Kent and Medway CIO Office

PACS Programme

Kent and Medway SHA PACS Implementation

Tony CorkettProgramme Director

Kent and Medway CIO Office

PACS Programme

Agenda

• Overview and Background to Kent and Medway

• Programme Management & Deployment

• Issues, Achievements & Deliverables• Benefits to the Service• Q&A

Kent and Medway CIO Office

PACS Programme

Kent and Medway Background

• Four acute trusts and 1 tertiary trust (from Surrey and Sussex)

• Approx. 3800 beds, 1.1m OPD attendances• All trusts have been working together for a

number of years on the proposal• Greenfield Site• Good clinical engagement across the SHA• Supported by the SHA and the Health

Informatics Service (HIS)

Kent and Medway CIO Office

PACS Programme

East1 Acute4 PCT

South West1 Acute2 PCT1 AmbulanceQueen Victoria Hospital

North East1 Acute2 PCT

North West1 Acute1 PCT

Mental Health2 Trusts

Health Communities

Kent and Medway

–Four acute trusts and 1 tertiary trust (SySx)–~ 3800 beds; 1.1m Opt

Kent and Medway CIO Office

PACS Programme

Suppliers• Fujitsu – Local Service Provider (LSP)

• HSS – Radiology Information System (RIS)

• GE – Picture Archiving and Communications Systems (PACS)

• Kodak – Computed Radiography (CR)

Kent and Medway CIO Office

PACS Programme

Innovative Solution

• Data Centre Architecture• 7 PACS /RIS ‘domains’ (SHA based)• Community Networks (COIN)• Shared RIS• Accessibility

Kent and Medway CIO Office

PACS Programme

How We Got Here

• Established a county wide approach– SHA, CEO buy in (Programme Board)– Clinical buy in (radiology, surgeons, medics

and nurses)– HIS (Health Informatics Service)

• Programme Management– SHA-wide RIS codes and management– SHA-wide agreed work flow– Cross organisational support and sharing– Project support

Kent and Medway CIO Office

PACS Programme

Southern Cluster NCRS Programme Board

Kent and Medway PACS Programme Governance Structure

Kent and Medway NCRS Programme Board

Kent and Medway PACS Programme Board

Southern Cluster PACS Programme Board

National PACS Programme

Kent and Medway NCRS Family Programme Boards

CIO(Quality Assurance Role)

CIO Support team

Health Informatics Service

PACS / RIS Programme Director

PACS/RIS Project Manager Manager

North East Locality East Locality South West LocalityNorth West Locality

Trust PACS Project Manager Trust PACS Project ManagerTrust PACS Project ManagerTrust PACS Project Manager

Kent and Medway PACS Project Group

Trust Project Teams Trust Project TeamsTrust Project TeamsTrust Project Teams

Strategic Health Authority

National Programme for IT

Health Informatics Service Programme team

Kent and Medway Clinical Advisory Group

RIS sub Group

Individual NHS Acute trusts

Chief Information Officer

Kent and Medway CIO Office

PACS ProgrammeProject Team

Kent and Medway PACS Programme Board

Health Informatics ServiceMorfydd Williams

PACS / RIS Programme Director

PACS/RIS Project Manager Manager

Miles Saunders

DartfordMaidstone & Tunbridge

WellsQueen Vistoria

East KentDavid Payne

Trust PACS Project Manager

Di ElphinstonePauline Causer

Trust PACS Project Manager

David Payne

Kent and Medway PACS Project Group

David Allan

Trust Project Teams Trust Project TeamsTrust Project Teams

Kent and Medway Clinical Advisory Group

RIS sub Group

TrainingDarren DaCosta

TechnicalPhil Vella

Medway

Trust PACS Project Manager

John Morris

Trust PACS Project Manager

Mike Beach

Trust PACS Project Manager

Christine Russell

Trust Project Teams Trust Project Teams

Fujitsu / HSS / GE

Kent and Medway CIO Office

PACS Programme

Deployment

Dartford and Gravesham– RIS 28/10/05, PACS 08/11/05

East Kent Hospitals– RIS 14/11/05 PACS 06/02/06

Maidstone and Tunbridge Wells Hospitals– RIS 28/11/05 PACS 06/02/06

Medway Hospitals– RIS 21/02/06 PACS 27/03/06

Queen Victoria Foundation Hospital– RIS April 2006 PACS June 2006

Kent and Medway CIO Office

PACS ProgrammeDeployment Model

SevenoaksHospital

EdenbridgeHospital

Kent & SussexHospital

PemburyHospital

Queen VictoriaHospital

MaidstoneHospital

PrestonHall

William HarveyHospital

Darent ValleyHospital Gravesend

Hospital

Medway MaritimeHospital

SittingbourneHospital

SheppeyHospital

Kent & CanterburyHospital

Herne BayHospital

DealHospital

BucklandHospital

Royal VictoriaHospital

Legend

1Gb/100Mb LAN Required

1Gb/100Mb LAN Existing

1Gb/100Mb LAN In Progress

Required 100Mb

Existing 100Mb

Existing 1Gb

Kent and Medway Health Informatics Service

PACS DATA NETWORKDATE : 5TH OCTOBER 2004

Queen Elizabeththe Queen

Mother Hospital

Kent and Medway CIO Office

PACS Programme

GP

Radiologist at Home

AcuteCommunity

Tertiary

Kent and Medway CIO Office

PACS Programme

Challenges

• IG – how to share data• Encryption routers• RIS codes and standards• Unique patient ID• Viewing PACS images

Kent and Medway CIO Office

PACS Programme

Patient

GP

Inpatient

A&E

ModalityModality

Order/comms

PAS

RISPACS Broker

Modality

PACS reporting

Storage

Paper request form

Information Flows

Kent and Medway CIO Office

PACS Programme

ModalityModalityRISRIS

RIS Server and database

Data Centre

PACS Archive

Encryption Router

Encryption Router

N3 Network

PACS Server PACS Web

Centricity WebCentricity Web

Legacy PAS Server

Interface Engine

PACS Broker

Reporting WorkStation with integrated RIS

Trust Computer

Room

Firewall

Firewall

Example of a network diagram

Kent and Medway CIO Office

PACS Programme

IG

• The RIS is a single domain• Clinically very acceptable • However until full functionality and audit

trail in place does not record consent• Data sharing protocol agreed by all

Caldicott Guardians • Staff training• Non-consent work around

Kent and Medway CIO Office

PACS Programme

Encryption Routers

• Secure data from edge of trust network – for us this was the edge of the COIN

• However single point of failure• ? Impact on traffic throughput• What about data elsewhere?

Kent and Medway CIO Office

PACS Programme

RIS Codes and Standards

• Agreed at outset to follow a single approach across the SHA to RIS coding:– Username – national registration code– Ward names - NACS and then agreed format– Rooms – NACS and agreed format– Examination codes – national

• Old RIS data extracted to a wed hosted viewer

Kent and Medway CIO Office

PACS Programme

Unique Patient ID

• Needed a unique patient ID across the SHA for RIS (not aware of this until second site went live)

• Currently business flow operates on PAS numbers

• Initial response was to add a prefix to PAS to create a unique number in RIS across the SHA

• This would be added on interface entry to RIS and stripped on interface out of RIS to PAS

• The prefix however would be used in PACS• NHS No. not sufficiently populated or

manageable to use.

Kent and Medway CIO Office

PACS Programme

PAS A

PAS 132456 – Joe Smith

PAS B

PAS 345678 Joe Smith

PAS C

PAS 123456 Mark Wright

CRIS Mirror PMI File

PAS A123456 Joe SmithPAS B345678 Joe Smith

PAS C123456 Mark Wright

CRIS System

CRIS no. 1 Joe Smith A123456. B345678CRIS No. 2 Mark Wright C123456 ..

PACS A

A123456Accession no.

PACS B

B345678Accession no.

PACS C

C123456Accession no.

Cluster PACS store

Filed by Accession no.

Kent and Medway CIO Office

PACS Programme

Patient

ModalityModality

Order/commsPAS

RISPACS Broker

Modality

PACS reporting

Local Storage

Paper request form

PASPre-PAS

Pre-PAS

&CRIS

Pre-PAS /

Accession No.

Pre-PAS /

Accession No. & CRIS

Data CentreStorage

Accession No.

Pre-PAS /

Accession No.

PACS Web

Viewer

Pre-PAS

Pre-PAS

PAS

CRS (launches

PACS viewer)

y

Accession No.

Kent and Medway CIO Office

PACS Programme

What Number do you use?

• PAS – PAS or NHS• RIS - pre-PAS, RIS or NHS• PACS – pre-PAS, RIS, NHS or

accession• Results – PAS or NHS • Web Viewer Pre-PAS or Name• CRS – CRS, old PAS, NHS, - launches

accession no. search on data centre

Kent and Medway CIO Office

PACS Programme

Challenges

• Mapping out the correct ID process through all stages

• Not blocking any clinical benefits from access to data

• Maximising the use of the NHS No.• Moving to a standard practice

everywhere.• Managing a single RIS instance across

an SHA including national code updates (links to letters, appointments, PACS and order comms)

Kent and Medway CIO Office

PACS Programme

Deliverables

• 1st SHA Wide Data Centre Solution• On time• In Budget• Single Workflow• SHA Wide RIS codes• Legacy RIS viewer• Information Sharing Protocol

Kent and Medway CIO Office

PACS Programme

Benefits from PACS

Kent and Medway CIO Office

PACS Programme

Benefits• Approach / Strategy• Benefits Realisation

– Cash releasing– Qualitative/ service improvement– Community wide

• Service Redesign– Overall view– Alignment with ISIP

• Challenges and Constraints

Kent and Medway CIO Office

PACS Programme

K&M Approach

• Vision– Expensive toy or enabler to change?– Community Wide

• Agree Coding, Terminology and Workflow• Explore SHA wide Imaging potential• Develop Radiology Network -?

– Utilise NPfIT• Community of Interest Network (COIN)

Kent and Medway CIO Office

PACS Programme

Cash ReleasingBenefits

• Conservative assessment • Film and Chemicals• Processor maintenance• Staff (film management, secretarial)• Stationary • £26m (over lifetime of project)

Kent and Medway CIO Office

PACS Programme

Non Cash Releasing• X-ray availability:

– Reduces NHS cancellations (OPt, ops, scans etc)– Reduction in delayed discharges

• Faster diagnosis• Fewer patient journeys• Film searches

– Junior doctors, estimated 45mins per day

• £19m (Over lifetime of project) (not shown in affordability gap)

Kent and Medway CIO Office

PACS Programme

SHA Wide Potential• Generic radiology model

– Agreed patient pathways– Community PACS– Standardised RIS reporting

• Pooled equipment usage • On-call services• Reporting pool• Centralised film store • Centralised maintenance contracts• Joint training• Joint recruitment and job descriptions• Reduced locum costs

Kent and Medway CIO Office

PACS Programme

Realising the Benefits Beyond the Trust - Options

• Realisation of strategic benefits requires joint working across the health community

• True, and beneficial, joint working requires formal governance structures to be in place with links to other initiatives

• The implementation of PACS could facilitate the creation of a radiology “body” within Kent and Medway

• A formal Radiology Network could be put in place catering for the health economy

• A Radiology Network could be a:– Less formal group/body– Part managed network– A managed network structure

Kent and Medway CIO Office

PACS Programme

Network Options

Federation Network Mutual Network Managed Network

Advice and guidance group Some central management of services

All radiology services centrally managed

Sharing best practice Centralised film archives

Central training and education

Pooled reporting

Reporting Centres

Teaching files

During PACS implementation

On completion of implementation

With a matured PACS

Kent and Medway CIO Office

PACS Programme

Next Steps / Challenges• Complete deployments• Operational handover• GP results reporting• PACS web service• Last few issues on performance and

service management• Integrate with other CfH Programmes• Agree Approach & Strategy for Benefits

Realisation• Integrate Service Redesign with ISIP

Kent and Medway CIO Office

PACS ProgrammeYesterday

Kent and Medway CIO Office

PACS Programme Today

Kent and Medway CIO Office

PACS Programme

Thank You

Any Questions