NHS Scotland National PACS

Today

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Population 5.1 million

Health budget of £14 billion

NHS is 33% of the public expenditure of the Scottish government.

eHealth expenditure £200million per annum

Scotland is one of the first examples of a National radiology system.

NHS Scotland

Scope & Reach

Dependencies

What we have

• Common user interface across all hospitals with access to the same features and functionality

• Managed storage service totalling 1 Petabyte, in mirrored National Image/Report Archive

• 24,000 registered users• Installation of 350, 3MP monitor diagnostic workstations

for use in radiology• Web-based image viewing in over 2000 wards

Chosen Architecture

Targets & Challenging Pathways

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BenefitsUrgent Transfers e.g. RTA, neurosurgery c. 100 per annum

Support for multi professional Groups reviewing cases remotely

Support for second opinion required in c. 10000 Per annum

Transfer of images for national waiting list hospital 45000 per annum

The solution accepts all images

and all reports and makes them

available across the country.

• Images available anywhere

• Image manipulation

• Less repeat exams

• Improved workflows

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Benefits

Miss D Patient in Stornoway

(Western Isles Hospital)

Chest physician in Inverness

Radiological opinion in Borders General Hospital

Patient received definitive treatment in ITU Glasgow Royal Infirmary

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Benefits Miss D

Age 18

Flu-like illness for 48 hours

Progressive SOB

Pleuritic chest pain

No significant past history

No drugs

No allergies

Erythromycin i.v.

Hydrocortisone 100mg iv

Chest opinion sought (Inverness)

CT scan (Borders General Hospital)

Decision to transfer

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Benefits

Miss D Transferred to Glasgow ITU bed Glasgow Royal

Infirmary Bronchio alveolar lavage Acute eosinophilic

pneumonia High dose steriods Recovered

Further BenefitsThe gross benefits conservatively extend to

• 10% reduction in re-examination• 100% reduction in film and chemical cost • Significant reduced time to treatment• Absorbing growing activity with existing radiologist establishment• Absorbing exponential data growth on existing infrastructure

Plus hard to quantify benefits such as:• Reduced litigation • CT dose monitoring a by product of data collection – dose management

now considered across the country• The difference in responsiveness and quality of care is also immense -

hard to over estimate.

Challenges • Explosion in data production – next batch of 128 slice

CT now in view• Cost pressures from data storage• Compression & life cycle management• Contract complexity• Disparity in RIS functionality and deployment

Lessons

•Need for corporate commitment•Need for strong clinical support and leadership•Need for strong support from eHealth community•Scottish Government political support •Good governance models facilitate cross organisational

working

The Future

• New version of Carestream PACS being rolled out - Technology Refresh and V11 Upgrade (Global Worklists, Tunnelling and Streaming) – different platforms and new ways of working

• National Licence for Volume Matching, Lesion Management• Same application now being rolled-out to Scottish Breast

Screening Service• Cloud computing for the long term future• Image database of 17 million studies now a key part of

Scottish Government inward investment strategy to attract commercial clinical research