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PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
PACS Realisation and Service Redesign Opportunities
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PACS Realisation and Service Redesign Opportunities

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  • 1. Modernisation Agency NHS PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) National Programme for Information Technology NHS National Radiology Service Improvement Team NHS Modernisation Agency 3rd Floor St John’s House East Street Leicester LE1 6NB Tel: 0116 222 5100 Fax: 0116 222 5101 www.modern.nhs.uk/radiology The NHS Modernisation Agency is part of the Department of Health National PACS Team National Programme for Information Technology 2nd Floor St John’s House East Street Leicester LE1 6NB Tel: 0116 222 5100 Fax: 0116 222 5101 www.npfit.nhs.uk
  • 2. Introduction Section 1 Benefits realisation – general benefits identified by participating sites Section 2 Benefits and redesign opportunities Section 3 Lessons learned Section 4 The bigger picture – organisational benefits Section 5 Strategic benefits Section 6 Future vision and directions Section 7 NHS Plan delivery Glossary of terms Further reading and key links Contents PACS Benefits Realisation and Service Redesign Opportunities - 3 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 4 7 18 23 26 31 32 35 53 53
  • 3. The Potential of PACS (Picture Archiving and Communications Systems) “Delivering the NHS Plan” (April 2002) set at its heart a vision of a patient centred service offering more choice, leading to improved services for all patients and staff, including healthcare outcomes and improved value for money. PACS has a very pivotal and extensive role to play in the delivery of the NHS plan. It lies at the heart of modernisation of the NHS IT infrastructure, and is inexorably linked to service improvement, advancing technology and a changing and developing workforce. PACS therefore has an amazing potential for the modernisation of service delivery for both patients and staff. PACS is a computer system that captures, stores, distributes and displays digitised images. Images can be relayed to any destination capable of receiving them, and can be reviewed in different destinations simultaneously. Improving the imaging of patients in healthcare will inevitably increase the efficiency of the healthcare system as a whole. This document sets out to demonstrate the impact that PACS can have across the wider healthcare community. Roy Male Chief Executive Officer, Blackpool Victoria Hospital, (Blackpool Fylde and Wyre NHS Hospital Trust) has said: “Putting all the technical and other benefits of going filmless aside, to my mind the true impact of PACS is that it has demonstrated real benefit to clinicians in their day to day work from IT systems. It changes the whole perception of IT from the back office to the clinical arena.” Paul Unsworth, Chief Executive Tendering PCT has said: “This is a very helpful report which demonstrates from the pilot sites the benefits to be delivered from PACS and breaks them down by qualitative, quantitive (non cash releasing) and cash releasing. It is our responsibility as commissioners and providers of health services to ensure we get maximum health gain from PACS in each of these areas. Therefore, there should be a well constructed plan to quantify and realise these benefits supported by strong performance management throughout the programme to justify this sizable but welcome investment.” Introduction This document is designed to assist NHS managers to take full advantage of the introduction of PACS through sharing the experience of users to date. It is a guide to the potential and realisable benefits offered by the technology from clinical and managerial perspectives in a range of service areas. The objective is to deliver the best possible outcomes for patient care. The Evidence Initially four sites were brought together for an exploration exercise, each site had a history of service redesign and full PACS. A day was spent exploring the benefits, lessons learned, impact on targets and the service redesign opportunities that PACS has demonstrated. It is accepted that PACS should not be limited to acute trusts but should be deployed throughout the healthcare community. It should also be linked to training establishments, and include numerous imaging specialities eg Radiology, Pathology, Endoscopy, Ophthalmology and Dermatology to name just some. PACS should support the wider modernisation of health services. The information in this report represents the experiences of the four sites and serves as a checklist that will demonstrate the benefits that can be achieved and where redesign opportunities exist for a whole range of users. It is envisaged that more information will be needed from other sites to confirm the messages in this document, and this will be one of the next steps. A further step will be the exploration of the concept of the extension of PACS to other specialities that generate digital images or images capable of digitalisation in their services. The sections are clearly laid out in the document and can be read in isolation if desired. PACS Benefits Realisation and Service Redesign Opportunities - 5 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 4 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA)
  • 4. Section 1 Benefits realisation - general benefits identified by participating sites The introduction of PACS in the NHS in England opens up potential to deliver a range of benefits to patients. Clinicians will be able to access images taken at stages along pathways and readily access relevant patient records. This will streamline care and speed up diagnosis and treatment. PACS offers the opportunity for radiology reporting to be done remotely, utilising telemedicine and potentially facilitating much more flexible working of radiologists who will be able to access images on a 24-hour, seven day a week basis. It challenges traditional radiology reporting structures and encourages organisational review and reconfiguration of imaging services across health communities for maximum efficiency. Critically, used to its maximum potential, PACS will be pivitol in all imaging to delivering the objective set out in the NHS Plan, a maximum wait of 18 weeks from the point of referral to the start of treatment. With the enabling of imaging services in primary care, PACS also underpins the concept of choice in imaging services. This section provides a comprehensive list of benefits that can be gained from the implementation of PACS and service redesign. The degree to which any benefit will be “cash releasing”, “non-cash releasing” , “quantitative” and “qualitative” will obviously depend upon the position of a department prior to PACS implementation, the realisation of benefits within a period of time will also vary. Benefits have been listed with their dependencies, to provide an ‘at a glance’ insight into: • Clinical Benefits • Patient Benefits • Staff Benefits • Business Benefits PACS Benefits Realisation and Service Redesign Opportunities - 7 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 6 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA)
  • 5. PACS Benefits Realisation and Service Redesign Opportunities - 9 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 8 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Image and Report Availability and Transfer Shorter reporting times, images immediately available, no manual handling of analogue images. A&E waiting times reduced, images quickly available, opportunity for quicker reporting. Benefits other departments (access to IT), other departments able to remotely access relevant images and reports for patients. No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. Home access ‘on call’, clinicians can successfully work from home where appropriate, to give expert advice at the most appropriate time. Communication with other departments, instant information transferred electronically across single or multiple organisations. Appropriate workstations and reporting areas. Appropriate staff available with skills to allow process to work eg. Reporting clinical staff. Appropriate sitting and provision of viewing stations. Clinicians must be able to use IT and there must be sufficient viewing stations available. Suitable technology at home to ensure appropriate transfer of patient information, images and safety of information. Full PACS availability across healthcare community. Patient, Trust, Clinicians, Primary Care Patient, Trust Patient, Trust, Clinicians, Clinical staff Patient, Trust, Clinicians, Clinical staff Clinicians, Clinical staff, Patients Trust, Radiology department BENEFITS Direct benefits from implementing PACS CLINICAL Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Image and Report Availability and Transfer Rapid image availability for wards, clinics, other areas, images remotely available any time any place. Multiple viewing of images, numerous specialists in various locations can view images simultaneously. Clinical outcome of IRMER improved, good quality images at source no repeat imaging. Consistency of comparability of images (clinical governance and audit) Improved knowledge management, up to date information and results for patients allowing for appropriate patient management decisions. Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes, especially in training academies. Access to speciality opinion and teaching will be possible. Linking of modalities, ability to view images from various modalities simultaneously. Full PACS availability across healthcare community. Staff are fully competent and confident with the PACS system. Appropriate archiving facility. Full PACS availability across healthcare community. Full PACS systems in place across organisations. Training academies with IT of appropriate specifications. Full PACS systems in place. Patient, Trust, Clinicians, Clinical staff Patient, Trust Clinician Trust, Patient, Clinician, Clinical staff Clinicians, Clinical staff Clinicians, Patient, BENEFITS Direct benefits from implementing PACS CLINICAL Y Y Y Y Y Y Y Y Y Y
  • 6. £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Image and Report Availability and Transfer No “plastics” (temporary envelopes), all patients images include previous images, available in one place. Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research. Near patient image viewing i.e. patients in clinical cubicles, beds or patients in GP surgeries. Patient satisfaction, high quality intervention at consultation times by appropriate people. Images and reports available at any stage of the patient’s journey. Reduction in hardware costs (e.g. reduction of film costs). Ease of consultation between clinicians, clinicians can consult in real time with the ability to view images simultaneously. Clinicians assisted, quick viewing of images and previous images instantaneously available. No image printing – consider patients with previous analogue images. Availability of images electronically – consider previous non- digital images. Appropriate specification and availability of workstations etc. Full PACS available across organisations. Full PACS available across organisations. Sufficient workstations or viewing areas. Trust, Clinicians, Clinical staff Patient, Clinicians Patient, Clinicians Trust, Patient Trust, Patient Clinicians Patient, Trust, Clinicians BENEFITS Direct benefits from implementing PACS CLINICAL Y Y Y Y Y Y Y Y Y Y Y Y £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Image and Report Availability and Transfer Elimination of time wasting for junior doctors re film management, junior doctors will not have to chase images and reports they will be available at the destination of the junior doctors. Improved quality of image, reduced repeat images due to poor quality. Image manipulation allowing reporting clinicians more versatility for image viewing for diagnosis. Free transfer of images between institutions will provide knowledge and learning. Healthcare Process Contribution to decreased length of patient stay, images and reports available at destination in a timely fashion, can potentially accelerate patient discharge. Reduced phone calls, fewer interruptions, fewer queries regarding reports or images. Reports attached to image comprehensive patient imaging record available. Sufficient workstations and IT competence for clinicians. Staff must be fully conversant with digital systems, excellent digital acquisition systems. Willingness of clinicians to share expertise and knowledge. The rest of the process must work well eg discharge plans, consultant ward rounds or nurse-led discharge to take out medicines Availability of sufficient viewing and workstations across organisations. Sufficient viewing and workstations available throughout organisation. Adequate quality PACS and RIS systems and good quality interfaces. Trust, DOH, Economics, Environment, Patient Patient, Trust Clinicians, Clinical staff Patient, Clinicians, Clinical Staff Trust, Patient, DOH Clinicians Clinical staff Admin & clerical Patient, Clinician, PCT, SHA, Trust BENEFITS Direct benefits from implementing PACS CLINICAL Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y PACS Benefits Realisation and Service Redesign Opportunities - 11 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 10 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Y
  • 7. £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits MDT – Links to other centres, complies with the standard that every patient with cancer must be discussed at MDT meetings. CHOICE – Potentially the cross site availability of electronic images and reports can contribute to patients desire to exercise choice of location for treatment. NEAR PATIENT IMAGE VIEWING – Patients in clinical consultation areas, beds or patients in GP surgeries. Patient satisfaction, high quality intervention at consultation times by appropriate people. Images and reports available at any stage of the patient’s journey. Appropriate IT systems at all places participating in MDTs good timing between them and a main archive. Full PACS available across healthcare community and between communities. Appropriate specification and availability of workstations etc. Patient (access to third or specialist opinion), Clinicians Patient Patient, Clinicians BENEFITS Direct benefits from implementing PACS PATIENT Y Y Y Y Y PACS Benefits Realisation and Service Redesign Opportunities - 13 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 12 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Improved Working Lives Reduced stress levels, happier staff, improved processes that improves working lives, less time wasted in futile tasks. Reduced paperwork, electronically generated and held reports lead to less paper shuffling and less stationery costs. No chemicals , Control of Substances Hazardous to Health (COSHH), reduced hazard to staff and reduced costs. Improved working environment. Staff Development Staff development (IT literacy), staff need to be fully conversant with the IT system that produces, manipulates and transfers images, this will lead to staff competence and confidence. Redesigned department and workflow, streamlined patient processes and improved electronic pathways will allow staff to work very differently. Redesign of processes and PACS implementation supporting the redesigned processes. No image or report printing except in exceptional circumstances ie non PACS unit Assume no film printing or very little film printing in special circumstances only. Timely IT training and competency assessment, priority given to being able to navigate the system. Flexible use of resources, both human and material. Patient, Trust, Clinical staff, Clinicians, Admin & Clerical, Porters, Organisation as a whole (reduced grievances) Trust (less stationery costs) Admin & Clerical Trust, Clinical staff, Environment Clinicians, Clinical staff, Admin & Clerical, (Lifelong learning for IT) Patient, Trust, Clinicians, Clinical staff, Porters BENEFITS Direct benefits from implementing PACS STAFF Y Y Y Y Y Y Y Y Y Y Y Y
  • 8. £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Health Care Process Reduced waiting times, appointments and time within department, streamlined process which leads to a more efficient service procedure at appointment stage and on day of diagnostic test. Reduced transport costs, there will be no need for the physical transportation of either images or paper reports these will all be available at any destination electronically. Healthcare efficiency, diagnostic procedures become much more streamlined leading to more effective and efficient hospital treatment, patient flow and more effective primary care. Reduced downtime of equipment compared to chemical “processing”, less equipment to maintain and less equipment failure. “Sceptics converted”, good planning and implementation overcoming original fears of systems failure. Fully integrated radiology information system with PACS. Commitment to no printing of images or reports. Full PACS availability across healthcare community. No conventional film processing undertaken. Excellent planning and good PACS manager in place. Patient, Trust, Clinician, Clinical staff Trust, PCT Trust, Patient, SHA, PCT Patient, Trust, Clinician, Clinical staff Trust, Clinicians, Clinical staff BENEFITS Direct benefits from implementing PACS BUSINESS Y Y Y Y Y Y Y Y Y Y Y Y £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Health Care Process Redefined staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. More quality time with patient. Outsourcing reporting, where a department cannot cope for capacity reasons with the reporting work load images requiring reporting can potentially be transported to other reporting centres. PACS offers the opportunity for reorganisation of radiology reporting to make the most efficient use of resources through telemedicine /remote image reporting. Financial Aspects Financial savings, there is potential for financial savings in the area of more appropriate use of staff cost, saving on chemistry and machine maintenance. However these benefits must be viewed against original capital out lay and costs. Must be able to redesign workflow of the department and take opportunities to work differently. Clinically sound reporting service available at other sites within UK and without. Capital and revenue costs of PACS, displaced staff appropriately and satisfactory redeployed in a new system. Trust, Clinical staff, Clinicians, DOH Trust, Patients, Clinicians Trust, SHA (less procedure cost per patient), Patient BENEFITS Direct benefits from implementing PACS BUSINESS Y Y Y Y Y Y PACS Benefits Realisation and Service Redesign Opportunities - 15 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 14 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA)
  • 9. £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Financial Aspects Reduced litigation costs, potentially because no films or reports will be lost and images and reports will always be available in a timely fashion, for appropriate patient management, this could lead to less litigation costs. Comprehensive Patient Record Aids audit and Clinical Governance, ready availability of images and reports and continuity of care. Supports the development of ICRS, in line with the NPfIT programme for comprehensive patient records. Security of images, patient confidence up held by a security system, all images held together centrally. Adherence to policies around imaging and reporting ensuring that images and reports are always up to date and sorted centrally. Good RIS and PACS system Integrations. Delivery of the NPfIT Programme. Individual systems must be totally secure. Trust Patient, Trust, Clinician DOH, SHA Trust, Patient Patient, Trust BENEFITS Direct benefits from implementing PACS BUSINESS Y Y Y Y Y Y Y £ Cash releasing Quantitative non-cash releasing Qualitative Dependency Who Benefits Medico-legal images Medico-legal images converted to CD ROM, no longer have to pull films physically, no packaging and no posting Capacity Planning Service Reconfiguration, the image availability and transportability of PACS will aid service reconfiguration and help address demand and capacity issues. There is a potential for sharing examination and reporting capacity. Environmental Issues Less background radiation (less unnecessary exposures) less chemistry and pollution. However consider energy use especially where air conditioning units are required. Film storage eliminated, less physical space required, No manual filing or pulling of images and reports. Sufficient IT to view in solicitors destinations. Discussions should begin early. Flexibility in the approach to the use of resources, need for more flexible budgets These benefits will only be realised with full PACS systems, including at satellite sites. Redesign the way the department will be working, use of PACS to support effective workflow, etc. Trust, Patient Patient (services closer to home), SHA, DOH Patient, Environment, Trust,Clinical Staff Patient, Trust Clinicians, Clinical staff BENEFITS Direct benefits from implementing PACS BUSINESS Y Y Y Y Y PACS Benefits Realisation and Service Redesign Opportunities - 17 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 16 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Y Y Y Y Y Y YY
  • 10. Section 2 Benefits and redesign opportunities This section identifies how particular benefits have strong links to service redesign. Representatives from the sites agreed that implementation of PACS would only be truly beneficial along with the appropriate service redesign. In some situations the service redesign may have taken place prior to PACS implementation or may take place alongside PACS implementation. It is hoped that this section will give the reader a valuable insight into the possibilities of different types of redesign, to establish a robust and sustainable PACS benefits maximisation. To achieve the NHS of the 21st Century departments need to consider different and innovative ways of working. PACS implementation offers an ideal opportunity to reassess working patterns and be at the forefront of truly effective service redesign. PACS Benefits Realisation and Service Redesign Opportunities - 19 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 18 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA)
  • 11. PACS Benefits Realisation and Service Redesign Opportunities - 21 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 20 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Redefined staff roles Improved information flow and knowledge management. Teaching and Learning Audit and Clinical Governance Redesign department processes Service reconfiguration Environment Reduced paperwork in radiology Reduce radiation doses for patients Medico-legal cost savings Improved process time Rapid report availability attached to images BENEFITS General benefits and redesign opportunities PACS will fundamentally alter some departmental staff roles. Instant availability of electronic images means that valuable staff will no longer have to chase film packets and reports meaning that their skills can be better utilised. Clerical and administrative staff and former ‘dark room’ staff are capable of taking enriched roles and are able to take up opportunities to undertake studies to extend their roles. The Changing Workforce Program has evidence of such changes. PACS will allow for improved information flow. It will also contribute to a comprehensive patient record, leading ultimately to an improved quality of care for the patient. Paper records will be superseded by electronically transferred data in a timely and dynamic fashion. Digital projection, MDTs, Smart Board, cascade learning, lecture preparation and medical photography. Consistent image display for clinical conferencing Dicom 14 and Integrated Healthcare Enterprise (IHE). The hospital’s IT and departmental IT networks may have to be redesigned alongside both physical and geographical redesign efforts. Future planning. The potential for choice for patients improving the quality of care; images available at any time anywhere would make this more feasible. Image, report and opinion availability leads to more flexible reconfiguration. Physical layout and COSHH needs to be considered. Designing the appropriate environment around PACS leads to an improved clinical environment and more staff satisfaction. The environment is improved due to reduced Health and Safety risk. PACS implementation means that there is no longer a need for transferral of paper based information. This effects the typing of reports referrals into the service and booking of appointments. Redesigned acquisition phase of imaging. There are less repeat images and therefore the potential for lower patient dose. Digital images easily located and dropped onto CD ROM. There are medico legal cost savings, images are now presented on a CD ROM. The improved process times involved when PACS is introduced can lead to a more streamlined service in general. Results include the potential for reduced length of stay and cross modality streamlined processes. Redesign of RIS around PACS (and network) including interface, electronic diary, post exam screen, clinical comments etc. The reports for images are now available with the images, across the network involved close linking of RIS and PACS. REDESIGN LINKS Speed and ease of MDTs Remote reporting Release of storage space Multiple location image availability and rapid reporting turnaround times Comparison and availability of previous studies Staff development IT literacy Teaching, audit and research Electronic links to other Trusts and organisations Communication with other departments Preparation for MDTs Medico-legal cost savings Outsourcing reporting Security of images Clinical Governance BENEFITS PACS, with appropriate structure, applications and links across a whole health care community can lead to fully informed MDT meetings. Reports for images can be generated from remote areas allowing images to be accessed by appropriate experts wherever they are and therefore quality reports to be sent rapidly back to the referrer. Physically, PACS releases significant space with the removal of old equipment and minimal space required for the storing of images. Network upgrade and appropriate workstations. Work-list production and PACS reporting room. Increasing the number of PCs for viewing around the hospital means that images are available quickly. The production of a work- list and a PACS reporting room allows for faster reporting. There are benefits from links to other centres, with image transmission externally. Centralised reporting is possible and radiologists could report across health communities, with easier access to specialist opinion. PACS allows an easier comparison when previous studies are available digitally, the early availability of such images saves a significant amount of staff time and frustration. There is a need for staff development such as European Common Driving License ECD ROML, for IT. A museum archive. There is a great improvement in the availability of images for teaching because of the archive. Improved way of delivering education and passing on knowledge, more easily accessible and quicker links. Image transmission externally across healthcare community. PACS allows for rapid transfer of images and reports in a timely package, hence providing efficient and effective communication. Data preparation can be carried out quickly and effectively by both clerical and clinical staff. CD ROM. Legal cases images are produced on CD ROM quickly from archive where available. Cost savings achieved. CD ROM or direct image transfer. There is the potential for outsourcing reporting, if direct PACS links are not available then images can be transferred to CD ROM. Back-up processes. There is security for images and a back up process which builds in resilience. Need for excellent PACS manager. Robust contingency planning in line with clinical governance. Future planning. REDESIGN LINKS The readers attention is drawn to the following document: PACS Practical Experiences
  • 12. PACS Benefits Realisation and Service Redesign Opportunities - 23 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 22 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Section 3 Lessons learned This document would not be complete if we did not acknowledge that along with the vast array of benefits that accompany the implementation of PACS, there are also aspects that were identified by the representatives from the participating sites, as lessons learned. This section is a record of these issues. The representatives were asked what they have learned and what they would have done differently.
  • 13. PACS Benefits Realisation and Service Redesign Opportunities - 25 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 24 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Benefits Realisation – Time Scales Benefits realised will depend upon where you are now with respect to electronic processes, equipment, staffing and space. Not all benefits will be realised instantaneously, some cost benefits may only become apparent after a period of time. Some benefits attributed to different ways of working may be realised immediately. Upfront Cost Implications There are local cost implications: • A good, electronic network system throughout the unit or healthcare community. • Sufficient PC workstations and clinical viewing stations. • A dedicated PACS manager. New Ways Of Working There is a need to consider the redesign of the existing department. Space will be released and there will need to be space for specific activities such as reporting. However, lessons from the sites suggest that there will need to be innovative thinking about how and where activities take place. Many users have found an air- conditioned digital reporting room to be an excellent resource for increasing efficiency in reporting and as a learning environment for staff. • What is the best way to work with a new digital system? • What challenges exist for altering traditional ways of doing things? These are challenges across the entire patient process from referral to report disseminated. Transition Issues This issue has become very apparent around Multi Disciplinary Team meetings, especially where there is cross-site involvement. Where the technology differs from one site to another there are issues to consider with respect to viewing images at MDTs, how the images will be supplied and equipment necessary to view them. Thought needs to be given to digital equipment and image management when equipment belongs to a department not linked to PACS. How will everything be linked up? For example, ultrasound examinations performed on equipment not directly linked to a main PACS department. Supportive Technology Voice recognition systems are seen as a potential positive innovation. Evidence suggests that there are some excellent systems available, the concept is well supported and its benefits acknowledged. PACS/RIS Links and interfaces have been identified as one of the main difficulties to overcome . Redesign associated with implementing voice recognition will bring about: • Changes in the role of the radiology secretary. • Improvements in reporting times. • Real time reporting. Role Redesign It is important to consider early on what impact PACS implementation will have upon the way in which people will be working. One of the most obvious areas is that of clerical and administrative roles. It is crucial to plan for different ways of working and it has been the experience of some departments that some staff can potentially be ‘displaced’. Additional Staff, such as a system administrator will be required, the role of radiology secretary may well change with the introduction of a voice recognition system. • Identification of the impact on staff roles should be carried out at an early stage. • Consider staff opportunities for redeployment. • Continuous good quality communications is essential. • Early involvement of the Human Resource department is important. Work-life Balance The potential for stress emanating from an alleged 24-hour availability was identified. Unless expectations are managed, the work-life balance can be disturbed. There is the potential for an unlimited call on an individuals time. There needs to be an established, accepted way of working, including flexible working using ‘at home’ technology. This could be managed by establishing protocols for ‘at home working’ Additionally it may prove to be an advantage to support flexible working using at home technology. Unsuitable New Accommodation One site in particular recognised that unsuitable new accommodation can have a serious effect on the working environment with PACS; there is a need to consider all aspects of implementation for PACS. For example, appropriate air conditioning in PACS reporting areas. Risk Assessment of all areas with major equipment installations is advisable. There is a need for security of areas with several expensive workstations. There is a need to establish fireproof status and process controls for computer server rooms. Protocols Establishing protocols at an early stage was seen as beneficial to avoid certain pitfalls, examples include: • Clinical colleagues acting on all electronically routed images before the formal report is available means that operator errors can go unquestioned. • Where radiology is a ‘gate keeping’ service the rapid return of reports is not to everyone’s satisfaction. General Comments Several general comments from a less tangible aspect were alluded to, but the sites recognised them as real. They included work rates for radiologists and secretaries; these could begin to increase without necessarily being recognised. Also included were: • Loss of autonomy and control. • Lack of urgency where there is no visible workload, means, no piles of paper and images. • There is potential for de-skilling with a completely digitised system. There is a need to have plenty of staff information about what’s happening and issues and concerns, and to involve staff across the organisation. Lessons Learned
  • 14. PACS Benefits Realisation and Service Redesign Opportunities - 27 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 26 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Section 4 The bigger picture - organisational benefits This section includes benefits specifically related to the wider organisations. It includes benefits linked to inpatients and outpatients, primary care and specifically changing workforce issues.
  • 15. PACS Benefits Realisation and Service Redesign Opportunities - 29 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 28 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Inpatient benefits Outpatient benefits Primary care benefits • Quicker reporting turnaround times, dependant on local circumstances – reports attached to images • Images available instantly between departments • No lost images • Near patient image viewing e.g. bedside, theatre, clinics and GP surgeries • Home access on-call – expert advice at the most appropriate time • Public expectation, reports and images available at any point through the patient’s journey • Elimination of wasted junior doctors time, less searching for forms and reports • Consistency of comparability of images. • Quicker reporting turnaround times dependant on local circumstances • No lost images • Near patient image viewing • Public expectation, reports and images available at any point through the patients journey • Improved quality of image, image manipulation • Reduced dose to patient • Streamlined patient processes in department • Reduced waiting times for appointments, radiology and operations • Increased patient satisfaction • Ease of consultation between clinicians, simultaneous viewing of images • Choice for patients, Choice of location for treatment • Reduced transport costs between sites • Improved knowledge management – up to date information and results for patients allowing appropriate patient management decisions. • Reports attached to images, comprehensive patient imaging record available • Shorter reporting times and more rapid turn around times • Aids audit and clinical governance, continuity of care • Multiple viewing of images at different destinations simultaneously • Near patient image viewing in GP surgery • Security of images, images held together centrally • Home access ‘on-call’ to give expert advice at most appropriate time • Public expectation, images and reports available at any stage of patients journey • Service reconfiguration, address demand and capacity issues • Supports the development of full ICRs in line with comprehensive patient records • Choice for patients- potentially cross site availability of electronic images, contributes to patients desire to exercise choice of location for treatment • Improved knowledge management – up to date information and results for patients allowing appropriate patient management decisions. Changing workforce Emergency care patients Daycase patients • Redefined staff roles • Teaching and learning • Redefined clerical roles, the PACS system has altered the way in which the clerical staff need to work • Clerical and darkroom staff are now helpers and assistants • Role redesign for some staff. Staff have new roles as receptionists and helpers • Instant availability of images means valuable staff do not chase films, packets and reports, they can be utilised more effectively elsewhere • An Imaging support worker (formally a darkroom technician) became assistant practitioner. • Shorter reporting times potential for more rapid turn around times • No lost images • Home access ‘on-call’ to give expert advice at most appropriate time • Communication with other departments • Rapid image availability • Clinical outcome under IRMER • Improved knowledge management - up to date information and results • No plastic wallets • Ease of consultation between clinicians, simultaneous viewing of images • Clinicians assisted quick viewing of images • Elimination of wasted junior doctors time, less searching for forms and reports • Contribution to reduced length of stay • Reports attached to images, comprehensive patient imaging record available • Near patient image viewing in A&E and theatres • Improved working lives of staff • Reduced paperwork • Redefined department workflows • Healthcare efficiency • Redefined staff roles. • Shorter reporting times potential for more rapid turn around times • No lost images • Improved communication with other departments • Consistency of comparability of images • Improved knowledge management - up to date information and results • Linking modalities • Near patient image viewing eg bedside, theatre, clinics and GP surgeries • Ease of consultation between clinicians, simultaneous viewing of images • Clinicians assisted rapid availability • Elimination of wasted junior doctors time, less searching for forms and reports • Reports attached to images, comprehensive patient imaging record available • Choice for patients - potentially cross site availability of electronic images contributes to patients desire to exercise choice of location for treatment • Healthcare efficiency. Organisational benefits
  • 16. PACS Benefits Realisation and Service Redesign Opportunities - 31 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 30 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Section 5 Strategic benefits PACS has the potential to be a strategic asset in the delivery and the management of healthcare. It has ramifications for the comprehensive patient record with a service that will not only support the day to day management of diagnostic services, but also allow access to information and knowledge out of hours, at all times at any destination. PACS will contribute to improved service standards of delivery and outcomes, and also contribute to improving value for money with processes that are more streamlined and less wasted time in the system. Diagnostics are an integral part of a patient’s journey through healthcare, PACS will enhance the performance in this area and increase the effectiveness of healthcare delivery, where accompanied by rigorous service redesign. PACS can support1 : • A balanced range of services which promote health and well-being and tackle health inequalities. • Ensuring safe and high quality care, with an increasing element of choice for the patient (the right care) • Fast and convenient (at the right time) • Ending delays at all stages of the elective and emergency system Improved patient choice could include the availability of images and reports in: • Walk in Centres • Treatment Centres • Minor Injury Units • One-Stop Clinics • Expanded GP Practices A community wide storage of digital images, based on practicality and affordability will aid successful collaborative care from multi- disciplinary teams. 1 Ref (PACS programme strategy 2nd September 2003.)
  • 17. PACS Benefits Realisation and Service Redesign Opportunities - 33 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 32 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Section 6 Future vision and direction All Diagnostic Specialities linked: PACS needs to be wider than one or two specialities. In principle, any diagnostic service that produces digital images could make excellent use of PACS technology. This would mean that the entire imaging record of the patient could be available at all times at any destination. Access to Specialist Opinion PACS would enable immediate access to specialist opinion not only across the NHS but also globally. Two areas that have been proposed as benefiting from this approach directly would be paediatric medicine and neurosciences. There are, of course, many more potential beneficiaries here, but some early thoughts have been around these two. Other beneficiaries would include: • Medical illustration • Dermatology • Endoscopy • Electro-physiology • Pathology • Ophthalmology There is also the potential for PACS to play a part in Computer Aided Diagnosis (CAD) and wireless technology. Teaching and Training The ability to access images and reports for teaching and training purposes is a huge positive aspect of PACS. There is a massive potential for learning and sharing across the whole of the NHS. With digitised information being able to be retrieved at any accredited training centre, and the advent of the new training academies for radiology, this potential offers an excellent training and teaching resource. Reporting Outsourcing Where a department requires assistance with reporting workload it is possible that reporting could be outsourced, to assist with the flow of diagnostic patients. Obviously, quality assurance needs to be in place, and departments need to be able to demonstrate their own lack of capacity in this area to warrant reporting outsourcing. Central Files SHAs with centralised files storage, data warehousing. Instant accessibility at all times.
  • 18. PACS Benefits Realisation and Service Redesign Opportunities - 35 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) 34 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Section 7 NHS Plan delivery The group believed that it was important to demonstrate that the implementation of PACS not only benefits the NHS in general ways, as in section 1, but also benefits the NHS in very specific ways in relation to the most prominent of the government targets. This section is an attempt to link some of the benefits to such targets. The list of targets is extensive and we have endeavoured to cover many aspects in quite a detailed way. The relevant target is listed clearly, at the beginning of each section, allowing the reader to skip from one target to another or to read the text in its entirety.
  • 19. 36 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Targets listing: (For detailed explanation of targets please see page numbers) PACS and Service Redesign can assist with the delivery of the following targets. Local Development Plans (LDP) Access: T1 Maximum wait in A+E - p37 T6 Pre-booked admission offering patient choice - p37 Cancer: T7 Maintain cancer waiting times leading to maximum waits of 1-2 months by December 2005 - p37 T9 Extending breast screening for all women 65-70 years of age - p37-38 Coronary Heart Disease: T12 Improve access and increase patient choice by achieving a 2-week wait for rapid access chest pain clinic - p38 T15 Improved management of patients with heart failure - p38 Emergency Hospital Admissions: T23 Less than 1% growth each year in emergency hospital admissions - p38 IM+T Capacity: - Access to Knowledge sources - p38-39 - Results reporting - Access to clinical records NHS Plan and National Cancer Plan Cancer Waiting Time Targets 2004, 2005, 2008 - p39- 48 Cancer Plan: - Save more lives - Patients with cancer to get professional support - Better use of skills of existing staff - Redesigning services - Earlier detection - Faster diagnosis and treatment - Consistent high quality services - Improved quality of life through better care - Streamlining process of care - Reduce waiting times - Education and research - New technologists - Easy access to up to date accurate information - Co-ordination and continuity of care - Expert advice formal reviews - Increased capacity through new ways of working - Improve working times of NHS staff - Multi disciplinary training and effectiveness - New ways of working in partnership, access to latest expertise and technology - Improve quality of services and minimise errors - Timely discharge into appropriate facilities Choice Agenda (DOH) - p48-52 Choice for patients summer 2004, December 2005. A+E 4 hour wait - p52 PACS Benefits Realisation and Service Redesign Opportunities - 37 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Benefits linked to targets National Access Trgets: Access • Efficient utilisation of PACS is critical to delivery of the NHS Plan target for 2008, that patients begin their hospital treatment a maximum of 18 weeks from the point of referral. • PACS facilitates the concept of choice in imaging services by enabling image services to be provided and reported on in primary care. • Improved access to diagnostic imaging services is also critical to achievement and sustained delivery of current access targets for 2005. A&E • Around one third of all patients attending A&E require an imaging test, particularly x-ray. • Rapid access to diagnostic imaging and reporting is therefore critical to sustained delivery of the four hour target. Outpatients • Imaging services provided in primary care and linked through PACS for reporting purposes - will enable more patients to be seen, diagnosed and treated in primary care. • This will significantly reduce the number of outpatient appointments and therefore outpatient waits. Inpatients • PACS enables remote reporting and therefore the potential of many imaging tests being undertaken in primary care settings (dependent upon expansion of practitioner roles and sensible location of equipment in addition to the existing secondary care base - potential for formation of imaging service networks across health communities). • This could reduce unnecessary hospital inpatient episodes, and current practice whereby patients are admitted to hospital in order to gain speedier access to imaging services. Local Development Plan Targets: Access T1 Reduce to 4 hours maximum A&E wait, from arrival to admission, transfer or discharge, by March 2004 for those trusts who have completed Emergency Services Collaborative, and by the end of 2004 for all others: • Reports attached to image, comprehensive patients imaging record available. • Benefits to other departments, other departments able to remotely access relevant images and reports for patients. • Clinicians assisted, quick viewing of images and previous images instantly available. • Reduced waiting times within departments, due to streamlined processes. • A&E waiting times reduced, images quickly available, quicker reporting. • Near patient image viewing. • Home access on-call, clinicians can successfully work from home where appropriate, to give expert advice at the most appropriate time. T6 Increase the level of choice in each year, offering routine choice of hospital provider at point of booking for all patients by December 2005: • Consistency of comparability of images. • Service reconfiguration – image availability and transportability • Choice for patients, potentially the cross-site availability of images and reports can contribute to the patient’s desire to exercise choice of location for treatment. Cancer T7 Maintain existing Cancer working time standards and set local waiting time targets for 2003/4 and 2004/5, so that by the end of 2005 there is a maximum one month wait from the diagnosis to treatment and 2 months from the urgent referral to treatment of all cancers: • Reports attached to image comprehensive patients imaging record available. • Improved quality of image, image manipulation, allowing reporting clinicians more versatility for image viewing for diagnosis. • Aids audit, clinical governance, readily available images and reports, continuity of care. • Rapid image availability and multiple viewing of images.
  • 20. T15 Improve management of patients with heart failure in line with the NICE Clinical Guideline due in 2003, and set local targets for the consequent reduction in patients admitted to hospital with a diagnosis of heart failure. • No lost images, image and reports instantly available at any destination. • Benefits to other departments, other departments able to remotely access relevant images and reports for patients. • Reduced waiting times for appointments and times within the department. • Opportunity for quicker reporting in A&E – potentially less admission. • Home access on call, clinicians can successfully work from home where appropriate, to give expert advice at the most appropriate time. • Elimination of wasted junior doctor time, images available for doctors at multiple locations. • Consistency of comparability of images. • Improved knowledge management, up to date information and results for patients allowing for appropriate patient management decisions. Emergency Hospital Admissions T23 Each year there will be less than 1% growth in re-admissions • Consistency of comparability of images. • Improved knowledge management, up to date information and results for patients allowing for appropriate patient management decisions. • Rapid image availability, multiple view of images in various locations simultaneously. • Near patient image viewing, eg A&E. theatres. • Home access on-call, clinicians can successfully work from home where appropriate, to give expert advice at the most appropriate time. • A&E waiting time reduced, images quickly available, opportunity for quicker reporting. IM+T Capacity Assumptions Electronic records - Access to knowledge sources - Results reporting (including pathology and radiology) - Access to clinical records • No lost images • Reports attached to images- comprehensive record • Benefits other departments, able to remotely access relevant images and reports • A&E time reduced, images quickly available, opportunity for quicker reporting • Teaching, image available in PACS fashion, transportable, access to specialist opinion • Research, long term availability of a comprehensive set of images and reports for patients, will aid those carrying out research • Links to other centres • MDT meetings • Near patient image viewing • Security of images • Home access on-call, clinicians can successfully work from home, give expert advice at the most appropriate time. • Ease of consultation between clinicians, aiding decision making • Improved knowledge management, up to date information and results for patients, allowing appropriate management decisions. Cancer waiting times targets 2004 Every patient diagnosed with cancer will benefit from pre-planned and pre booked care. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS will aid service reconfiguration and assist in addressing some demand and capacity issues. • Sharing capacity for examinations and reporting, potentially with electronic transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. Cancer waiting times targets 2004 Maximum two-month wait for first outpatient appointment for patients referred urgent for suspected cancer by a GP. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potential with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. Cancer waiting times targets 2005 Maximum two-month wait from urgent GP referral for suspected cancer to first treatment for all cancers by 2005. • MDT meetings. • Healthcare efficiency, diagnosis procedure becomes much more streamlined leading to more effective and efficient hospital treatment. • Public expectation – patients now expect their images and reports to be available at any stage of their journey and in an appropriate time scale. • Ease of consultation between clinicians, consult in real time, viewing images simultaneously. • Improved knowledge management, up to date information and results, appropriate management decisions. T9 Extending breast screening to all women aged 65 – 70: • No lost images, images and reports instantly available to clinicians at any destination. • Improved quality of image, image manipulation allowing clinicians more versatility for image viewing for diagnosis. • Redesigned department and workflow, streamlined patient processes • Reduced working times for appointments and time within departments • Research, long-term availability of a comprehensive set of images and reports. • MDT meetings. • Service reconfiguration, image availability and transportability, address demand and capacity issues. • Improved knowledge management, up to date information and results for patients allowing for appropriate patient management decisions. Coronary Heart Disease. T12 Improve access to services across the patient pathway, and increase patient choice by achieving the two week wait standard for Rapid Access Chest Pain Clinics; setting local targets to make progress towards the NSF goal of a 3 month maximum want for angiography; and delivering maximum waits of 3 months for revascularisation by March 2005, or sooner if possible: • Reduced waiting times for appointments and reduced waiting times within the department. • Service reconfiguration, image availability and transportation, address some demand and capacity issues. • Choice for patients. 38 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 39 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potential with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. Cancer waiting times targets 2005 Maximum one-month wait from urgent GP referral to treatment for children’s, testicular cancers and acute leukaemia by 2005. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging, posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds or patients in GP surgery.
  • 21. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds or patients in GP surgery. Cancer waiting times targets 2005 Maximum one-month wait from diagnosis to first treatment for all cancers by 2005 • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment and patient flow and more effective primary care. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Near patient image viewing i.e. patients in clinical cubicles or beds or patients in GP surgery. Cancer waiting times targets 2008 No patient with suspected cancer will wait longer than one month from urgent GP referral to treatment • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment and patient flow and more effective primary care. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Near patient image viewing i.e. patients in clinical cubicles or beds or patients in GP surgery. Executive summary 2 The Cancer Plan sets out the first comprehensive national cancer programme for England. It has four main aims: to save more lives… • Shorter reporting times, images initially available no manual handling of analogy images. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinician at any destination. • Radiographer led ultrasound examinations. • Improved process times for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Near patient image viewing i.e. patients in clinical cubicles or beds or patients in GP surgery • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Aids audit, clinical governance, ready availability of images and reports and continuity of care. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment and patient flow and more effective primary care. Cancer waiting times targets 2005 Maximum two-month wait from urgent GP referral to first treatment for breast cancer. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy/mammography. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds or patients in GP surgery. Cancer waiting times targets 2005 Maximum one-month wait from diagnosis to first treatment for breast cancer • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potential with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment, patient flow and more effective primary care. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy/mammography. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT. 40 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 41 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Executive summary 2 The Cancer Plan sets out the first comprehensive national cancer programme for England. It has four main aims: – to ensure people with cancer get the right professional support as well as the best treatments • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process times for fluoroscopy procedures. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Near patient image viewing i.e. patients in clinical cubicles or beds or patients in GP surgery. • Electronic links to other Trusts and organisations. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Teaching, image available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academy. Access to speciality opinion and teaching will be possible. • Aids audit, clinical governance, ready availability of images, reports and continuity of care. Executive summary 28 Investment in staff and equipment the introduction of these new targets will be supported by investment to tackle key gaps in the cancer workforce and make better use of the skills of existing staff, investing in extra equipment for diagnosis and treatment, and action to redesign and streamline existing services to cut out delays. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Aids audit, clinical governance, ready availability of images and reports and continuity of care • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting.
  • 22. • Reduced waiting times, appointments and time within department, streamlined process which lead to more efficient service procedure at appointment stage and on day of diagnostic test. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academy. Access to speciality opinion and teaching will be possible. • Service reconfiguration, the image availability and transportability of PACS will aid service reconfiguration will result to demand and capacity issues. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Proportion of “helper” time spent with patients, streamlined procedure and reduced none value added work allowing worker to spend quality time with patients. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. The challenge of cancer 1.17 However, there are some key challenges that must be met if the NHS is to provide world-class cancer care: ….faster diagnosis and treatment…. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinician at any destination. • Shorter reporting times, images initially available no manual handling of analogy images. • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very different. • Reduced waiting times, appointments and time within department, streamlined process which lead to more efficient service procedure at appointment stage and on day of diagnostic test. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Proportion of “helper” time spent with patients, streamlined procedure and reduced none value added work allowing worker to spend quality time with patients. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment, patient flow and more effective primary care. The challenge of cancer 1.17 However, there are some key challenges that must be met if the NHS is to provide world-class cancer care: ….consistent high quality services…. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very differently. • Reduced waiting times, appointments and time within department, streamlined process which lead to more efficient service procedure at appointment stage and on day of diagnostic test. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Teaching, image available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Aids audit, clinical governance, ready availability of images, reports and continuity of care • Shorter reporting times, images initially available no manual handling of analogy images. • Staff development (IT literacy), staff need to be fully conversed with the IT system that produces, manipulates and transfers images, this will lead to staff competence and confidence. Executive summary 31 Redesigning services, new investment alone is not enough. Services need to be streamlined, and new approaches are needed to make best use of skills in the cancer workforce • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very different. • Aids audit, clinical governance, ready availability of images and reports and continuity of care. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles, beds or patients in GP surgery. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment, patient flow and more effective primary care. The challenge of cancer 1.17 Nevertheless, there are some key challenges that must be met if the NHS is to provide world-class cancer care: ….earlier detection….. • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very differently. 42 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 43 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) • Proportion of “helper” time spent with patients, streamlined procedure and reduced none value added work allowing worker to spend quality time with patients. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment, patient flow and more effective primary care The challenge of cancer 1.17 However, there are some key challenges that must be met if the NHS is to provide world-class cancer care: ….improved quality of life through better care... • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Reports attached to image comprehensive patient’s imaging record available. • Catalyst for IT staff training. • Elimination of wasted junior doctors time re film management, junior doctors will not have to chase images and reports, they will be available at the destination of the junior doctor. • Reduction of manual handling (film packets and chemistry). • Reduced phone calls, less interruption about queries regarding reports or images. • Ease of consultation between clinicians, clinicians can consult in real time with the ability to view images simultaneously. • No chemicals (COSHH), reduced hazard to staff and reduced costs. • Financial savings, there is potential for financial savings in the area or more appropriate use of staff cost saving on chemistry and machine maintenance however these benefits must be viewed against original capital out lay and costs.
  • 23. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. The challenge of cancer 1.19 Reduce waiting times for cancer treatment – recognising the urgency of the condition…. • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very differently. • Reduced downtime of equipment compared to chemical “processing,” less equipment maintain and less equipment fail Reducing downtime in equipment. • Reduced waiting times, appointments and time within department, streamlined process which lead to more efficient service procedure at appointment stage and on day of diagnostic test. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy procedures. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. The challenge of cancer 1.19 To prepare for the future through education and research….. • Aids audit, clinical governance, ready availability of images, reports and continuity of care. • Links to other centres, especially useful for such events as MDT meetings. • Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Shorter reporting times, images initially available no manual handling of analogy images. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. Improving screening 3.13 New technologies may assist the screening process. The NHS Breast Screening Programme is to publish the results of a working party group which has reviewed Computer Aided Detection in breast screening. We are closely monitoring other new technologies such as digital mammography, on-site processing of mammograms and new innovative designs for screening vans and will refer them to NICE for appraisal, if appropriate. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Reduction of manual handling (film packets and chemistry). • Reduced phone calls, less interruption about queries regarding reports or images. • Improved clinical environment. • Communication with other departments, instant information transferred electronically across single or multiple organisations • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Aids audit, clinical governance, ready availability of images and reports and continuity of care. • Reduced waiting times, appointments and time within department, streamlined process which leads to a more efficient service procedure at appointment stage and on day of diagnostic test. • Proportion of “helper” time spent with patients, streamlined procedure and reduced none value added work allowing worker to spend quality time with patients. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment, patient flow and more effective primary care. • Shorter reporting times, images initially available no manual handling of analogy images. The challenge of cancer 1.19 Shorten the time taken to diagnose cancer by streamlining the process of care and investing more in equipment and staff…. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Staff retention. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy procedures. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. 44 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 45 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) • Ease of consultation between clinicians, clinicians can consult in real time with the ability to view images simultaneously. • No chemicals (COSHH) reduced hazard to staff and reduced costs. • Improved clinical environment. • Communication with other departments, instant information transferred electronically across single or multiple organisations. Improving Treatment 6.7 A consistent theme in the “improving outcomes” guidance is that cancer services are best provided by teams of clinicians – doctors, nurses, clinical staff and other specialists – who work together effectively. Team working brings together staff with the necessary knowledge, skills and experience to ensure high quality diagnosis, treatment and care. It also improves the co- ordination and continuity of care for patients. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Shorter reporting times, images initially available no manual handling of analogy images. • Aids audit, clinical governance, ready availability of images, reports and continuity of care. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Links to other centres, especially useful for such events as MDT meetings. • Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment, patient flow and more effective primary care.
  • 24. • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. Investing in Staff 8.32 Increased Capacity through new ways of working these initiatives to increase the number of staff in training will ease the pressures on the cancer workforce and improve the service to patients. But further action is needed to tackle problems in specific areas, notably diagnostic and therapeutic radiography. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Sharing capacity for examinations and reporting, potentially with electrical transfer of images a balance may be struck with respect to peaks and troughs of demand for reporting. • Healthcare efficiency, diagnosis procedures become much more streamline leading to more effective and efficient hospital treatment, patient flow and more effective primary care. Investing in staff 8.41 The NHS Plan sets out wide-ranging new initiatives to improve the working lives of NHS staff which will benefit cancer staff. Improving the working lives of staff contributes directly to enhance cancer services through improved recruitment and retention. Offering new opportunities for development and extended roles will open up new career opportunities for staff that have previously faced restriction and dead ends. • Reduction of manual handling (film packets and chemistry). • Improved working environment, no chemistry no wasted tasks (film hunting) more physical space(overall future requirement may be for less physical space leading to reduced capital costs), rooms fit for purpose (e.g. reporting) less manual handling. • Retention of staff. • Catalyst for IT training. • Elimination of wasted junior doctors time re film management, junior doctors will not have to chase images and reports, they will be available at the destination of the junior doctor. • Reduced phone calls, less interruption about queries regarding reports or images. • Ease of consultation between clinicians, clinicians can consult in real time with the ability to view images simultaneously. • No chemicals (COSHH), reduced hazard to staff and reduced costs. • Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Financial savings, there is potential for financial savings in the area or more appropriate use of staff cost saving on chemistry and machine maintenance however these benefits must be viewed against original capital out lay and on costs. • Improve clinical environment. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible • Aids audit, clinical governance, ready availability of images, reports and continuity of care •Staff development (IT literacy), staff need to be fully conversed with the IT system that produces, manipulates and transfers images, this will lead to staff competence and confidence. • Prestige. Investing in staff 8.51 Education and training for cancer staff will need to underpin cancer network workforce strategies. All cancer service providers will be required to draw up a written training strategy for cancer clinicians, both medical and non-medical. Multi-disciplinary training will support and develop the effectiveness of the specialist multi-disciplinary teams providing cancer care. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Shorter reporting times, images initially available no manual handling of analogy images. Improving Treatment 6.11 The care of all patients with cancer should be formally reviewed by a specialist team. This will be done either through direct assessment or through formal discussion with the team by the responsible clinician. This will help ensure that all patients have the benefit of the range of expert advice needed for high quality care. The delivery plans to be prepared by the cancer networks should set out a timetable for the achievement of this standard. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Shorter reporting times, images initially available no manual handling of analogy images. • Aids audit, clinical governance, ready availability of images, reports and continuity of care. • Improved quality of image, excellent digital acquisition systems, reduced repeat images due to poor quality. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Links to other centres, especially useful for such events as MDT meetings. • Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research . • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very differently. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Reduced waiting times, appointments and time within department, streamlined process which leads to more efficient service procedure at appointment stage and on day of diagnostic test. • Proportion of “helper” time spent with patients, streamlined procedure and reduced none value added work allowing worker to spend quality time with patients. 46 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 47 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) • Aids audit, clinical governance, ready availability of images, reports and continuity of care. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Links to other centres, especially useful for such events as MDT. • Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible. • Improved knowledge management, up to date information and results for patients convenience available allowing for appropriate patient management decisions. • Staff development. • Prestige. Investing in facilities 9.10 In implementing this expansion, we will explore the scope for public private partnerships with service providers and the industry, particularly in relation to pathology and imaging. Where new ways of working offer advantages to patients, they need to be implemented. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues.
  • 25. • Improved quality of image, excellent digital acquisition systems, reduced repeat images due to poor quality. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Public expectation, patients now expect their images and reports to be available at any stage of their journey and in an appropriate time scale. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Choice for patients, potentially the cross-site availability of electrical images and reports can contribute to patient’s desire to exercise chose of l ocation for treatment. • Comprehensive patient record. All patients who may require planned surgery will be offered a choice of four or five hospitals or providers when they are referred by their GP (From Dec 2005) • Shorter reporting times, images initially available no manual handling of analogy images. • Improve process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Choice for patients, potentially the cross-site availability of electrical images and reports can contribute to patient’s desire to exercise chose of location for treatment. • Comprehensive patient records. • Patient satisfaction, high quality intervention at appointment times by appropriate people based on images available. MA document Radiology National Framework for Service Improvement – support redesign in diagnostic imaging and extend the role of healthcare professionals • Shorter reporting times, images initially available no manual handling of analogy images. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Teaching, images available in PACS mode will be extremely versatile and transportable for teaching purposes especially in training academies. Access to speciality opinion and teaching will be possible • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Improved knowledge management, up to date information and results for patients convenience available allowing for appropriate patient management decisions. • Retention of staff. • Staff development (IT literacy), staff need to be fully conversed with the IT system that produces, manipulates and transfers images, this will lead to staff competence and confidence. Investing in facilities 9.12 These new partnerships will extend over a number of NHS organisations rather than being restricted to a single NHS Trust. Public private partnerships offer new ways to organise services in a way which improves services for patients and provides them with access to the latest expertise and technology where and when they are required. • Shorter reporting times, images initially available no manual handling of analogy images. • Radiographer led ultrasound examinations. • Improve process time for fluoroscopy. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very differently. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Communication with other departments, instant information transferred electronically across single or multiple organisations. Non Referenced The supportive and palliative care guidance recommends that patients and carers are offered high quality information materials, tailored to their individual needs, at appropriate points in the care pathway • Patient satisfaction, high quality intervention at appointment times by appropriate people based on images available. Choice Agenda (DOH) All patients waiting over six months for surgery will be offered a choice of moving to another hospital or provider (Summer 2004) • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. 48 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 49 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) NHS Cancer Plan (DOH) Preface 5 – The NHS will work continuously to improve quality services and to minimise errors. The NHS will ensure that services are driven by a cycle of continuous quality improvement. Quality will not just be restricted to the clinical aspects of care, but include quality of life and the entire patient experience. Healthcare organisations and professions will establish ways to identify procedures that should be modified or abandoned and new practices that will lead to improved patient care. All those providing care will work to make ever safer, and support a culture where we can learn from and effectively reduce mistakes. The NHS will continuously improve its efficiency productivity and performance. • Aids audit, clinical governance, ready availability of images and reports and continuity of care. • Shorter reporting times, images initially available no manual handling of analogy images. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinician at any destination. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery. • Research, long term availability of a comprehensive set of images and reports for patients will aid those carrying out research Improved. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Catalyst for IT skills. • Elimination of wasted junior doctors time re film management, junior doctors will not have to chase images and reports they will be available at the destination of the junior doctor. • Reduction of manual handling (film packets and chemistry). • Reduced phone calls, less interruption about queries regarding reports or images. • Ease of consultation between clinicians, clinicians can consult in real time with the ability to view images simultaneously. • No chemicals (COSHH), reduced hazard to staff and reduced costs. • Financial savings, there is potential for financial savings in the area or more appropriate use of staff cost saving on chemistry and machine maintenance
  • 26. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Service reconfiguration, the image availability and transportability of PACS which will aid service reconfiguration will result to demand and capacity issues. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Comprehensive patient records. • Proportion of “helper” time spent with patients, streamlined procedure and reduced none value added work allowing worker to spend quality time with patients. Investing in facilities 4.4 Respondents saw the use of intermediate care as central to this more joined up approach. It should concentrate on maintaining and restoring independence, and on rehabilitation. It would act as a bridge between community and hospital care. Both staff and patients would experience new ways of working which would blur the boundary between primary and secondary care. Specific elements of the new service would include ...timely discharge into appropriate settings… • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Near patient image viewing i.e. patients in clinical cubicles or beds, or patients in GP surgery • Shorter reporting times, images initially available no manual handling of analogy images. • Contribution to decreased length of patient stay, images and reports availability at destination in a timely fashion can potential accelerate patient discharge. • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills. • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very differently. • Service reconfiguration, the image availability and transportability of PACS will aid service reconfiguration will result to demand and capacity issues. • Communication with other departments, instant information transferred electronically across single or multiple organisations. Investing in facilities 4.22 NHS staff will also benefit from the investment in new information technology. Staff will get easy access to up- to-date and accurate information on patients’ medical histories. NHS staff will be able to order tests, refer patients and make booking of appointments for patients using new IT. The National Electronic Library for Health will provide electronic access to state-of-the-art information on latest treatments and best practice. This investment will allow for greater efficiency and also for easier access to the information necessary to monitor local performance and practices against national standards and performance indicators. • Supports the development of ICRS, in line with the NPfIT programme for comprehensive patient record. • Communication with other departments, instant information transferred electronically across single or multiple organisations. • Environmental, less background radiology (less unnecessary exposure) less chemistry and pollution. However consider energy use especially where air condition units are required. • Hospital efficiency. Investing in NHS staff 5.5 These are very challenging targets but we must meet them – and, if possible, exceed them – if the NHS is to make the service gains for patients they need. We will achieve them by... improving the working lives of staff. • Reduced stress levels, happier staff, improved process that improves working lives less time wasted in futile tasks. • Reduced phone calls, less interruption about queries regarding reports or images • Redefines staff roles, new ways of working as a result of streamlined process, role enrichment opportunities, better usage of staff skills • Staff retention • Improved working environment, no chemistry no wasted tasks (film hunting) more physical space (overall future requirement may be for less physical space leading to reduced capital costs), rooms fit for purpose (e.g. reporting) less manual handling. • Catalyst for IT skills • Elimination of time wasted for junior doctors. • Reduced manual handling risks • Ease of consultation between radiologists and other clinicians • Improved teaching and research facilities however these benefits must be viewed against original capital out lay and on costs. • Improved clinical environment. • Aids audit, clinical governance, ready availability of images, reports and continuity of care. • Reduced litigation costs, potentially because no films or reports will be lost and images and reports will always be available in a timely fashion for appropriate patient management, this could lead to less litigation costs. • Improved knowledge management, up to date information and results for patients convenience available allowing for appropriate patient management decisions. Investing in facilities 4.4 Respondents saw the use of intermediate care as central to this more joined up approach. It should concentrate on maintaining and restoring independence, and on rehabilitation. It would act as a bridge between community and hospital care. Both staff and patients would experience new ways of working which would blur the boundary between primary and secondary care. Specific elements of the new service would include ...fast access to diagnostics and pathology leading to effective interventions…. • No lost images, less wasted time for staff hunting images and reports. Images and reports instantaneously available to clinicians at any destination. • Shorter reporting times, images initially available no manual handling of analogy images. • Redesign department and workflow, streamlined patient process and improved electrical pathways will allow staff to work very differently. • Image manipulation, allowing reporting clinical more versatile for image viewing for diagnosis. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. • Reduced waiting times, appointments and time within department, streamlined process which leads to more efficient service procedure at appointment stage and on day of diagnostic test. • Clinicians assisted quick viewing of images and previous images instantaneously available. • Radiographer led ultrasound examinations. • Improved process time for fluoroscopy. • Medico-legal images converted to CD ROM, no longer have to pull films physically no packaging posting etc. • Links to other centres, especially useful for such events as MDT meetings. • Multiple viewing of images, numerous specialists in various locations can view images simultaneously. • Rapid image availability wards, clinics, other areas, images remotely available any time any place. 50 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 51 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) • Production of portables images CD ROM • Medico-legal cost savings • Rapid reporting turnaround times • Recruitment and retention • Staff development • Teaching and learning • Electronic links to other Trusts and organisations Investing in NHS staff 5.16 The Improving Working Lives standard means that every member of staff in the NHS is entitled to belong to an organisation that can prove that it is investing in their training and development, tackling discrimination and harassment, improving diversity, applying a zero tolerance on violence against staff, reducing workplace accidents, reducing sick absences, providing better occupational health and counselling services, conducting annual attitude surveys – asking relevant questions and acting on the key messages. Standards and targets have already been established to support these goals. It is now down to NHS employees to deliver them. As a result of the NHS Plan we give their efforts a further impetus. • Improved environment (COSHH) • Reduced manual handling • Reduced telephone calls • Reduced stress levels • Catalyst for IT skills • Redefine staff roles • Teaching and learning • Clinical governance • Training facilities (Academies and local) • Knowledge management • Recruitment Changed systems for the NHS 6.11 Support to design care around patients ... planning the pathway or route that a patient takes from start to finish to see how it could be easier and swifter – every step, from the moment a patient arrives at the GP up to and including when they are discharged. Unnecessary stages for care are removed, more test and treatment are done on a one-stop and day-case basis. • Radiographer led ultrasound examinations • Improved process time for fluoroscopy • Production of portable images CD ROM • Speed and ease of MDT meeting • Simultaneous multi-user access to images and reports • 24 hour availability of images • Electronic link to other Trusts and organisations • Rapid reporting turnaround times • Redefine staff roles • Improved information flow
  • 27. • Rapid report availability attached to images • Image manipulation • Catalyst for IT skills • Elimination of time wasted by junior doctors • Reduced manual handling risks • Reduced telephone calls • Ease of consultation between radiologists and other clinicians • Improved environment (COSHH) • Medico-legal cost savings • Improved clinical environment A & E 4-hour wait • No lost images • Rapid report availability attached to images • Redefine staff roles • Reduced waiting times in department • Reduced downtime of equipment • Radiographer led ultrasound examinations • Increased helper time with patient • Elimination of time wasted for junior doctors • Remote reporting • Image manipulation • Electronic links to other Trusts and organisations • Consistency and comparability • 24 hour availability • Improved information flow • Meeting public expectation • Audit and clinical governance • Redesigned departmental processes • Choice for patients • Shared capacity • Reduced radiation dose for patients • Reduced length of stay • Comprehensive patient record • Politically appropriate • Service reconfiguration • Redesign departmental processes • No lost images • Hospital efficiency Cutting waiting for treatment 12.10 By 2004, no one should be waiting more than four hours in accident and emergency from arrival to admission, transfer or discharge. Average waiting times accident and emergency will fall as a result to 75 minutes. By then we will have ended inappropriate trolley waits for assessment and admission. Of course, some patients such as those emergencies arriving by ambulance will clinically need to be assessed on a trolley, but after that if they need a hospital bed they should be admitted to one without undue delay. • A & E waiting time reduced • Radiographer led ultrasound examinations • Improved process time for fluoroscopy • Production of portable images CD ROM • Speed and ease of MDT meeting • Simultaneous multi-user access to images and reports • 24 hour availability of images • Electronic link to other Trusts and organisations • Rapid reporting turnaround times • Redefine staff roles • Improved information flow • Redesign departmental processes • Service reconfiguration • No lost images Aim A3.1 To transform the health and social care system so that it produces faster, fairer services that deliver better health and tackles health inequalities. • Redefine staff roles • Improved information flow • Redesign departmental processes • Service reconfiguration • Hospital efficiency • Rapid reporting turnaround times • Radiographer led ultrasound examinations • Improved process time for fluoroscopy • Production of portable images CD ROM • No lost images • Speed and ease of MDT meetings • Simultaneous multi-user to access and reports • 24 hour availability of images • Electronic links to other Trusts and organisations • Improved teaching and research facilities 52 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS Benefits Realisation and Service Redesign Opportunities - 53 National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) PACS - Picture Archiving and Communications Systems RIS - Radiology Information System IRMER - Ionising Radiation (Medical Exposure) Regulations COSHH - Control of Substances Hazardous to Health NPfIT - National Programme for Information Technology ICRS - Integrated Care Record System CD-Rom - Compact Disc Read Only Memory CR - Computerised Radiology DR - Digital Radiology MDT - Multidisciplinary Team IHE - Institute of Health Education PC - Personal Computer SHA - Strategic Health Authority IT - Information Technology Glossary of terms PACS Practical Experience www.npfit.nhs.uk/programmes/pacs Radiology: A National Framework for Service Improvement. NHS Modernisation Agency (June 2003) NHS Modernisation Agency radiology website www.modern.nhs.uk/radiology Secondary care booking: towards a fully booked NHS www.modern.nhs.uk/access National Programme for Information Technology (NPfIT) website www.npfit.nhs.uk National Programme for Information Technology (NPfIT) electronic booking website www.chooseandbook.nhs.uk Further reading and key links
  • 28. 54 - PACS Benefits Realisation and Service Redesign Opportunities National PACS Team (NPfIT) and National Radiology Service Improvement Team (MA) Acknowledgements Our thanks go to the following people for their contribution to this report. Dr. Laurence Sutton Consultant Radiologist, Calderdale Royal Hospital, Diane Rooney Service Lead, Calderdale Royal Hospital Mark Rodgers Radiology Service Manager, Calderdale Royal Hospital Glynis Wivell Acting Service Manager, Norwich & Norfolk Helen Clarke PACS Systems Administrator, Norwich & Norfolk Will Smith Radiology Services Manager, Telford Richard Williams PACS Manager, Telford Julie Young Superintendent Radiographer, Telford Douglas Manton Directorate Manager, Derriford Hospital Dr. Graham Hoadley Consultant Radiologist, Blackpool, Fylde & Wyre. National Clinical Lead for Radiology Service Improvement Stewart Whitley Radiology Services Manager, Blackpool, Fylde & Wyre David Dewitt, General Manager X-ray Services, Blackpool, Fylde & Wyre Dr Stephen Davies Consultant Radiologist, Royal Glamorgan Hospital Paul Unsworth Chief Executive Tending PCT Beverly Peacock Director of Finance, Bolton NHS Hospital Trust Keith Smith Branch Head - DH Diagnostic Services Branch Kate Prangley Director of National PACS team Lesley Wright Associate Director - Diagnostics, NHS Modernisation Agency Sue Beckman National Manager for Radiology, NHS Modernisation Agency David Jennings NPfIT PACS Team Report Composition by Sue Beckman, Hannah Bywater and Shirley Steeples

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