In the picture

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In the picture?
An exploration of diagnostic imaging and
interface issues
GP and consultant workshopThree Ways House 2nd
July 2007
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Thank you to our sponsors.

• Roche Products Ltd

Pierre Fabre
Wyeth Pharmaceuticals
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A G E N D A
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25th April EventEnd of Life care

• The patients story
• Communication
• Knowledge and expertise
• Access to emotional, physical and financial
  support
• Gloucestershire Palliative Care Review
• Secondary care perspective
• Primary care perspective
• See Trust web site (Healthcare Professionals) for
  notes and more details

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AIMS FOR THIS EVENING

• PACS whats in it for me?
• PACS what could be in it for me?
• The Chuckle Brothers To me, to you, to me..
  (Interfaces)
• Explore service developments
• New imaging developments
• Network with primary/secondary care colleagues to
  discuss joint issues

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PACSNext stages, what it will and what it wont
do

• Dr Frank Jewell

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What is PACS?

• Picture Archiving and Communications System
• A set of technology components used together to
  capture, store, distribute and display any
  digital medical image, static or moving, and any
  associated media. The solution operates across
  multiple sites and multiple Trusts with
  consistent and seamless capture of, access to and
  use of digital images by any health care
  practitioner authorised to do so at locations
  where they undertake their clinical work,
  research or education.
• Electronic image files replace hard copy film
• Any image, any time, any place by as many
  clinicians as required

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Why?

• Information for Health (1998)
• Aims to enhance patient care by introducing
  modern computing technology into the workplace
• The challenge for the NHS is to harness the
  information revolution and use it to benefit the
  patient
• Rt. Hon Tony Blair

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CfH portfolio

• Care records service
• Choose and Book
• NHS spine
• N3
• National service desk
• PACS

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Clusters
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Historical practice

• Single hard copy
• Mobile clinicians and patients
• Huge administrative overheads
• Temporary packets, delayed reporting, cancelled
  appointments       

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Alternative Archive
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PACS overview
PAS
WAN
Modalities
RIS
PACS
Diagnostic Workstations
Web server
Archive
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Gloucestershire PACS
Failover datacentre
Gloucester PACS servers
ER
N3
Datacentre SHA RIS database PACS archive
N3
Cheltenham PACS servers
ER
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Southern Cluster PACS
SHA 1
Glos UBHT NBHT Bath Salisbury
Fujitsu data centre PACS archive 7 RIS databases
SHA7
SHA6
SHA5
SHA4
SHA2
SHA3
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PACS benefits

• Cash releasing
• Film and chemicals
• Staff costs
• Non-cash releasing
• Clinical
• Clerical
• Radiographic
• Patient
• Flexible working

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Non-cash releasing benefit

• Clinical
• Any image, any place any time
• No lost images
• Remote consultation
• Image manipulation
• Clerical
• Digital dictation
• Fewer enquiries
• Radiographic
• Good and bad
• Patient
• Tangible impact and better workflows
• Flexible working

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PACS history

• Commercially available for 20 years
• Mainly USA, Europe and the Far East
• Uptake in the UK has been slow
• Mainly new build hospitals
• Many partial PACS
• Few full PACS

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NPfIT or CfH

• Gloucestershire PACS
• Capital programmes
• Trust mergers and PCTs
• South West EPR and PACS
• No interest
• NPfIT
• Swindon and Norwich
• PACS quick win
• Whole of England by March 2007

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New practice
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New ways of working

• Radiology workflows
• Percentage reported
• Report turnaround times

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Workflow errors and PACS
Workflow errors in PACS
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Productivity
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New ways of working

• Radiology workflows
• Percentage reported
• Report turnaround times
• Work timetable and allocation
• Paperless working
• Vetting
• Reporting
• 24 hour turnaround for inpatient CT
• Minor injuries units

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New ways of working

• Full exploitation of imaging modalities

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New ways of working

• Full exploitation of imaging modalities
• MDTs
• On call
• Image sharing
• CDs
• Tertiary centres
• 3 counties cancer services

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GPs and PACS

• Who wants it?

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Southern Cluster PACS
GP
SHA 1
Glos UBHT NBHT Bath Salisbury
Fujitsu data centre PACS archive 7 RIS databases
SHA7
SHA6
SHA5
SHA4
SHA2
SHA3
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Southern Cluster PACS
Spine security RBAC and LR
GP
SHA 1
Glos UBHT NBHT Bath Salisbury
Fujitsu data centre PACS archive 7 RIS databases
SHA7
SHA6
SHA5
SHA4
SHA2
SHA3
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GP PACS access

• Accessing local image archive
• Technically possible via N3 and firewall
  configuration
• Information governance
• Performance issues
• Images v reports
• Administration overheads
• Accounts
• Licenses

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New initiatives

• GP electronic reporting
• Daily dump of imaging reports each evening to
  patient record and mailbox (EMIS, In Practice)
• GP initiated reports only
• Begun before PACS in the West but new RIS allows
  roll out to East of County

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New initiatives

• Combined electronic ordering and reporting
• Integrated web page within GP application
• Pathology and radiology accessed in same way
• Select test from pick list
• Enter clinical details
• Send
• All reports for patient are available not just
  those ordered by GP
• Hyperlinks for additional information and RCR
  guidelines

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Benefits to Practices

• A reduction in manually generated paperwork
• Improved clinical decision-making process
• Fewer lost or missing test requests
• Improved quality of clinical data
• Fewer telephone enquiry calls required
• An increased number of patients seen with
  relevant information
• A reduced number of inappropriate test requests

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ISTCs

• Alliance Medical (Phase 1)
• 600 MRI cases/year
• Cherry picked
• Automated upload of images into PACS
• Manual upload of report into RIS
• Delays and re-reporting
• ATOS (Phase 2)
• No upload of images or reports into RIS/PACS
• Information cul de sac
• Contractual constraints
• MRI not available to GPs

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Summary

• PACS has made a difference
• Challenge is to find new ways to exploit PACS
• Improvements in information transfer between
  primary and secondary care are on the way

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Radiology, evolution and revolution
Dr Garrett McGann
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• 49,000
• 20 min
• 18 weeks
• 15

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THE RADIOLOGISTS VIEWAccess and opportunities

• Dr Richard Hopkins

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New services

• Moreton Hospital

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New services

• Moreton Hospital
• Ultrasound Service

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New services

• Moreton Hospital
• Ultrasound Service
• 2 hours
• Friday mornings
• 9.15 11.15

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New services

• Moreton Hospital
• Ultrasound Service
• Standard range of anatomical areas indications
• Bookings via CGH
• Male female patients
• Initially restrict to normal range BMI (please!)

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New services

• Moreton Hospital
• Radiology Consultation
• 1/2 hour
• Friday mornings
• Drop in
• Discuss difficult x-rays
• Suggest the most appropriate test for further
  investigation

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• Thanks for
• your attention

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PRIMARY CARE ISSUESDiscussion
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• ELECTRONIC REQUESTING

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• SHARING RESULTS

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• A CHANCE TO TALK/LISTEN

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• SERVICE DEVELOPMENTS

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FEEDBACK/EVALUATION
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SUMMING UP AND CLOSE
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Let us know what you think about our web site and
what information you would find helpful
Irwin.Wilson_at_glos.nhs.uk
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NEXT EVENTTrust me Im a doctor?Opportunities
for joint approaches to governance, appraisal,
and personal development Wednesday 12th
September 6.30 for 7 pmSandford Education
Centre, Cheltenham