PACS - The Role of Digital Imaging

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  • Specifies transactions that function to maintain the integrity of patient, image, and order information across systems
    Integrates modalities with information and imaging systems
    Biggest Value of IHE
    Smooth flow of patient, image and order information across systems
    Status updates of orders
    Integrates modalities with information and imaging systems
  • PACS - The Role of Digital Imaging

    1. 1. PACS - The Role ofPACS - The Role of Digital ImagingDigital Imaging Dr G.M.HoadleyDr G.M.Hoadley National Clinical Lead, RadiologyNational Clinical Lead, Radiology
    2. 2. What is PACS?What is PACS?  P ictureP icture  A rchivingA rchiving  C ommunicationC ommunication  S ystemS ystem
    3. 3. HRM ACUTE TRUST – Core PACS Local PACS Store RADIOLOGY Scanner A&E LAN view ing Monitor Monitor RADIOLOGY RIS Image acquisition viewing CR V DR
    4. 4. HRM ACUTE TRUST – Full PACS : Hospital Wide Local PACS Store MDT RADIOLOGY Scanner Scanner OUTPATIENTS WARDS A&E LAN viewing image acquisition view ing THEATRES Monitor Monitor RADIOLOGY RIS ONCOLOGY
    5. 5. HRM ACUTE TRUST – Stretching PACS : Hospital & Community Wide Local PACS Store MDT RADIOLOGY Scanner OUTPATIENTS WARDS A&E LAN viewing image acquired view ing THEATRES Monitor Monitor RADIOLOGY RIS ONCOLOGY PRIMARY CARE AT HOME/ REMOTE
    6. 6. Enterprise-wide/Health economyEnterprise-wide/Health economy PACS?PACS? ““AA set of technology components used together toset of technology components used together to capture, store, distribute and display any digitalcapture, store, distribute and display any digital medical images, static or moving, and any associatedmedical images, static or moving, and any associated media.media. The solution operates across multiple sites andThe solution operates across multiple sites and multiple Trusts with consistent and seamless capturemultiple Trusts with consistent and seamless capture of, access to and use of digital images by anyof, access to and use of digital images by any healthcare practitioner authorised to do so at locationshealthcare practitioner authorised to do so at locations where they undertake their clinical work, research orwhere they undertake their clinical work, research or education.”education.”
    7. 7. Who is interested in the technologyWho is interested in the technology  DoH / GovernmentDoH / Government  NPfITNPfIT  MA diagnosticsMA diagnostics  FHNFHN  IHEIHE  Commissioning bodiesCommissioning bodies  TrustsTrusts  CliniciansClinicians  IndustryIndustry
    8. 8. M.A.M.A.
    9. 9. 44 Key Areas of Strategy in M.A.Key Areas of Strategy in M.A. Improve Patient Experience New patterns of service delivery Treatment centres PCTs Choice New ways of working Service redesign & improvementNew technologies E Booking Telemedicine Electronic record PACS 4 Tier Structure Radiology Academies Process mapping C & D
    10. 10. Radiological TechnologiesRadiological Technologies  PACSPACS  RISRIS  Speech recognition softwareSpeech recognition software  NHS net – securityNHS net – security Information SharingInformation Sharing  National SpineNational Spine  Electronic Record – Order CommsElectronic Record – Order Comms  StandardsStandards  I.H.E.I.H.E.  DICOMDICOM  TeleradiologyTeleradiology
    11. 11. Technical planningTechnical planning procurement Private public partnerships Changing workforce New Clinical models Building design Technology Change Whole system configuration
    12. 12. Scope and TimescaleScope and Timescale year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 2002/3 2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 PFI Building process DTC development Primary building process Technology procurement Care redesign processes Workforce change 29 large PFI projects phase 1 Projects 42 LIFT projects IT procurement process pilots phase 2 pilots
    13. 13. IINTEGRATEDNTEGRATED CCAREARE RRECORDECORD SSYSTEMYSTEM ICRS PACS EPR RAD REPORTS THE NATIONAL PACS PROGRAMME IS AN INTEGRAL PART OF ICRS
    14. 14. NPfIT FUNDING SCOPENPfIT FUNDING SCOPE ININ  CRCR  ArchiveArchive  Diagnostic WorkstationsDiagnostic Workstations (within Radiology)(within Radiology)  SoftwareSoftware  Web serverWeb server OUTOUT  LANLAN  DRDR  PC’s on wardsPC’s on wards
    15. 15. What is IHE?What is IHE? INTEGRATING HEALTHCARE ENTERPRISEINTEGRATING HEALTHCARE ENTERPRISE  An independent body with representatives from RCR, BIR, COR,An independent body with representatives from RCR, BIR, COR, IPEM, NHSIA, MHRA, IndustryIPEM, NHSIA, MHRA, Industry  Part of a global initiative to promote better interoperability of computerPart of a global initiative to promote better interoperability of computer systems in healthcaresystems in healthcare  Currently radiology and hospital information systemsCurrently radiology and hospital information systems  Based on real workflow processesBased on real workflow processes
    16. 16. What does it do?What does it do? Scheduled workflow patternScheduled workflow pattern::  Takes existing “computer language” standards and definesTakes existing “computer language” standards and defines their use.their use.  Defines the exact use of DICOM and HL7 needed toDefines the exact use of DICOM and HL7 needed to achieve workflow processachieve workflow process  Systems that achieve this can be reliably integrated withSystems that achieve this can be reliably integrated with other “IHE” systems provided they both advertise the sameother “IHE” systems provided they both advertise the same process regardless of manufacturerprocess regardless of manufacturer
    17. 17. images stored patient information RIS examination orders images retrieved HIS PACS procedure scheduled Prefetch any relevant prior studies modality worklist report report Registration Orders Placed Orders Filled Film Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisitionacquisition in-progressin-progress acquisition completed acquisition completed images printed Acquisition Modality Scheduled Workflow ProfileScheduled Workflow Profile
    18. 18. Benefits of this approachBenefits of this approach  A more cohesive workflow process for transfer ofA more cohesive workflow process for transfer of information from HIS to RIS to PACSinformation from HIS to RIS to PACS  Smooth, reliable transfer of information betweenSmooth, reliable transfer of information between computer systems from different companiescomputer systems from different companies  Patient journey can be more efficiently and accuratelyPatient journey can be more efficiently and accurately plannedplanned  Mistakes can be more easily correctedMistakes can be more easily corrected
    19. 19. The futureThe future  This approach will extend beyond radiology toThis approach will extend beyond radiology to areas such as theatres and pathologyareas such as theatres and pathology  The aims will be to facilitate patient workflowThe aims will be to facilitate patient workflow processes by improving computer systemsprocesses by improving computer systems interoperabilityinteroperability  a patient (user) driven approacha patient (user) driven approach
    20. 20. Enterprise-wide PACS?Enterprise-wide PACS? ““A set of technology components used together toA set of technology components used together to capture, store, distribute and display any digitalcapture, store, distribute and display any digital medical images, static or moving, and any associatedmedical images, static or moving, and any associated media.media. The solution operates across multiple sites andThe solution operates across multiple sites and multiple Trusts with consistent and seamless capturemultiple Trusts with consistent and seamless capture of, access to and use of digital images by anyof, access to and use of digital images by any healthcare practitioner authorised to do so at locationshealthcare practitioner authorised to do so at locations where they undertake their clinical work, research orwhere they undertake their clinical work, research or
    21. 21. PACS Programme visionPACS Programme vision Filmless (and ideally paperless) diagnostic services toFilmless (and ideally paperless) diagnostic services to be made possible in all health economies in Englandbe made possible in all health economies in England by the end of 2006.by the end of 2006. This should encompass Acute Trusts (where the bulkThis should encompass Acute Trusts (where the bulk of diagnostic services currently take place)of diagnostic services currently take place) andand otherother NHS organisations where digital images are (or canNHS organisations where digital images are (or can be) created and/or used for clinical care education,be) created and/or used for clinical care education, planning or delivery.planning or delivery.
    22. 22. Organisational ScopeOrganisational Scope ININ  HospitalsHospitals  DTCsDTCs  WI CentresWI Centres  Minor Injury UnitsMinor Injury Units  GP PracticesGP Practices  NHS Dental PracticesNHS Dental Practices  Military HospitalsMilitary Hospitals  Specialists’ homesSpecialists’ homes  Anywhere for mobileAnywhere for mobile practitionerspractitioners OUTOUT  PrisonsPrisons  Private SectorPrivate Sector  ScotlandScotland  WalesWales  Northern IrelandNorthern Ireland
    23. 23. HRM ACUTE TRUST – Stretching PACS Hospital Wide/Community/ALL Images Local PACS Store DERMATOLOGY RADIOLOGY Scanner Scanner ENDOSCOPY Scanner CARDIOLOGY/ECG Scanner PATHOLOGY Scanner A&E/OP/WARDS/ THEATRES/MDT/ ONCOLOGY LAN viewing image acquired view ing Monitor Monitor RADIOLOGY RIS OPHTHALMOLOGY Scanner Scanner REMOTE/ AT HOME All digital images
    24. 24. Image ScopeImage Scope RadiologyRadiology  RadiotherapyRadiotherapy  Computed tomographyComputed tomography  MRIMRI  Nuclear medicineNuclear medicine  AngiographyAngiography  CardiologyCardiology  FluoroscopyFluoroscopy  UltrasoundUltrasound  DentalDental  Symptomatic mammographySymptomatic mammography Non-radiologicalNon-radiological  Retinal screeningRetinal screening  EndoscopyEndoscopy  ColposcopyColposcopy  ECGECG  AudiologyAudiology  Blood filmsBlood films  Clinical photographyClinical photography  HistologyHistology  DermatologyDermatology  Diagrammatic imagesDiagrammatic images  Laparoscopic imagesLaparoscopic images  GeneticsGenetics  CytologyCytology  HaematologyHaematology
    25. 25. Acute Trust Acute Trust Acute Trust N3 PACS Local Store Com m unity Community Com m unity Com m unity ACUTE TRUSTS Strategic H ealth A uthority PCT PCT Local Store PACS Acute Trust Local Store PACS Data Centre Central Image Store NHS Intranet
    26. 26. A likely national architectureA likely national architecture Cluster Health economy Hospital Trust Core Image store Core Image store National Spine Record Service Viewing Reporting Report and diagnostic image Viewing image PACS1 PACS2 PACSn Legacy  New
    27. 27. What are the benefits?What are the benefits?  Access to specialist /2nd opinionAccess to specialist /2nd opinion  Access to pathology & radiology opinionAccess to pathology & radiology opinion  MDTM supportMDTM support  Support EPR/Single patient recordSupport EPR/Single patient record –– patient choicepatient choice  Reporting – flexible capacityReporting – flexible capacity  Quality – all images always availableQuality – all images always available
    28. 28. What are the benefits?What are the benefits?  Training academies / distance learningTraining academies / distance learning  Home working (IWL, EWTD) Q.o.LHome working (IWL, EWTD) Q.o.L  Hospital @ nightHospital @ night  Cost saving – fewer patient transfersCost saving – fewer patient transfers  Primary care development (DTC, U/S)Primary care development (DTC, U/S)  Reduce car parkingReduce car parking  Lower outpatient attendancesLower outpatient attendances  Monitoring of chronic diseasesMonitoring of chronic diseases  Requires – New ways of workingRequires – New ways of working
    29. 29. POTENTIAL BENEFITS OF STRETCHING PACS BEYOND RADIOLOGY & INTO THE COMMUNITY 0 50 100 150 200 250 PACS Investment Radiology Benefit Stretching PACS Hospital Wide Community and whole image wide Patient/user/financial/quality/efficiency
    30. 30. Near Patient TestingNear Patient Testing
    31. 31. Business Architectures –Business Architectures – Strategic HA Wide ServiceStrategic HA Wide Service Acute hospital Primary diagnostics DATC Dentists Opticians Acute hospital Primary diagnostics Acute hospital Primary diagnostics DATC Dentists Opticians Acute hospital Primary diagnostics Acute hospital Primary diagnostics DATC Dentists Opticians Acute hospital Primary diagnostics Service spanning all primary and secondary care within a whole Strategic HA area
    32. 32. Problems with DTC & IS / OutsourcingProblems with DTC & IS / Outsourcing  Lack of continuity – IT systemsLack of continuity – IT systems  Leeching of expertise from NHS (U/S, MR)Leeching of expertise from NHS (U/S, MR)  No training inputNo training input  Poorer equipment utilisationPoorer equipment utilisation  Access of clinicians to reportersAccess of clinicians to reporters  Duplication of work – protocols, reports, etcDuplication of work – protocols, reports, etc  Transmission of data – images, reportsTransmission of data – images, reports  Governance (teleradiology)Governance (teleradiology)  Complexity of work (that left takes longer)Complexity of work (that left takes longer)
    33. 33. One stop clinicsOne stop clinics  HaematuriaHaematuria US Cystoscopy ?CTUS Cystoscopy ?CT  RAPACRAPAC TRUS BiopsyTRUS Biopsy  PMBPMB US HysteroscopyUS Hysteroscopy  BreastBreast FNA Mammo US BiopsyFNA Mammo US Biopsy  Chest painChest pain CXR Echo ECG etcCXR Echo ECG etc  Chest clinicChest clinic CXR Bronchoscopy CTCXR Bronchoscopy CT
    34. 34. Thank youThank you

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