconnected labs live for COVID-19 testing within two weeks of their project kick-off. This has required the NPEx team to work closely with stakeholders, such as LIMS suppliers, to ensure the participating laboratories are ready to commence deployment.

Mat Barrow, the Managing Director of X-Lab, said:
‘The entire NPEx team, across X-Lab and The Health Informatics Service have worked tirelessly and done an amazing job to mobilise and connect so many labs in record time under such difficult working conditions. The feedback from sites has been extremely positive, with many already seeing the value to their patients and staff that the rapid turnaround of COVID-19 results delivers. We are proud and honoured to be able to contribute to the international effort to defeat COVID-19.’

Having successfully delivered a national scale deployment across NHS Scotland in the last 18 months, the NPEx team was equipped to provide a fast-paced and intensive implementation in a time of national crisis. In the last month alone, COVID-19 requests through NPEx have increased by 25 times and, on average, four new laboratories are going ‘Live’ with COVID-19 digital requesting and reporting each day. Laboratories which are joining a network of NHS Trusts, PHE laboratories (including Colindale and Manchester), private laboratories, and overseas laboratories that will stand 170 strong by the end of the NHS directed project.