PACS The Role of Digital Imaging

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PACS - The Role of Digital Imaging

• Dr G.M.Hoadley
• National Clinical Lead, Radiology

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What is PACS?

• P icture
• A rchiving
• C ommunication
• S ystem

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CR V DR
ACUTE TRUST Core PACS
RADIOLOGY
Scanner
viewing
Image acquisition
Local PACS Store
Monitor
HRM
Monitor
RIS
RADIOLOGY
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ACUTE TRUST Full PACS Hospital Wide
THEATRES
RADIOLOGY
AE
viewing
Scanner
image acquisition
ONCOLOGY
WARDS
Local PACS Store
Monitor
HRM
Monitor
RIS
RADIOLOGY
OUTPATIENTS
MDT
Scanner
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ACUTE TRUST Stretching PACS Hospital
Community Wide
THEATRES
PRIMARY CARE
RADIOLOGY
AE
viewing
Scanner
image acquired
ONCOLOGY
Local PACS Store
WARDS
Monitor
HRM
Monitor
RIS
RADIOLOGY
AT HOME/ REMOTE
OUTPATIENTS
MDT
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Enterprise-wide/Health economy PACS?

• A set of technology components used together to
  capture, store, distribute and display any
  digital medical images, static or moving, and any
  associated media.
• The solution operates across multiple sites and
  multiple Trusts with consistent and seamless
  capture of, access to and use of digital images
  by any healthcare practitioner authorised to do
  so at locations where they undertake their
  clinical work, research or education.

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Who is interested in the technology

• DoH / Government
• NPfIT
• MA diagnostics
• FHN
• IHE
• Commissioning bodies
• Trusts
• Clinicians
• Industry

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M.A.
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4 Key Areas of Strategy in M.A.
New ways of working
4 Tier Structure Radiology Academies
Process mapping C D
Improve Patient Experience
Service redesign improvement
New technologies
Treatment centres
E Booking Telemedicine Electronic record PACS
New patterns of service delivery
PCTs
Choice
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Radiological Technologies

• PACS
• RIS
• Speech recognition software
• NHS net security Information Sharing
• National Spine
• Electronic Record Order Comms
• Standards
• I.H.E.
• DICOM
• Teleradiology

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Technical planning
Changing workforce
Whole system configuration
New Clinical models
Building design
procurement
Technology Change
Private public partnerships
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Scope and Timescale
29 large PFI projects phase 1
phase 2
Projects
42 LIFT projects
IT procurement process
pilots
pilots
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INTEGRATED CARE RECORD SYSTEM
THE NATIONAL PACS PROGRAMME IS AN INTEGRAL PART
OF ICRS
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NPfIT FUNDING SCOPE

• IN
• CR
• Archive
• Diagnostic Workstations (within Radiology)
• Software
• Web server

• OUT
• LAN
• DR
• PCs on wards

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What is IHE?

• INTEGRATING HEALTHCARE ENTERPRISE
• An independent body with representatives from
  RCR, BIR, COR, IPEM, NHSIA, MHRA, Industry
• Part of a global initiative to promote better
  interoperability of computer systems in
  healthcare
• Currently radiology and hospital information
  systems
• Based on real workflow processes

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What does it do?

• Scheduled workflow pattern
• Takes existing computer language standards and
  defines their use.
• Defines the exact use of DICOM and HL7 needed to
  achieve workflow process
• Systems that achieve this can be reliably
  integrated with other IHE systems provided they
  both advertise the same process regardless of
  manufacturer

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Scheduled Workflow Profile
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Benefits of this approach

• A more cohesive workflow process for transfer of
  information from HIS to RIS to PACS
• Smooth, reliable transfer of information between
  computer systems from different companies
• Patient journey can be more efficiently and
  accurately planned
• Mistakes can be more easily corrected

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The future

• This approach will extend beyond radiology to
  areas such as theatres and pathology
• The aims will be to facilitate patient workflow
  processes by improving computer systems
  interoperability
• a patient (user) driven approach

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Enterprise-wide PACS?

• A set of technology components used together to
  capture, store, distribute and display any
  digital medical images, static or moving, and any
  associated media.
• The solution operates across multiple sites and
  multiple Trusts with consistent and seamless
  capture of, access to and use of digital images
  by any healthcare practitioner authorised to do
  so at locations where they undertake their
  clinical work, research or education.

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PACS Programme vision

• Filmless (and ideally paperless) diagnostic
  services to be made possible in all health
  economies in England by the end of 2006.
• This should encompass Acute Trusts (where the
  bulk of diagnostic services currently take place)
  and other NHS organisations where digital images
  are (or can be) created and/or used for clinical
  care education, planning or delivery.

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Organisational Scope

• IN
• Hospitals
• DTCs
• WI Centres
• Minor Injury Units
• GP Practices
• NHS Dental Practices
• Military Hospitals
• Specialists homes
• Anywhere for mobile practitioners

• OUT
• Prisons
• Private Sector
• Scotland
• Wales
• Northern Ireland

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ACUTE TRUST Stretching PACS Hospital
Wide/Community/ALL Images
CARDIOLOGY/ECG
AE/OP/WARDS/ THEATRES/MDT/ ONCOLOGY
RADIOLOGY
viewing
Scanner
Scanner
image acquired
OPHTHALMOLOGY
PATHOLOGY
Local PACS Store
Monitor
HRM
Monitor
Scanner
All digital images
RIS
Scanner
RADIOLOGY
Scanner
ENDOSCOPY
REMOTE/ AT HOME
Scanner
DERMATOLOGY
Scanner
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Image Scope

• Radiology
• Radiotherapy
• Computed tomography
• MRI
• Nuclear medicine
• Angiography
• Cardiology
• Fluoroscopy
• Ultrasound
• Dental
• Symptomatic mammography

• Non-radiological
• Retinal screening
• Endoscopy
• Colposcopy
• ECG
• Audiology
• Blood films
• Clinical photography
• Histology
• Dermatology
• Diagrammatic images
• Laparoscopic images
• Genetics
• Cytology
• Haematology

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N3
NHS Intranet
ACUTE TRUSTS
Community
Acute Trust
Community
Acute Trust
Community
Acute Trust
Strategic Health Authority
Community
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A likely national architecture
National Spine Record Service
Cluster
Health economy
Viewing
Viewing image
Report and diagnostic image
Trust
PACS1
PACS2
PACSn
Reporting
Hospital
Legacy ? New
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What are the benefits?

• Access to specialist /2nd opinion
• Access to pathology radiology opinion
• MDTM support
• Support EPR/Single patient record
• patient choice
• Reporting flexible capacity
• Quality all images always available

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What are the benefits?

• Training academies / distance learning
• Home working (IWL, EWTD) Q.o.L
• Hospital _at_ night
• Cost saving fewer patient transfers
• Primary care development (DTC, U/S)
• Reduce car parking
• Lower outpatient attendances
• Monitoring of chronic diseases
• Requires New ways of working

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POTENTIAL BENEFITS OF STRETCHING PACS BEYOND
RADIOLOGY INTO THE COMMUNITY
Patient/user/financial/quality/efficiency
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Near Patient Testing
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Business Architectures Strategic HA Wide Service
Primary diagnostics
Primary diagnostics
Acute hospital
Acute hospital
Acute hospital
Acute hospital
Opticians
Opticians
Dentists
DATC
Dentists
Primary diagnostics
DATC
Primary diagnostics
Primary diagnostics
Acute hospital
Acute hospital
Opticians
Dentists
DATC
Primary diagnostics
Service spanning all primary and secondary care
within a whole Strategic HA area
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Problems with DTC IS / Outsourcing

• Lack of continuity IT systems
• Leeching of expertise from NHS (U/S, MR)
• No training input
• Poorer equipment utilisation
• Access of clinicians to reporters
• Duplication of work protocols, reports, etc
• Transmission of data images, reports
• Governance (teleradiology)
• Complexity of work (that left takes longer)

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One stop clinics

• Haematuria US Cystoscopy ?CT
• RAPAC TRUS Biopsy
• PMB US Hysteroscopy
• Breast FNA Mammo US Biopsy
• Chest pain CXR Echo ECG etc
• Chest clinic CXR Bronchoscopy CT

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Thank you