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Kent and Medway SHA PACS Implementation

Kent and Medway SHA PACS Implementation. Tony Corkett Programme Director. Agenda. Overview and Background to Kent and Medway Programme Management & Deployment Issues, Achievements & Deliverables Benefits to the Service Q&A. Kent and Medway Background.

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Kent and Medway SHA PACS Implementation

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  1. Kent and Medway SHA PACS Implementation Tony Corkett Programme Director

  2. Agenda • Overview and Background to Kent and Medway • Programme Management & Deployment • Issues, Achievements & Deliverables • Benefits to the Service • Q&A

  3. 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)

  4. Kent and Medway Four acute trusts and 1 tertiary trust (SySx) ~ 3800 beds; 1.1m Opt

  5. Suppliers • Fujitsu – Local Service Provider (LSP) • HSS – Radiology Information System (RIS) • GE – Picture Archiving and Communications Systems (PACS) • Kodak – Computed Radiography (CR)

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

  7. 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

  8. Project Team

  9. Deployment Dartford and Gravesham • RIS 28/10/05, PACS 08/11/05 East Kent Hospitals • RIS 14/11/05PACS 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

  10. Deployment Model

  11. Tertiary Community Acute GP Radiologist at Home

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

  13. Information Flows

  14. Example of a network diagram

  15. 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

  16. 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?

  17. 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

  18. 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.

  19. 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

  20. 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)

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

  22. Benefits from PACS

  23. Benefits • Approach / Strategy • Benefits Realisation • Cash releasing • Qualitative/ service improvement • Community wide • Service Redesign • Overall view • Alignment with ISIP • Challenges and Constraints

  24. 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)

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

  26. 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)

  27. 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

  28. 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

  29. Network Options During PACS implementation On completion of implementation With a matured PACS Federation Network Mutual Network Managed Network All radiology services centrally managed Some central management of services Advice and guidance group Sharing best practice Centralised film archives Reporting Centres Teaching files Pooled reporting Central training and education

  30. 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

  31. Yesterday

  32. Today

  33. Thank You Any Questions

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