Dr Laurence Sutton. Consultant Radiologist Calderdale and Huddersfield NHS Trust.

1. Dr Laurence Sutton. Consultant Radiologist Calderdale and Huddersfield NHS Trust. National Clinical PACS Lead NE Cluster Image Data Management. Laurence Sutton

2. Dr Laurence Sutton. Consultant Radiologist Calderdale and Huddersfield NHS Trust. National Clinical PACS Lead NE Cluster Secretary PACS Group EuroPACS Board Member UKRC Digital Imaging Committee Laurence Sutton

3. NHS CfH PACS PACS Calderdale Royal HospitalHalifax,West YorkshireApril 2001 Laurence Sutton

4. 23 TRUSTS 9 CLUSTER CONNECTION ONLY The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities in England) Intra and Inter cluster Data Sharing Laurence Sutton

5. NHS CfH PACS Image Data Management inthe Community PACSEnvironment: Laurence Sutton

6. NHS CfH PACS Key Issues • Entity Data Management. • Modality Data Management. • Local Data Storage. • Local Patient Workflows • Data transfer to another Entity • RIS-PACS Integration. • Strategic RIS. • Cluster Data Store. • Data Integrity. • Ease of Access/Updating. • Data Retention Policies. • Storage Volume Solutions. • Image Data Sharing (Intra and Inter cluster). • Disaster planning Laurence Sutton

7. NHS CfH PACS How do we ensure patient confidentiality and safety? Laurence Sutton

8. NHS CfH PACS Key Issues • General Issues. • Data Security • Data Integrity • Patient Confidentiality • Patient Consent. • Data Ownership • General Information Governance Issues. • Integration with the Spine,e.g. LRS. Laurence Sutton

9. NHS CfH PACS What do we do with Image Data? • Workflow and Patient flow analysis should tell us this. Laurence Sutton

10. NHS CfH PACS What do we do with Image Data? • Managing the Patient Pathway in a Healthcare community within the CCS Architecture. Laurence Sutton

11. NHS CfH PACS Courtesy of Dr. Richard Fowler, Leeds General Infirmary Laurence Sutton

12. NHS CfH PACS Managing the Patient Pathway in a Healthcare community within the CCS Architecture. Laurence Sutton

13. NHS CfH PACS The Image/Patient Pathway • 5 Large Geographically (Regionally) defined clusters. • HCC Natural Pool of HCO in which the Majority of patient movements take place. • Specialities may not be co-terminus. • Experience indicates that the Majority of acquired Images once reported are never retrieved again. • A secondary care provider exports <1% of acquired images to a Tertiary Centre • A Tertiary Centre is a net importer of Images. Laurence Sutton

14. NHS CfH PACS Managing Images and patient data in the CCS REQUEST FOR ASSESSMENT September 2005. CCS v HCC options. Laurence Sutton

15. NHS CfH PACS Managing Images and patient data in the CCS REQUEST FOR ASSESSMENT SUMMARY RESPONSE RE FEATURES OF CCS Laurence Sutton

16. NHS CfH PACS Managing Images and patient data in the CCS SUMMARY RESPONSE • Requirement to support Patient Journey across boundaries. • Challenges in sharing data across HCCs. • CCSs not modelled around patient journeys. • Fluid Nature of HCCs plus overlap of HCCs. • Speciality variation.Tertiary centre part of several. • HCC model more complex architecture(Image tracking) Laurence Sutton

17. NHS CfH PACS Managing Images and patient data in the CCS • High Level Advantages. • Reduced local store requirements. • Reduced multiplicity and sharing complexities. • Secure storage and ease of data management and access • Central Reporting,Facilitates workflow across entities. • Supports wider referral pattern in cluster • Integration with future NCRS Laurence Sutton

18. NHS CfH PACS How long do we keep Images for? • Review and Refine the current policies and recommendations Laurence Sutton

19. NHS CfH PACS Retention Policies for Image and Image related Data.Acknowledgement toDr.Stephen DaviesRCR IT Subcommittee Laurence Sutton

20. NHS CfH PACS Retention Policies for Image and Image related Data • Management of the Request,Image and Report. • Range of Statutes and Advice. • ‘For the Record’ [HSC 99/053, WHC 00/71] • "Using Electronic Patient Records in Hospitals: Legal Requirements and Good Practice" [HSC 98/153]. Laurence Sutton

21. NHS CfH PACS Retention Policies for Image and Image related Data • Apply to the NHS • Independent Sector and Private Practice • All Practitioners using Imaging Services. Laurence Sutton

22. NHS CfH PACS Records Management: NHS Code of Practice (RMCoP) • Report is the permanent record. • (Retention Schedules) • Images are Transitory • (Local determination and Policy) • Patient Data (RIS) now closely linked. • Complete electronic workflow from order to report distribution. An Integrated Radiological Record. • Cost of Storage.(Space and Methods). • The Image Evidence. Laurence Sutton

23. NHS CfH PACS Retention and Storage of Imagesand Radiological Patient Data. Request for Assessment February 2006 Impact on technical requirements To support the level of Functionality required To fulfil RCR Guidelines. Based on RCR Draft Document. Laurence Sutton

24. NHS CfH PACS Retention and Storage of Imagesand Radiological Patient Data. RCR VIEW IMAGE AND REPORT SHOULD BE REGARDED AS THE SAME AND COMPLY TO THE SAME GUIDANCE REGULATIONS Laurence Sutton

25. NHS CfH PACS Request for Assessment • Images and Report the same and comply with guidance document. • Robust Long Term Storage and Accessibility • Image Data stored will reflect that which is normally sent • Differential Retention Requirements/Study Tagging • Compression of Data preferable to Deletion. • Secure Environment with Backup Laurence Sutton

26. NHS CfH PACS Finally.How much can you compress Image data by without loss of clinical value? The Canadian Association of Radiologists has endorsed lossy compression for primary reads. a 50:1 compression ratio is acceptable for large-matrix images, with 25:1 optimal. An acceptable ratio for small-matrix images is 20:1, with 10:1 optimal. Laurence Sutton