BloodNet keeps track of precious supplies

It's not every day that a new IT system receives a 100 per cent approval rating from end-users, but this is exactly the score that the National Blood Authority's BloodNet system received when it was trialled in public hospitals in late 2010.

Two years later and now in use by all hospitals in the country, BloodNet is a web-based system that allows hospital laboratories to order blood supplies from the Red Cross Blood Service, keep track of their inventory and better manage receipting and wastage.

Designed and managed by the National Blood Authority (NBA), BloodNet is one of a number of systems that the authority will now oversee from its new Blood Systems Operations Centre, which was officially opened in Canberra last month. The centre will allow the authority to monitor in real time the operations of the entire national blood supply chain and to intervene in case of shortages or emergencies.

In addition to BloodNet, the centre will also help coordinate the other online networks the authority manages, including the Australian Bleeding Disorders Registry and the Blood Chat forum for those working in the blood sector to discuss pertinent issues.

The NBA has also established a Blood Portal through which registered users can access a range of systems that the NBA manages, all secured by single sign-on.

The NBA's general manager, Leigh McJames, admits that the authority has had a low profile since its establishment in 2003. When the collection of blood moved from hospitals to state-based Red Cross groups and now to the nationally coordinated Red Cross Blood Service, the NBA was set up to manage the blood supply on a national scale.

“Our role is to be responsible for managing the supply of blood and blood products to Australia and we have a contract with the Red Cross to provide the fresh blood,” Mr McJames said. “That's worth over half a billion dollars, and the total budget for all blood and blood products is about $1.1 billion.”

Mr McJames said the blood products sector is divided into three sources: fresh blood collected by the Red Cross Blood Service; plasma, which is also collected by the Red Cross and used in a range of products such as intravenous immunoglobulin and albumin, which are manufactured in Victoria by CSL; and specialty blood products that are generally imported. Supplies of IVIg are also imported as Australia generally doesn't collect enough plasma for the demand.

When the NBA was first established, orders from hospitals were generally phoned or faxed to the blood service and dispatched from its regional collection centres. Inventory management was done using manual entry on spreadsheets, as was reporting.

In 2008, however, the work done by Queensland Health on its Ordering and Receipting of Blood System (ORBS) impressed the NBA with the system's ability to increase efficiency and the management of inventory, but also its ability to make clear the transport challenges and cold chain management issues that a country the size of Australia faces.

The NBA's deputy chief information officer, Nathan Kruger, said the NBA then developed BloodNet based on modifications to ORBS, which was put through a successful proof-of-concept trial before a roll out to South Australia and Tasmania.

“We then did an assessment and a survey of those sites and one of the questions was, 'would you like to go back to your faxing and manual ordering process?' and they categorically said no,” Mr Kruger said. “100 per cent said no.”

Mr McJames said the wide user acceptance of BloodNet system is very unusual in his experience, having worked in the past in a regional health service and having seen IT systems come and go.

The beauty of BloodNet is its simplicity, Mr McJames said. “It is very simple but it also has a number of useful functions and capabilities. When [the hospital laboratory] brings up an order sheet, it also brings up their ideal inventory, saying this is where we should be.

“It has order quantities, the price – which is a powerful tool, because people in the past have not realised that blood is an expensive and precious resource – and then it will provide a cumulative total.”

The hospital laboratory simply has to press 'submit' on the order template through BloodNet, and the order is transferred by an encrypted email to the Red Cross Blood Service.

The hospital is sent an acknowledgement that the order has been received by the blood service, which Mr McJames said has been invaluable as the hospital now knows that the order is on its way.

“It has priority levels in the order, so if you have a very urgent order it will flag that to the blood service,” he said.

Mr Kruger said there are three different categories of urgency – life-threatening, which has a 30-minute turnaround; urgent, which usually has a 30-minute to three-hour turnaround; and routine.

The orders are received in an email box monitored 24/7 by the blood service. “As soon as that is delivered to the email box for each state inventory and distribution area, we get the acknowledgement within minutes – depending on traffic we usually get it anywhere between 30 seconds and five minutes,” Mr Kruger said.

“We'll know it has been acknowledged and that is then presented instantly to our users, so they can see that the order has categorically been received by the inventory and distribution unit in their state or territory.

“As soon as the blood service sees that, they've got a protocol that they follow for standard operating procedures and once they have the product packed and have the order consignment printed, they then send an acknowledgement back to the system to tell it the item is now ready for dispatch.

“So it has a dispatch status, and it also generates a receipting note so they can automatically barcode it and scan it in efficiently when it gets to the hospital.”

Since the roll-out of BloodNet began, additional functionality has been added, including a fate module that allows hospitals to record transfers and discards and make inventory management decisions based on evidence.

Mr Kruger said about 80 to 85 per cent of hospitals are now using this module, and the organisation was also moving into using video conferencing and remote desktop functionality to do remote training on how to use the system.

Also on the drawing board is designing interfaces with commonly used laboratory information systems. The NBA is currently trialling an interface with WA's PathWest service, and next month will begin interfacing with the Hunter New England eBlood system, Mr Kruger said.

“That interface will basically do all of the information processing backwards and forwards,” he said. “It will be a nice neat step for people who are receipting because they receipt into BloodNet, and the information passes straight through the lab information management interface, putting in all of the different details it can into their system, and then they only have to update the unique elements of their system.

“Part of the proof of concept is also to go to Queensland and work with a system up there called AusLab, and we are now in discussions for an agreement to start that trial. Additionally, some of the private pathology services want to go ahead and do things like this themselves.

“We've identified a whole range of lab information management systems and we are in proof-of-concept trials, but we have to show what the results are to the jurisdictional blood committee before we can make any further proposals.”

Mr McJames said the new operational centre in Canberra will have a range of benefits, not only for the NBA itself but for the blood supply as a whole.

“Because it's real time, we can monitor that the distribution system is actually working as it's supposed to and that blood is being delivered within the required timeframe,” he said.

“That's a service performance advantage. The second one is in terms of managing shortages – it does happen now and again that if there is a national shortage we can see inventory levels within hospitals, combined with what the Blood Service has in process, to manage the shortage to ensure that the blood is available where it is needed, despite the contingency, whatever that may be.”

Mr McJames used the example of the recent dengue fever outbreak in Cairns, which has forced the blood service to stop taking donations from people in the area as dengue is transmitted by blood.

“Where there is that sort of outbreak and they won't collect blood, there has to be management to ensure that blood is shipped in to those areas. There is also the possibility of wider shortages because of a disaster or some sort of national contingency. [With the new monitoring capability], what you have is real-time nationwide visibility of blood stocks down to the hospital level.

“The immediate benefits that weren't there before for the states who manage the hospitals are they have visibility now of what wastage is happening. It is fairly important to avoid wastage; one, because of the cost, but two because it actually takes a lot of effort to collect blood and it's really not acceptable to waste it.

“It provides jurisdictions a direct look at hospitals in the way they are using blood and to ensure they are using it as efficiently and effectively as they should.”

Posted in Australian eHealth

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