pacs - the role of digital imaging
TRANSCRIPT
PACS - The Role of PACS - The Role of
Digital ImagingDigital ImagingDr G.M.HoadleyDr G.M.Hoadley
National Clinical Lead, National Clinical Lead, RadiologyRadiology
What is PACS?What is PACS?
P ictureP icture
A rchivingA rchiving
C ommunicationC ommunication
S ystemS ystem
HRM
ACUTE TRUST – Core PACS
Local PACS
Store
RADIOLOGY
Scanner
A&E
LAN
viewing
Monitor
Monitor
RADIOLOGY
RIS
Image acquisition
viewing
CRV
DR
HRM
ACUTE TRUST – Full PACS : Hospital Wide
Local PACS
Store
MDT
RADIOLOGY
Scanner
Scanner
OUTPATIENTS
WARDS
A&E
LAN
viewing
image acquisition
viewing
THEATRES
Monitor
Monitor
RADIOLOGY
RIS
ONCOLOGY
HRM
ACUTE TRUST – Stretching PACS : Hospital & Community Wide
Local PACS
Store
MDT
RADIOLOGY
Scanner
OUTPATIENTS
WARDS
A&E
LAN
viewingimage acquired
viewing
THEATRES
Monitor
Monitor
RADIOLOGY
RIS
ONCOLOGY
PRIMARY CARE
AT HOME/REMOTE
Enterprise-wide/Health Enterprise-wide/Health economy PACS?economy PACS?
““A A set of technology components used set of technology components used together to capture, store, distribute and together to capture, store, distribute and display any digital medical images, static display any digital medical images, static or moving, and any associated media. or moving, and any associated media. The solution operates across multiple The solution operates across multiple sites and multiple Trusts with consistent sites and multiple Trusts with consistent and seamless capture of, access to and and seamless capture of, access to and use of digital images by any healthcare use of digital images by any healthcare practitioner authorised to do so at practitioner authorised to do so at locations where they undertake their locations where they undertake their clinical work, research or education.”clinical work, research or education.”
Who is interested in the Who is interested in the technologytechnology
DoH / GovernmentDoH / Government NPfITNPfIT MA diagnosticsMA diagnostics FHNFHN IHEIHE Commissioning bodiesCommissioning bodies TrustsTrusts Clinicians Clinicians IndustryIndustry
M.A.M.A.
4 4 Key Areas of Strategy in M.A.Key Areas of Strategy in M.A.
Improve Patient
Experience
New patterns of service delivery
Treatment centres
PCTs
Choice
New ways of working
Service redesign & improvementNew technologies
E Booking
Telemedicine
Electronic record
PACS
4 Tier Structure
Radiology Academies
Process mapping
C & D
Radiological TechnologiesRadiological Technologies PACSPACS RISRIS Speech recognition softwareSpeech recognition software NHS net – securityNHS net – security Information SharingInformation Sharing National SpineNational Spine Electronic Record – Order CommsElectronic Record – Order Comms Standards Standards
I.H.E.I.H.E. DICOMDICOM
TeleradiologyTeleradiology
Technical planningTechnical planning
pro
cure
men
t
Private public partnerships
Changing workforce
New Clinical models
Building design
TechnologyChange
Wholesystem
configuration
Scope and TimescaleScope and Timescale
year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 82002/3 2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10
PFI Building process
DTC development
Primary building process
Technology procurement
Care redesign processes
Workforce change
29 large PFI projects phase 1
Projects
42 LIFT projects
IT procurement process
pilots
phase 2
pilots
IINTEGRATED NTEGRATED CCARE ARE RRECORD ECORD SSYSTEMYSTEM
ICRS
PACS EPR RAD REPORTS
THE NATIONAL PACS PROGRAMME IS AN INTEGRAL
PART OF ICRS
NPfIT FUNDING SCOPENPfIT FUNDING SCOPE
ININ CRCR ArchiveArchive Diagnostic Diagnostic
Workstations (within Workstations (within Radiology)Radiology)
SoftwareSoftware Web serverWeb server
OUTOUT LANLAN DRDR PC’s on wardsPC’s on wards
What is IHE?What is IHE?
INTEGRATING HEALTHCARE ENTERPRISEINTEGRATING HEALTHCARE ENTERPRISE
An independent body with representatives from RCR, An independent body with representatives from RCR, BIR, COR, IPEM, NHSIA, MHRA, IndustryBIR, COR, IPEM, NHSIA, MHRA, Industry
Part of a global initiative to promote better Part of a global initiative to promote better interoperability of computer systems in healthcareinteroperability of computer systems in healthcare
Currently radiology and hospital information systemsCurrently radiology and hospital information systems
Based on real workflow processesBased on real workflow processes
What does it do?What does it do?
Scheduled workflow patternScheduled workflow pattern:: Takes existing “computer language” Takes existing “computer language”
standards and defines their use.standards and defines their use. Defines the exact use of DICOM and HL7 Defines the exact use of DICOM and HL7
needed to achieve workflow processneeded to achieve workflow process Systems that achieve this can be reliably Systems that achieve this can be reliably
integrated with other “IHE” systems provided integrated with other “IHE” systems provided they both advertise the same process they both advertise the same process regardless of manufacturerregardless of manufacturer
imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
Registration
Orders Placed
Orders Filled
Film
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
DiagnosticWorkstation
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
Scheduled Workflow Scheduled Workflow ProfileProfile
Benefits of this approachBenefits of this approach
A more cohesive workflow process for transfer of A more cohesive workflow process for transfer of
information from HIS to RIS to PACSinformation from HIS to RIS to PACS
Smooth, reliable transfer of information between Smooth, reliable transfer of information between
computer systems from different companiescomputer systems from different companies
Patient journey can be more efficiently and Patient journey can be more efficiently and
accurately plannedaccurately planned
Mistakes can be more easily correctedMistakes can be more easily corrected
The futureThe future
This approach will extend beyond This approach will extend beyond radiology to areas such as theatres radiology to areas such as theatres and pathologyand pathology
The aims will be to facilitate patient The aims will be to facilitate patient workflow processes by improving workflow processes by improving computer systems interoperabilitycomputer systems interoperability a patient (user) driven approacha patient (user) driven approach
Enterprise-wide PACS?Enterprise-wide PACS?
““A set of technology components used together A set of technology components used together to capture, store, distribute and display any to capture, store, distribute and display any digital medical images, static or moving, and digital medical images, static or moving, and any associated media. any associated media.
The solution operates across multiple sites and The solution operates across multiple sites and multiple Trusts with consistent and seamless multiple Trusts with consistent and seamless capture of, access to and use of digital images capture of, access to and use of digital images by any healthcare practitioner authorised to do by any healthcare practitioner authorised to do so at locations where they undertake their so at locations where they undertake their clinical work, research or education.”clinical work, research or education.”
PACS Programme visionPACS Programme vision
Filmless (and ideally paperless) diagnostic Filmless (and ideally paperless) diagnostic services to be made possible in all health services to be made possible in all health economies in England by the end of 2006. economies in England by the end of 2006.
This should encompass Acute Trusts This should encompass Acute Trusts (where the bulk of diagnostic services (where the bulk of diagnostic services currently take place) currently take place) andand other NHS other NHS organisations where digital images are (or organisations where digital images are (or can be) created and/or used for clinical can be) created and/or used for clinical care education, planning or delivery.care education, planning or delivery.
Organisational ScopeOrganisational Scope ININ HospitalsHospitals DTCsDTCs WI CentresWI Centres Minor Injury UnitsMinor Injury Units GP PracticesGP Practices NHS Dental PracticesNHS Dental Practices Military HospitalsMilitary Hospitals Specialists’ homesSpecialists’ homes Anywhere for mobile Anywhere for mobile
practitionerspractitioners
OUTOUT PrisonsPrisons Private SectorPrivate Sector ScotlandScotland WalesWales Northern Northern
IrelandIreland
HRM
ACUTE TRUST – Stretching PACS Hospital Wide/Community/ALL Images
Local PACS
Store
DERMATOLOGY
RADIOLOGY
Scanner
Scanner
ENDOSCOPY
Scanner
CARDIOLOGY/ECG
Scanner
PATHOLOGY
Scanner
A&E/OP/WARDS/THEATRES/MDT/
ONCOLOGY
LAN
viewingimage acquired
viewing
Monitor
Monitor
RADIOLOGY
RIS
OPHTHALMOLOGY
Scanner
Scanner
REMOTE/AT HOME
All digital images
Image ScopeImage Scope RadiologyRadiology
RadiotherapyRadiotherapy Computed tomographyComputed tomography MRIMRI Nuclear medicineNuclear medicine AngiographyAngiography CardiologyCardiology FluoroscopyFluoroscopy UltrasoundUltrasound DentalDental Symptomatic Symptomatic
mammographymammography
Non-radiologicalNon-radiological
Retinal screeningRetinal screening EndoscopyEndoscopy ColposcopyColposcopy ECGECG AudiologyAudiology Blood filmsBlood films Clinical photographyClinical photography HistologyHistology DermatologyDermatology Diagrammatic imagesDiagrammatic images Laparoscopic imagesLaparoscopic images GeneticsGenetics CytologyCytology HaematologyHaematology
Acute Trust
Acute Trust
Acute Trust
N3
PACS
Local Store
Community
Community
Comm
unity
Comm
unity
ACUTE TRUSTS
Strate
gic H
ealth
Authorit
y
PCT
PCT
Local Store
PACS
AcuteTrust
Local Store
PACS
Data Centre
Central Image Store
NHS Intranet
A likely national architectureA likely national architecture
Cluster
Health economy
Hospital
Trust
Core Image store
Core Image store
National Spine Record Service
Vie
win
gR
epor
ting
Report and diagnostic
image
Viewing image
PACS1 PACS2 PACSn
Legacy New
What are the benefits?What are the benefits?
Access to specialist /2nd opinionAccess to specialist /2nd opinion Access to pathology & radiology opinionAccess to pathology & radiology opinion MDTM supportMDTM support Support EPR/Single patient record Support EPR/Single patient record
– – patient choicepatient choice Reporting – flexible capacityReporting – flexible capacity Quality – all images always availableQuality – all images always available
What are the benefits?What are the benefits?
Training academies / distance learningTraining academies / distance learning Home working (IWL, EWTD) Q.o.LHome working (IWL, EWTD) Q.o.L Hospital @ nightHospital @ night Cost saving – fewer patient transfersCost saving – fewer patient transfers Primary care development (DTC, U/S)Primary care development (DTC, U/S)
Reduce car parkingReduce car parking Lower outpatient Lower outpatient
attendancesattendances
Monitoring of chronic diseasesMonitoring of chronic diseases Requires – New ways of workingRequires – New ways of working
POTENTIAL BENEFITS OF STRETCHING PACS BEYOND RADIOLOGY & INTO THE
COMMUNITY
0
50
100
150
200
250
PACS InvestmentRadiology
Ben
efit
Stretching PACS Hospital Wide
Community and whole image wide
Patient/user/financial/quality/efficiency
Near Patient Near Patient TestingTesting
Business Architectures –Business Architectures –Strategic HA Wide ServiceStrategic HA Wide Service
Acute hospital
Primary diagnostics DATC
Dentists
Opticians
Acute hospital
Primary diagnostics
Acute hospital
Primary diagnostics DATCDentists
Opticians
Acute hospital
Primary diagnostics
Acute hospital
Primary diagnostics DATCDentists
Opticians
Acute hospital
Primary diagnostics
Service spanning all primary and secondary care within a whole Strategic HA area
Problems with DTC & IS / Problems with DTC & IS / OutsourcingOutsourcing
Lack of continuity – IT systemsLack of continuity – IT systems Leeching of expertise from NHS (U/S, MR)Leeching of expertise from NHS (U/S, MR) No training inputNo training input Poorer equipment utilisationPoorer equipment utilisation Access of clinicians to reportersAccess of clinicians to reporters Duplication of work – protocols, reports, Duplication of work – protocols, reports,
etcetc Transmission of data – images, reportsTransmission of data – images, reports Governance (teleradiology)Governance (teleradiology) Complexity of work (that left takes longer)Complexity of work (that left takes longer)
One stop clinicsOne stop clinics
HaematuriaHaematuria US Cystoscopy ?CTUS Cystoscopy ?CT RAPACRAPAC TRUS BiopsyTRUS Biopsy PMBPMB US HysteroscopyUS Hysteroscopy BreastBreast FNA Mammo US FNA Mammo US
BiopsyBiopsy Chest painChest pain CXR Echo ECG etcCXR Echo ECG etc Chest clinicChest clinic CXR Bronchoscopy CTCXR Bronchoscopy CT
Thank youThank you