How we helped support women's breast screening in Scotland
Aging screening equipment and inefficient paper-based information systems.
This was an opportunity to transform the whole system - and we were able to help this happen.
Within four years the whole screening programme was transformed to be 'digital by default'.
The x-ray equipment used was based on an analogue ‘wet-film’ technology, which was labour-intensive in developing and preparing – and time-consuming in the review and reporting. The reporting of results was paper-based, with results being entered into an IT system by hand on a batch basis which required a significant allocation of support staff and constant manual quality checks.
In time, it became impossible for the SBSP to continue to provide a high-quality screening programme with an aging suite of analogue radiological equipment and an information system which was no longer fit for purpose.
The National Services Division (NSD) of National Services Scotland and the SBSP saw that these challenges represented an opportunity to transform the whole system – and we were appointed to partner with them to help this happen. The project aimed to:
- Re-map all clinical and business processes with ‘digital as default’.
- Plan the commissioning of digital mammography equipment throughout the six static regional centres and 23 mobile screening units.
- Integrate the digital screening modalities with a national Picture Archiving and Communication System (PACS) to provide a seamless, economical mechanism for storage and retrieval of images.
- Specify and develop a new IT application to facilitate a woman’s pathway from her first appointment letter to referral to secondary care (where appropriate).
- Implement this system supporting frontline teams in the adoption of the new technology, the modification of local and national processes and the management of the evolving change process.
This transformation was not limited to a technological solution but extended into a transformation of the whole programme, affecting people, processes and performance.
Capita has made it their business to understand how screening services should be delivered, and have developed a sustainable partnership with NSD supporting a number of national screening programmes across NHS Scotland from initial concept through to post implementation management and support.
Nation screening coordinator, NSD, NHS National Services Scotland
Within four years, the SBSP had been transformed around the new digital service across all 23 mobile and 6 static centres. Staff were fully trained to use the system and an ongoing change process was implemented to allow them to adapt the service to their needs.
The positive effects of the transformation were felt throughout the service – and in related services including, radiology, pathology and surgery services.
Achievements so far:
- Successfully created a single breast screening history and call/recall service for all eligible women.
- 100% of appointments are digital.
- 100% availability of digital images at the point of reading and reporting.
- Provided access for all eligible residents in Scotland, including those of the transgender community and those not registered with a GP.
- Provided digital integration of all the information within the breast screening process.
- Delivered a paperless digital service to departments that were previously wholly reliant on paper-based systems with 100% of all scheduling now electronic and over 98% of all correspondence (invitations, reminders, results) now centralised and outsourced to a print supplier.
- Minimised the need for manual safeguarding checks by automating data gathering.
- Enabling staff to monitor the standards and efficiency in the performance of each phase of the screening.
- Provided a platform that facilitates multidisciplinary team working across clinical specialties.
Integrated breast screening data with a woman’s wider electronic heath record, with 100% of women registered with a GP now have screening results directly transferred to their GP’s clinical system.
The implementation of the Scottish Breast Screening IT system has been one of the most significant updates in the evolution of the Scottish Breast Screening Programme in tandem with the conversion to digital imaging providing an integrated IT solution for the women who attend for breast screening in Scotland. The system now provides for seamless end to end management for clients allowing for greater efficiency and providing a higher quality service. The fact that the system and imaging also are linked in a global worklist allows a woman to be screened wherever she is in Scotland allowing for greater flexibility and cover. The system now facilitates better communication and team working between all members of the breast team and reduces errors as all activity from screening to MDT involving the client can be seen by the users allowing for improved quality and patient care.
Clinical director of the North-East Scotland Breast Screening Programme, Consultant Radiologist at Aberdeen Royal Infirmary (NHS Grampian) and Chair of the SBSS National User Group