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Long Term Trends in Referrals for Radiology Diagnostics by Dr David Parker , Consultant Radiologist & John Collins, Head of Systems & Information Management from Betsi Cadwaladr University Health Board. Presented at "Using Research Evidence to Improve Health and Social Care". A NISCHR AHSC Workshop to Explore Strategies in Knowledge Transfer. 6th May 2014 – Cardiff
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Long Term Trends in Referrals for Radiology
DiagnosticsDr David Parker
Consultant RadiologistDavid.Parker2@wales.nhs.uk
John CollinsHead of Systems & Information Management
John.Collins@wales.nhs.uk
NISCHR Knowledge Transfer Workshop 6th May 2014 1
Before 1950
1878: Crookes Tube1895: Roentgen Rays1896: Becquerel - Radioactivity1897: Marie Curie – Radium1897: Braun – Oscilloscope1904: Fleming Valve1913: Coolidge – X-ray Tube1926: Baird’s Televisor1934: Telefunken CRT TV
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NISCHR Knowledge Transfer Workshop 6th May 2014 3
NISCHR Knowledge Transfer Workshop 6th May 2014 4
Late 1950’s
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Development of Ultrasound
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Diasonograph (Early 1960’s)
Howry’s Sonascope (Life Magazine 1954)
Early Use of Ultrasound
1960’s
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Transluminal Treatment of Arteriosclerotic Obstruction: Description of a new technique and a preliminary report of it’s application
Charles T Dotter M.D., Melvin P Judkins M.D. Circulation 1964
1970’s
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1980’s
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Medical Radiology Workforce
Source: RCR Workforce Census 2011
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Radiology Equipment Replacement
Source: RCR Good Practice Guide for Clinical Radiologists 2012
Equipment Type Age
Ultrasound 5 yrs
Nuclear Medicine 7 yrs
Interventional 7 yrs
Computed Tomography
7 yrs
MRI 7 yrs
X-ray 10 yrs
Technology lifecycle
imposes a natural
frequency of innovation
Data & Knowledge Transfer
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Wisdom
Intelligence
Knowledge
Information
Data
Tuomi I (1999) Data is more than knowledge
Implications of the reversed knowledge hierarchy for knowledge management and organisational memory.
Proceedings of the 32nd Hawaii International Conference on System Science
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Normal Variation?
Key Range0 to 0.49%0.5 to 0.951 to 1.49%1.5 to 1.9%2 to 2.49%2.5 to 2.9%
Data Shows % of population attending for MRI
Is variation ‘normal’?
Data Collection
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• Data extracts from RadIS 2 RIS (Radiology Information System)
• Monthly activity totals for specific exam code groups and referral streams
• Identified codes that reflected a narrow group of clinical indications for referral
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A&E Referrals for Skull X-ray
Oct Aug Jun Apr Feb Dec Oct Aug Jun Apr Feb Dec Oct Aug Jun Apr Feb Dec Oct Aug Jun Apr Feb Dec Oct Aug1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013
0
50
100
150
200
250
300
350
Site 1Site 2Site 3
Nice Head Injury Clinical Guideline, June 2003
Nice Head Injury Clinical Guideline, Sept 2007
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CT Referrals for Investigation of Suspected Pulmonary Embolism
Jun DecJun Dec Jun Dec Dec Jun Dec Jun Jun Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
0
10
20
30
40
50
60
70
80
Site 1Site 2Site 3
BTS Guidelines for the management of suspected acute PE, June 2003
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Referrals for IVU
Sep Jun Mar Dec Sep Jun Mar Dec Sep Jun Mar Dec Sep Jun Mar Dec Sep Jun Mar Dec Sep Jun Mar Dec Sep Jun1995 1997 1999 2001 2003 2005 2007 2009 2011 2013
0
20
40
60
80
100
120
140
Site 1Site 2Site 3
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Where Are We Now?
• Data rich / information poor
• Poorly structured / coded data sources
• Retrospective view of practice
• Target focussed NHS
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What Have We Learned?
• Changes in practice are often not associated with issuing of clinical evidence
• Technology / Capacity are not the primary drivers or constraints
• Human factors seem to have a significant role to play
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What Are The Barriers?
Is the evidence good enough?• NICE Head Injury 2003 vs 2007• NICE CG131 (Nov 2011) vs SIGGAR Trial
(Feb 2013)
Do we focus too much on the individual right to practice the ‘art’ of medicine?• Accountability = autonomy• Reluctant to get involved in ‘management’Doctors Championing Change, Dr Jack Silversin 2013
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What Would Google Do?
Big Data• Relationships between data sources• Improve data quality
Timeliness• Provide near ‘real time’ access to data• Encourage experimentation through PDSA
cycles
Relevance• Ensure efforts are aligned to corporate
objectives• Shorten feedback loops
NISCHR Knowledge Transfer Workshop 6th May 2014 22
Prerequisites for Innovation?
Leadership
Teamwork
Intelligence
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