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1885

2001

 

Scottish coffee - Camp Coffee Essence (1885); Californian (2001)

 

 

 

 

 

 

   

 New RIE 1878

New RIE 2000

 

 

 

 

 

 

 

 

 

 

"The right image in the right place at the right time"

 Radiology 1895

Radiology 2001

 

 

 

 

 

 

 

 

What's wrong with film?

 

 

Images often not available to clinician

  • 45% of inpatient films available on ward at RIE

Images often not available to radiologist

  • 72% of previous films available at WGH radiology reporting
  • unreported plain film rate:
    • 50% at RIE
    • 34% at WGH
    • 6% at RHSC

Audit data, early 2001

 

 

 

 

 

 

 

What's wrong with film? (contd.)

 

 

Changing radiological techniques

  • New modalities generate more, and more complex, images

Storage and retrieval

  • 6.5km (4 miles) of shelving for X-ray storage across the trust, and growing
  • Problems locating space
  • Problems finding and retrieving stored images

 

 

 

 

 

 

 

 

 

Consequences

 

 

Decisions often made without full information

Delays and cancellations

  • Operations, clinic appointments

Repeat exposures

  • Increased radiation dose to patient

Opportunity cost to clinical staff

  • Large amounts of time spent retrieving unavailable images

 

 

 

 

 

 

 

 

 

 

 

Issues for 2001-5

 

 

Shorter admissions

More rapid turnaround of investigations required

Increased interhospital transfers

  • Expect increasingly poor performance of existing systems in these circumstances

Storage space in new build hospital

  • Notably NRIE

Fit with aspirations for healthcare information flow

  • To Primary Care, Scotland, and the UK

 

 

 

 

 

 

 

 

What can PACS offer?

 

 

 

 

 

 

 

 

 

 

 

Radiologist's interface at PACS reporting station

 

View of an ankle by CR/PACS

 

 

Enlarged view, showing measuring

 

 

How does PACS do this?

 

Images digitized at acquisition (CR, Computed Radiography)

  • Greater dynamic range and exposure tolerance
  • Fewer repeat exposures
  • No chemical processing

As soon as image quality verified by radiographer, sent immediately to electronic archive

  • No shelved film storage required

Immediate viewing possible

  • By radiologist at reporting station
  • By clinician on admitting ward
  • By clinicians/ radiologists in other locations

No lost images

 

 

What else can PACS do?

 

Integrate other kinds of image?

  • Not off-the-shelf at present
  • Some suggestions that some types may be included in the future
  • But image-handling abilities of networks and PCs developed; integration simpler after PACS

Catalyze the Electronic Patient Record

  • Elsewhere, EPR often introduced in parallel or on the back of PACS

Provide exceptional resource for

  • Teaching
  • Research
  • Clinical governance and audit

 

 

 

What is required

 

 

 

 

Integration

 

Integration between PAS (or HIS), RIS and PACS is essential

  • PAS - Patient Administration System (identifier, location, appointments)
  • HIS - Hospital Information System - a more ambitious integration of many different sources of information to a single interface
  • RIS - Radiology Information System - arranges appointments, worklists etc within Radiology

Communications must be two-way

  • To remove need for data re-entry
  • To permit electronic ordering of investigations

 

 

 

 

 

 

 

 

How should PACS be introduced in LUHNT?

 

 

On May 31st the Trust Board approved the Outline Business Case for a Lothian-wide scheme for the introduction of PACS

 

 

 

 

 

 

 

PRIORITIES

2003

NRIE from opening of Phase II ('big bang')

  • Inadequate current service provision
  • Extra cost from installing then replacing
  • Inadequate storage space
  • Staff savings already assumed
  • Opportunity window for staff acceptance

2003-4

Add WGH when information systems (and £?) permit

  • Increase coverage from 50% to 85% of images in LUHNT
2003-5

Add Community hospitals

  • High rate of transfer to and from acute hospitals

2003?

Link to SJH

  • As soon as communications permit

2006-7

Add RHSC

  • Volume of traffic smaller, current situation least critical

 

 

 

What will it cost?

 

 

 

Initial capital cost £6.7M  
Lifetime revenue cost £25.7M  
Annualized extra cost by site

RIE

RIE

LPCT

RHSC

£200,000

£200,000

£150,000

£50,000