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NSW Health Pathology helping transform medical testing and patient care with cloud, data and AI

Anyone who has endured a COVID-19 test and then counted down the hours until the results arrived knows how important it is to the patient to shrink the wait, and reduce anxiety and time in self-isolation.

For clinicians and public health workers, the opportunity to accelerate access to test results is equally important because it means enhancing outbreak prevention, faster treatment and better outcomes.

NSW Health Pathology has been working on a ground-breaking initiative – using cloud technology and artificial intelligence to allow faster diagnosis and care for patients – no matter where they are.

NSW Health Pathology, deployed rapid testing for COVID-19 across 35 point of care devices to enable access to testing for urgent, priority patients within three hours.

Working with eHealth NSW and Microsoft they have taken quality endorsed data from point-of-care testing devices, uploaded that securely to the internet, using the 4G mobile network, to their clinician network where the test results can be reviewed and provided to clinicians in near real time.

The digital solution means that patients requiring urgent or critical care can be tested anywhere there is a point of care testing device and 4G connectivity.

For rural and remote patient testing, where internet connectivity can be patchy, this is a real telehealth breakthrough allowing speedier diagnosis and treatment.

The system has also been used in specific COVID-19 testing situations, for example allowing test data collected from crew and passengers on ships to be instantly uploaded and analysed in order to speed access to results.

James Patterson, NSW Health Pathology’s Chief Information Officer says that the platform allows NSW Health to explore a broad range of options to speed testing and care. It’s currently looking at how data collected in clinical lateral flow tests can be uploaded and analysed in a similar way to how point of care test data is handled.

World leading testing

NSW Health Pathology provides the world’s largest managed point of care testing service.

There are more than 680 point of care test devices deployed across 200 NSW Health locations – with thousands more planned. These devices can be used for multiple tests, for example, to assess risk following a heart attack, or check a patient’s blood glucose levels.

The Microsoft Azure cloud is at the heart of the platform that takes data from those test devices and makes it available for fast diagnosis. Azure’s scale and reach make the service deployable anywhere in NSW over both internal networks and via secure mobile networks. Additional Microsoft technologies including Azure CosmosDB, IoT Hub, Event Hub, Azure Databricks, Power BI and Dynamics 365 are also being leveraged.

Eventually this approach to medical testing could transform the way many medical tests are conducted, allowing medical devices to be deployed more widely in hospitals, clinics, ambulances, pharmacies, aged care facilities, even in people’s own homes and in workplaces.

According to Dr Nic Woods, Chief Medical Officer, Microsoft Australia who has been involved with the project since the beginning:

This promises a new approach to expedite diagnoses and therefore treatment, including for rural and remote Australians who will need to travel less for tests and will open up new possibilities for monitoring diagnostic data. I, like NSW Health Pathology, am a strong proponent of bringing care near to the patient and using available technologies such as intelligent IoT services to support care near the patient as well.

Better patient care

NSW Health Pathology is also testing new ways to use the faster results to improve patient care. NSW Health Pathology has been running trials in Blacktown and Westmead Hospitals, combining the point of care pathology results with other vital signs results to help identify when patients are at risk of sepsis in the Emergency Department.

Sepsis can be fatal unless treated early – but its onset can be hard to predict. The NSW Health Clinical Excellence Commission recommends an algorithm which can help clinicians detect sepsis. This platform helps to automate the capture of the data feeding into that algorithm, which should help with providing doctors with early warning of sepsis risk.

James Patterson, NSW Health Pathology’s Chief Information Officer says that the platform allows NSW Health to explore a broad range of options to speed testing and care. It’s currently looking at how data collected in clinical lateral flow tests can be uploaded and analysed in a similar way to how point of care test data is handled.

“The power of this is really around doing the test and wrapping a service around that,” he says. The services he envisages range from straight diagnostics to rapid public health reporting.

Steven Worrall, Managing Director, Microsoft Australia describes the work being undertaken by NSW Health Pathology as a huge step forward in providing advanced statewide pathology testing, heralding faster and smarter testing, speedier treatment and better outcomes.

“Eventually this approach – combining cloud, data and AI – could transform the way diagnostic tests are carried out and analysed, making sure those patients that most need it have access to real-time tests and results regardless of where they live.”

Basing the system on the Azure cloud and having access to the broad array of Azure services also accelerates the opportunity for innovation Patterson says, as there are no legacy computing constraints.

It’s that innovation capability, he says, that allowed NSW to rapidly spin up the service that was able to send NSW residents an SMS if their Covid-19 test came back negative.

“The agile, iterative approach that’s been really successful in other industries can be applied quite well here. You can hit the ground running,” says Patterson.

The cloud-based platform and anywhere, anytime access to results also allows NSW Health to leverage medical expertise across the State connecting its specialised wherever they are across the state, country or city.

“I think with remote monitoring and remote testing you can start to change service models so you can have self-service in communities. That’s how you you’re improving the quality of care, not just the availability of care,” Patterson adds.

For example, if someone has a stroke, the speed at which that is diagnosed and treatment commenced has a critical impact on the patient’s ability to recover. Being able to conduct tests in aged care homes, and have that instantly available to treating doctors can have an enormous impact.

Patterson says that being platformed on the high performance and trusted Azure cloud accelerates opportunities for innovation and enhanced reporting. Data can be ingested from different sources – the point of care devices, from electronic medical records including My Health records, and also data stored in NSW’s Health’s AWS based systems – and then made securely available for analysis and reporting using Power BI.

“The whole volume of our COVID-19 tests are now visible through that secure Power BI platform, covering around 1.7 million patients as at October 2020,” he says. It’s streamlined tasks across NSW Health, to such an extent says Patterson that it has saved over 300,000 hours of manual calls by healthcare staff to patients and stripped friction from the user experience.

Ultimately, it points to operational efficiencies and improved health outcomes and experiences for everyone in NSW wherever they live.