25.09.13
Simplified sharing
Source: National Health Executive Sept/Oct 2013
Royal Liverpool & Broadgreen University Hospitals NHS Trust is one of 11 trusts in a North West consortium implementing a new PACS. Dr Peter Rowlands, consultant radiologist, talks to NHE.
A consortium of acute and community trusts across Cheshire and Merseyside have implemented a contract for a new Picture Archiving and Communications System (PACS) to speed up file sharing, cut costs and improve patient care.
It’s a huge contract – set to run for five years, across 11 trusts, with the option to extend for a further five.
Dr Peter Rowlands, consultant radiologist at the Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) and clinical lead for the procurement, spoke to NHE.
The contract was divided up into several workstreams, including clinical requirements for the new system, as well as an IT stream to support the process and identify the necessary changes in infrastructure across the consortium.
Within the Cheshire/Merseyside area, 11 of the 13 trusts went in on the project, which replaces contracts developed under the National Programme for IT (NPfIT).
As well as the RLBUHT, the contract includes: Aintree University Hospitals, Alder Hey Children’s, Clatterbridge Centre for Oncology, Liverpool Community Health, Liverpool Heart and Chest Hospital, Liverpool Women’s, Southport and Ormskirk Hospital, St Helens and Knowsley Teaching Hospitals, Walton Centre, and Warrington and Halton Hospitals.
Tough deadlines
Once the contract had been awarded to Carestream UK after nearly two years of negotiation, the system went live quite quickly, with the whole RLBUHT trust online within four months of the first installation.
“It was quite a challenging schedule,” Dr Rowlands said.
“The good part of this was that we had a deadline of June 30 because the old system had been switched off – that concentrated people’s minds!”
The system allows diagnosis to be carried out from different locations regardless of where the patient is and means different medical staff can discuss a case remotely, both seeing the same image at the same time.
“It’s very important that the images are available to all the clinicians; we’ve had a lot of positive feedback from that process because previously they were initially sent around on CD and then subsequently emailed and that was a massive job with hundreds and hundreds of scans being transferred every day.”
From A to C
The new system allows the trust to store and share images more easily, but also includes “the bells and whistles” of teaching support and functionality for regional multidisciplinary meetings.
Dr Rowlands said: “One of our problems with having multiple trusts is that we’ve had a huge overhead in the past of transferring images from trusts to trusts to make sure that patients and their images arrive in the right place.
“So someone can be seen at hospital A, have their procedure, biopsy or surgery at hospital B, and their radiotherapy at hospital C and be followed up at any of those hospitals.”
Dr Rowlands said it was a huge time-saver, especially for specialists working across multiple hospitals.
Vendor-neutral
The contract includes a computerised radiology information system (CRIS) with Healthcare Software Systems, and a picture archive and communications system (PACS) with Carestream UK.
RLBUHT also implemented a vendor neutral archive (VNA), designed for long-term storage of images. If the trust wishes to change PACS provider in the future they can simply switch over, safe in the knowledge that previous images have been saved independently via the VNA, rather than that data being held by an external provider under the previous PACS.
“That was a big fuss for us. Other trusts chose a Carestream archive, so they chose a long-term archive which happened to be provided by Carestream.”
Dr Rowlands continued: “We chose to have a non-Carestream archive for a couple of reasons; to make migration easier, and secondly we’ve got a programme of getting other people onto the VNA archives – our partners in cardiology and gastroenterology etc, so their images will be available on the VNA archives and we’ll be able to share those images far more freely.”
Organic access
The new system is part of a wider move towards greater efficiency: “Eventually the idea will be to have all the important clinical information stored on the VNA archive and just viewed by the appropriate application, so there aren’t many systems and many archives within the trust.”
The VNA also means clinicians can access the same data and files through whichever system they prefer.
While the infamous NPfIT “hasn’t delivered what we all hoped it would deliver”, this system could offer “more of an organic process” to accessing centrally-stored data, Dr Rowlands said.
Having a VNA in place also gives the trust more control over software upgrades in the future, as they can pick and choose providers whilst maintaining the security of their records.
“Essentially the PACS for us is just a front end to that, whereas for other places that have a Carestream archive it’s controlled and managed by Carestream and not by a local team.”
Electronic patient record
Dr Rowlands continued: “The aim is in due is course to make these things more powerful and to have a full electronic patient record integrating with all these systems – but not necessarily have a massive ‘big bang’ system with all the modules live at once.
“And there’s no need to replace PACS or the RIS because their functionality is probably better than the ones that incorporated into the electronic patient record, so we just see it as being a view-port to display the images rather than having to move to another system.”
Having a single national system would be the holy grail of NHS IT, but the programme was plagued with escalating costs and complexity before being abandoned in 2011.
Dr Rowlands said “the job is so huge” that it was “hard to imagine” how any one system could have the best functioning modules across all the different functionality.
Proven product
Dr Rowlands said he would “definitely” recommend this model to other trusts now the benefits had been demonstrated.
“The issue was that the product wasn’t particularly mature at the time we were looking; it was in the early days of that, the products are not that mature – I think that’s why some of our partners chose a conventional archive for imaging – they didn’t see that there were enough benefits to go for something that was not proven.
“I’d certainly recommend it now because we’ve delivered it, it works extremely well and we’ve got confidence in that.”