NHS Scotland National PACS Today Scope and

NHS Scotland National PACS

Today Scope and Reach of National PACS Infrastructure Impact on service delivery & patient care Benefits Challenges Future

p. 3 NHS Scotland Population 5. 1 million Health budget of £ 14 billion NHS is 33% of the public expenditure of the Scottish government. e. Health expenditure £ 200 million per annum Scotland is one of the first examples of a National radiology system. 47, 500 The NHS in nurses, Scotland midwives and has around health 146, 000 staff visitors 3, 800 consultants 12, 000 GPs

Scope & Reach Live in 38 radiology departments, in 15 satellite imaging departments and on 20, 000 clinical browser PCs across all acute wards All images taken are available to authorised & trained & registered users anywhere in NHS Scotland (now 18 million studies) Access is governed by clinically agreed information governance framework Offers the same features and functionality for all hospitals—rural areas, Highlands and Islands and city centres

Dependencies CHI (community health index) Common unique identifier for all people living in Scotland DICOM compliance Not all modalities were DICOM compliant at the start of the project Update of RIS across the whole country All parts of the system required a common RIS standard Not present at the start of the project - still have three main suppliers Common examination code names nationally agreed UK Royal College of Radiologist standardis ed code list (SNOMED) N 3 WAN 2 -300 MB circuits now in place across most sites

What we have • Common user interface across all hospitals with access to the same features and functionality • Managed storage service totalling 1 Petabyte, in mirrored National Image/Report Archive • 24, 000 registered users • Installation of 350, 3 MP monitor diagnostic workstations for use in radiology • Web-based image viewing in over 2000 wards

Chosen Architecture

Targets & Challenging Pathways Staged waiting list targets beginning 12 weeks, now 4 weeks from referral to report Remote & Rural – reporting networks 4 hr wait for unscheduled care SIGN guidelines for head injury, hip and stroke Urban – cross site capacity & reporting Decreasing LOS Neuro radiology – assess pre transfer Move to 23 hour beds for elective surgery Paediatric radiology – specialist referrals Clinical & data governance Tele radiology – remote reporting

p. 9 Benefits The solution accepts all images and all reports and makes them available across the country. • Images available anywhere • Image manipulation • Less repeat exams • Improved workflows Urgent Transfers e. g. RTA, neurosurgery c. 100 per annum Support for multi professional Groups reviewing cases remotely Support for second opinion required in c. 10000 Per annum Transfer of images for national waiting list hospital 45000 per annum

p. 10 Benefits Miss D § Patient in Stornoway (Western Isles Hospital) § Chest physician in Inverness § Radiological opinion in Borders General Hospital § Patient received definitive treatment in ITU Glasgow Royal Infirmary

p. 11 Benefits Miss D § Age 18 § Flu-like illness for 48 hours § Progressive SOB § Pleuritic chest pain § No significant past history § No drugs § No allergies § Erythromycin i. v. § Hydrocortisone 100 mg iv § Chest opinion sought (Inverness) § CT scan (Borders General Hospital) § Decision to transfer

p. 12 Benefits Miss D § Transferred to Glasgow § ITU bed Glasgow Royal Infirmary § Bronchio alveolar lavage § Acute eosinophilic pneumonia § High dose steriods § Recovered

Further Benefits The gross benefits conservatively extend to • • 10% reduction in re-examination 100% reduction in film and chemical cost Significant reduced time to treatment Absorbing growing activity with existing radiologist establishment • Absorbing exponential data growth on existing infrastructure Plus hard to quantify benefits such as: • Reduced litigation • CT dose monitoring a by product of data collection – dose management now considered across the country • The difference in responsiveness and quality of care is also immense - hard to over estimate.

Challenges • • • Explosion in data production – next batch of 128 slice CT now in view Cost pressures from data storage Compression & life cycle management Contract complexity Disparity in RIS functionality and deployment

Lessons • • • Need for corporate commitment Need for strong clinical support and leadership Need for strong support from e. Health community Scottish Government political support Good governance models facilitate cross organisational working

The Future • New version of Carestream PACS being rolled out Technology Refresh and V 11 Upgrade (Global Worklists, Tunnelling and Streaming) – different platforms and new ways of working • National Licence for Volume Matching, Lesion Management • Same application now being rolled-out to Scottish Breast Screening Service • Cloud computing for the long term future • Image database of 17 million studies now a key part of Scottish Government inward investment strategy to attract commercial clinical research