Progress on Tactical and Strategic Data Sharing Dr

Progress on Tactical and Strategic Data Sharing Dr Rhidian Bramley RCR PACS & Teleradiology Group Spring Meeting Newquay 30/03/07

Drivers and Challenges • 18 week wait • Patient Choice – Choose & Book • National Service Frameworks – Clinical Networks/MDTMs • Independent Sector and PCT providers – National wave 2 contracts – Local ICATS etc.

PACS Deployment Model Tactical Data Sharing Strategic Data Sharing

Progress on Tactical Data Sharing

National Image Sharing Policy • Sets out principles for data sharing across a Healthcare Community (HC) – Must specify participating organisations – Clinical business process to be supported • Sets out framework for setting up data protocol across the HC • Authorises various technical options

National Image Sharing Policy • Sets out a framework for setting up data sharing protocol across a HC – Access control framework • Patient consent model for data to be shared • User access controls to patient identifiable data • Audit trails of data sharing and access – Assess requirement for data encryption – Error correction procedures

National Image Sharing Policy • Authorises Various Technical Options – Where available and supported, the following image sharing mechanisms can be facilitated: • secure transfer on removable media • point-to-point sender initiated ‘push’ DICOM image transfer, for example via Teleradiology products • DICOM query/retrieve from another PACS Entity’s local data store • web accessing another PACS entity’s local data store within a healthcare community

Transfer of images on CD 2 Mp PACS web Workstation 1 Mp PACS Server PACS RA 600 System Admin Workstation PACS Server PACS Reporting Workstation PACS RA 600 System Admin Workstation 2 Mp Imaging Modality • Access control frameworks • Encryption • Error correction 3 Mp RIS Modality Workstation

DICOM teleradiology ‘push’ 2 Mp 1 Mp N 3 Teleradiology Link PACS web Workstation 1 Mp PACS Server PACS RA 600 System Admin Workstation PACS Reporting Workstation PACS RA 600 System Admin Workstation 2 Mp Imaging Modality • Access control frameworks • Encryption • Error correction Modality Workstation 2 Mp 3 Mp RIS

DICOM teleradiology ‘pull’ 2 Mp 1 Mp N 3 Teleradiology Link PACS web Workstation 1 Mp PACS Server PACS RA 600 System Admin Workstation PACS Reporting Workstation PACS RA 600 System Admin Workstation 2 Mp Imaging Modality • Access control frameworks • Encryption • Error correction Modality Workstation 2 Mp 3 Mp RIS

Web based access teleradiology PACS web Workstation N 3 Teleradiology Link PACS Server Web access https/SSL Imaging Modality • Access control frameworks • Encryption • Error correction PACS web Workstation

National Report Sharing Policy • Doesn’t yet exist • Clear message from clinical community that images and reports MUST be kept together at all times. • Tactical solutions MUST keep images and reports together. You MUST address this in your data sharing protocol.

Transfer of reports on CD 2 Mp PACS web Workstation 1 Mp PACS Server PACS RA 600 System Admin Workstation 1 Mp DICOM SR PACS Server PACS Reporting Workstation PACS RA 600 System Admin Workstation 2 Mp Imaging Modality 3 Mp RIS Modality Workstation

DICOM teleradiology ‘push’ 2 Mp 1 Mp PACS Server PACS RA 600 System Admin Workstation N 3 Teleradiology Link DICOM SR PACS web Workstation 1 Mp PACS Server PACS Reporting Workstation PACS RA 600 System Admin Workstation 2 Mp Imaging Modality Workstation 2 Mp 3 Mp RIS

Tactical Use of Cluster Data Store For data sharing prior to integration with PDS, SSO, LRS • Benefits – Single repository = single search – Not limited to web based access • Risks and Issues – – User logon management Multiple patient Ids. No NHS number prefetch No report sharing Error correction procedures • Feasibility studies – Kent & Medway pilot – Broadview risk assessment

Progress on Strategic Data Sharing

Strategic Clinical Requirements • Workshops – January SC/NWWM Clusters/FJA/CSC – March NEEM Cluster/Accenture – April London cluster/BT • National PACS Clinical Imaging Data Sharing Requirements document – 20 clinical best practice requirements – Describes primary imaging/reporting and imaging review workflows to be supported

Strategic Technical Requirements • Keeping Images and Reports together document – IHE Reporting Workflow & Portable Data for Imaging • IHE Profiles for NHS Cf. H PACS – Scheduled workflow, patient information reconciliation – Reporting Workflow, PDI, Import reconciliation workflow – XDS-I Cross enterprise data sharing for imaging

Clinical Imaging Data Sharing Workflow Requirements

Objectives 1. Identify common clinical data sharing workflows 2. Form a consolidated set of clinical requirements (best practice guidelines) 3. Use 1 and 2 to perform a gap analysis with existing and proposed LSP services 4. Determine priority and feasibility for implementation of changing system design/features in parallel with the New Functional Requirements process

Primary Clinical Imaging Workflow Overview Referring Clinician IRMER Practitioner IRMER Operator Reporting Clinician All will benefit from access to relevant clinical imaging history, study images and reports Reviewing Clinician

Primary Clinical Imaging Workflow Outsourced Reporting Referring Clinician Reviewing Clinician IRMER Practitioner IRMER Operator Admin Process Reporting Clinician

Primary Clinical Imaging Workflow Outsourced Image Acquisition Referring Clinician Reviewing Clinician IRMER Practitioner Reporting Clinician IRMER Operator Admin Process

Primary Clinical Imaging Workflow Outsourced Acquisition & Reporting Referring Clinician Reviewing Clinician IRMER Practitioner Admin Process IRMER Operator Reporting Clinician

Imaging Review Workflow Informal Imaging Review Referring Clinician Reviewing Clinician

Imaging Review Workflow Formal Imaging Review Referring Clinician Reviewing Clinician Reporting Clinician

Imaging Review Workflow MDT Imaging Review Referring Clinician Reviewing Clinician MDT Organiser Imaging Lead Reviewing Clinician Reporting Clinician

Clinical Data Sharing Requirements 1. Study images and reports MUST remain associated at all times. Reports of a displayed study MUST be available via the user interface, by means of a single mouse click or equivalent. Study images SHOULD be made available through an automated direct link from the report so the user does not have to re-key patient or study data.

DICOM teleradiology ‘push’ 1 Mp PACS RA 600 System Admin Workstation 1 Mp 2 Mp PACS web Workstation N 3 Teleradiology Link 1 Mp PACS Server PACS RA 600 System Admin Workstation Imaging Modality PACS Reporting Workstation PACS RA 600 System Admin Workstation 2 Mp 1 Mp Modality Workstation PACS RA 600 System Admin Workstation 1 Mp • Encryption • Access control frameworks • Error correction PACS RA 600 System Admin Workstation 2 Mp 3 Mp RIS

DICOM teleradiology ‘pull’ 1 Mp PACS RA 600 System Admin Workstation 1 Mp 2 Mp PACS web Workstation N 3 Teleradiology Link 1 Mp PACS Server PACS RA 600 System Admin Workstation Imaging Modality PACS Reporting Workstation PACS RA 600 System Admin Workstation 2 Mp 1 Mp Modality Workstation PACS RA 600 System Admin Workstation 1 Mp • Encryption • Access control frameworks • Error correction PACS RA 600 System Admin Workstation 2 Mp 3 Mp RIS