PACS - The Role of PACS - The Role of

Digital ImagingDigital ImagingDr G.M.HoadleyDr G.M.Hoadley

National Clinical Lead, National Clinical Lead, RadiologyRadiology

What is PACS?What is PACS?

P ictureP icture

A rchivingA rchiving

C ommunicationC ommunication

S ystemS ystem

HRM

ACUTE TRUST – Core PACS

Local PACS

Store

RADIOLOGY

Scanner

A&E

LAN

viewing

Monitor

Monitor

RADIOLOGY

RIS

Image acquisition

viewing

CRV

DR

HRM

ACUTE TRUST – Full PACS : Hospital Wide

Local PACS

Store

MDT

RADIOLOGY

Scanner

Scanner

OUTPATIENTS

WARDS

A&E

LAN

viewing

image acquisition

viewing

THEATRES

Monitor

Monitor

RADIOLOGY

RIS

ONCOLOGY

HRM

ACUTE TRUST – Stretching PACS : Hospital & Community Wide

Local PACS

Store

MDT

RADIOLOGY

Scanner

OUTPATIENTS

WARDS

A&E

LAN

viewingimage acquired

viewing

THEATRES

Monitor

Monitor

RADIOLOGY

RIS

ONCOLOGY

PRIMARY CARE

AT HOME/REMOTE

Enterprise-wide/Health Enterprise-wide/Health economy PACS?economy PACS?

““A A set of technology components used set of technology components used together to capture, store, distribute and together to capture, store, distribute and display any digital medical images, static display any digital medical images, static or moving, and any associated media. or moving, and any associated media. The solution operates across multiple The solution operates across multiple sites and multiple Trusts with consistent sites and multiple Trusts with consistent and seamless capture of, access to and and seamless capture of, access to and use of digital images by any healthcare use of digital images by any healthcare practitioner authorised to do so at practitioner authorised to do so at locations where they undertake their locations where they undertake their clinical work, research or education.”clinical work, research or education.”

Who is interested in the Who is interested in the technologytechnology

DoH / GovernmentDoH / Government NPfITNPfIT MA diagnosticsMA diagnostics FHNFHN IHEIHE Commissioning bodiesCommissioning bodies TrustsTrusts Clinicians Clinicians IndustryIndustry

M.A.M.A.

4 4 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

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 Standards Standards

I.H.E.I.H.E. DICOMDICOM

TeleradiologyTeleradiology

Technical planningTechnical planning

pro

cure

men

t

Private public partnerships

Changing workforce

New Clinical models

Building design

TechnologyChange

Wholesystem

configuration

Scope and TimescaleScope and Timescale

year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 82002/3 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

IINTEGRATED NTEGRATED CCARE ARE RRECORD ECORD SSYSTEMYSTEM

ICRS

PACS EPR RAD REPORTS

THE NATIONAL PACS PROGRAMME IS AN INTEGRAL

PART OF ICRS

NPfIT FUNDING SCOPENPfIT FUNDING SCOPE

ININ CRCR ArchiveArchive Diagnostic Diagnostic

Workstations (within Workstations (within Radiology)Radiology)

SoftwareSoftware Web serverWeb server

OUTOUT LANLAN DRDR PC’s on wardsPC’s on wards

What is IHE?What is IHE?

INTEGRATING HEALTHCARE ENTERPRISEINTEGRATING HEALTHCARE ENTERPRISE

An independent body with representatives from RCR, An independent body with representatives from RCR, BIR, COR, IPEM, NHSIA, MHRA, IndustryBIR, COR, IPEM, NHSIA, MHRA, Industry

Part of a global initiative to promote better Part of a global initiative to promote better interoperability of computer systems in healthcareinteroperability of computer systems in healthcare

Currently radiology and hospital information systemsCurrently radiology and hospital information systems

Based on real workflow processesBased on real workflow processes

What does it do?What does it do?

Scheduled workflow patternScheduled workflow pattern:: Takes existing “computer language” Takes existing “computer language”

standards and defines their use.standards and defines their use. Defines the exact use of DICOM and HL7 Defines the exact use of DICOM and HL7

needed to achieve workflow processneeded to achieve workflow process Systems that achieve this can be reliably Systems that achieve this can be reliably

integrated with other “IHE” systems provided integrated with other “IHE” systems provided they both advertise the same process they both advertise the same process regardless of manufacturerregardless of manufacturer

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

Scheduled Workflow Scheduled Workflow ProfileProfile

Benefits of this approachBenefits of this approach

A more cohesive workflow process for transfer of A 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 between Smooth, reliable transfer of information between

computer systems from different companiescomputer systems from different companies

Patient journey can be more efficiently and Patient journey can be more efficiently and

accurately plannedaccurately planned

Mistakes can be more easily correctedMistakes can be more easily corrected

The futureThe future

This approach will extend beyond This approach will extend beyond radiology to areas such as theatres radiology to areas such as theatres and pathologyand pathology

The aims will be to facilitate patient The aims will be to facilitate patient workflow processes by improving workflow processes by improving computer systems interoperabilitycomputer systems interoperability a patient (user) driven approacha patient (user) driven approach

Enterprise-wide PACS?Enterprise-wide PACS?

““A set of technology components used together A set of technology components used together to capture, store, distribute and display any to capture, store, distribute and display any digital medical images, static or moving, and digital medical images, static or moving, and any associated media. any associated media.

The solution operates across multiple sites and The solution operates across multiple sites and multiple Trusts with consistent and seamless multiple Trusts with consistent and seamless capture of, access to and use of digital images capture of, access to and use of digital images by any healthcare practitioner authorised to do by any healthcare practitioner authorised to do so at locations where they undertake their so at locations where they undertake their clinical work, research or education.”clinical work, research or education.”

PACS Programme visionPACS Programme vision

Filmless (and ideally paperless) diagnostic Filmless (and ideally paperless) diagnostic services to be made possible in all health services to be made possible in all health economies in England by the end of 2006. economies in England by the end of 2006.

This should encompass Acute Trusts This should encompass Acute Trusts (where the bulk of diagnostic services (where the bulk of diagnostic services currently take place) currently take place) andand other NHS other NHS organisations where digital images are (or organisations where digital images are (or can be) created and/or used for clinical can be) created and/or used for clinical care education, planning or delivery.care education, planning or delivery.

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 mobile Anywhere for mobile

practitionerspractitioners

OUTOUT PrisonsPrisons Private SectorPrivate Sector ScotlandScotland WalesWales Northern Northern

IrelandIreland

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

viewingimage acquired

viewing

Monitor

Monitor

RADIOLOGY

RIS

OPHTHALMOLOGY

Scanner

Scanner

REMOTE/AT HOME

All digital images

Image ScopeImage Scope RadiologyRadiology

RadiotherapyRadiotherapy Computed tomographyComputed tomography MRIMRI Nuclear medicineNuclear medicine AngiographyAngiography CardiologyCardiology FluoroscopyFluoroscopy UltrasoundUltrasound DentalDental Symptomatic Symptomatic

mammographymammography

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

Acute Trust

Acute Trust

Acute Trust

N3

PACS

Local Store

Community

Community

Comm

unity

Comm

unity

ACUTE TRUSTS

Strate

gic H

ealth

Authorit

y

PCT

PCT

Local Store

PACS

AcuteTrust

Local Store

PACS

Data Centre

Central Image Store

NHS Intranet

A likely national architectureA likely national architecture

Cluster

Health economy

Hospital

Trust

Core Image store

Core Image store

National Spine Record Service

Vie

win

gR

epor

ting

Report and diagnostic

image

Viewing image

PACS1 PACS2 PACSn

Legacy New

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 record Support EPR/Single patient record

– – patient choicepatient choice Reporting – flexible capacityReporting – flexible capacity Quality – all images always availableQuality – all images always available

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 Lower outpatient

attendancesattendances

Monitoring of chronic diseasesMonitoring of chronic diseases Requires – New ways of workingRequires – New ways of working

POTENTIAL BENEFITS OF STRETCHING PACS BEYOND RADIOLOGY & INTO THE

COMMUNITY

0

50

100

150

200

250

PACS InvestmentRadiology

Ben

efit

Stretching PACS Hospital Wide

Community and whole image wide

Patient/user/financial/quality/efficiency

Near Patient Near Patient TestingTesting

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 DATCDentists

Opticians

Acute hospital

Primary diagnostics

Acute hospital

Primary diagnostics DATCDentists

Opticians

Acute hospital

Primary diagnostics

Service spanning all primary and secondary care within a whole Strategic HA area

Problems with DTC & IS / Problems with DTC & IS / OutsourcingOutsourcing

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, Duplication of work – protocols, reports,

etcetc 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)

One stop clinicsOne stop clinics

HaematuriaHaematuria US Cystoscopy ?CTUS Cystoscopy ?CT RAPACRAPAC TRUS BiopsyTRUS Biopsy PMBPMB US HysteroscopyUS Hysteroscopy BreastBreast FNA Mammo US FNA Mammo US

BiopsyBiopsy Chest painChest pain CXR Echo ECG etcCXR Echo ECG etc Chest clinicChest clinic CXR Bronchoscopy CTCXR Bronchoscopy CT

Thank youThank you