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The Benefits of PACS. Communication Patients Clinicians Changing Patterns of Healthcare Delivery

DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Dr Laurence Sutton. Clinical PACS Implementation Lead West Yorkshire Strategic Health Authority Clinical PACS Implementation Lead NE Regional Cluster. The Benefits of PACS. Communication Patients Clinicians

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The Benefits of PACS. Communication Patients Clinicians Changing Patterns of Healthcare Delivery

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  1. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!Dr Laurence Sutton.Clinical PACS Implementation Lead West Yorkshire Strategic Health Authority Clinical PACS Implementation Lead NE Regional Cluster. The Benefits of PACS. Communication Patients Clinicians Changing Patterns of Healthcare Delivery Healthcare Economies. !More Patients does not mean more People!? Laurence Sutton

  2. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! RADIOLOGY IMAGE MANAGEMENT SYSTEM ACUTE TRUST OR COMMUNITY WIDE. WHAT IS PACS? PACS RIS NETWORK LAN WAN INTELLIGENT DATA HANDLING PAS MPI Laurence Sutton

  3. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! BACKGROUND TO NPfIT AND ICRS • ‘Information for Health’ document published in September 1988. A National Strategy for local Implementation. • ‘Building the Information Core: Implementing the NHS Plan’ published in January 2001 • ‘Delivering 21st Century IT, Support for the NHS’ published June 2002 • NPfIT start October 2002 • National Service Frameworks. (Cancer, Heart disease). • Modernisation Agency; Improving Radiology Services. Laurence Sutton

  4. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! What is NPfIT • NPfIT is an organisation set up to implement projects vital to the NHS modernisation programme. It currently focuses on the four key developments which will make a significant difference to patients: • integrated care record service • electronic booking • electronic transfer of prescriptions • infrastructure Laurence Sutton

  5. Procurement • NPfIT is one of the largest single IT procurement programmes in the world • The National Programme aims to conduct procurement: • rapidly, with solutions that are responsive to business needs • to provide value for money • to optimise the cost of participation in the procurement by suppliers • following the process outlined in the Procurement Approach document http:/www.doh.gov.uk/ipu/programme/ issued in January 2003 £ Laurence Sutton

  6. Aim To deliver a 21st century health service through the efficient use of information technology • To improve the quality and convenience of care by ensuring that those who receive care have the right information, at the right time • To implement projects vital to the NHS modernisation programme using IT to directly improve the patient experience and clinical care Laurence Sutton

  7. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! • The Plan (PID) • E-Booking functional December 2005 • ETP 50% national implementation December 2004 – 100% December 2007 • ICRS phase 1 December 2004 – phase 2 December 2006 • PACS 1/3 roll out by December 2004 – completed December 2006 • Infrastructure full connectivity March 2005 Laurence Sutton

  8. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! ICRS. • ICRS will facilitate the sharing of electronic patient records to provide clinical support across all care settings: • providing a national set of standards and a national repository of information (NHS Spine) • aiding delivery of patient-centred care • facilitating the sharing of electronic patient records • aiding clinical support Laurence Sutton

  9. INTEGRATED CARE RECORD SYSTEM THE NATIONAL PACS PROGRAMME IS AN INTEGRAL PART OF ICRS Laurence Sutton

  10. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! • Procurement levels. • National infrastructure, N3, (NISPs). • Enabling continuity of NHSNet after the end of 2003 • National applications, (NASPs). • Data spine for the integrated care record service • The national electronic booking service • Picture archiving and communications systems!!! • Electronic transfer of prescriptions Laurence Sutton

  11. Local Service Providers (LSPs) • Provide IT systems and services, in the five geographic clusters dividing England • Ensure that the national applications can be delivered locally • Ensure that both national standards and local business needs are met Laurence Sutton

  12. The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities in England) Laurence Sutton

  13. DELIVERING PACS TO YOUR HOSPITALThe 5 Clusters. Laurence Sutton

  14. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!The Organisations and Supporting Bodies. • An Evolving Process! NPfIT Operational Management Team. NCAB To NPfIT.(PACS subgroup) Modernisation Agency. NPfIT-PACS Board. PACS NCAB.(RCR PACS SIG) Regional Clusters (5) Local Service Providers (5) SHA (28) TRUSTS Diagnostic Imaging Departments. PACS Project Teams. YOU TURMOIL Laurence Sutton

  15. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!Organisational Roles. • NPfIT Operational Management Team. • STRATEGIC AND HIGH LEVEL OPERATIONAL FUNCTIONS • Streamlining of previously bureaucratic processes • Integration of systems with scalability • Identify additional resources. Laurence Sutton

  16. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Organisational Roles. NATIONAL CLINICAL ADVISORY BOARD TO NPfIT PACS SUBGROUP(inc MA) BENEFITS REALISATION • NPfIT Operational Management Team. • STRATEGIC AND HIGH LEVEL OPERATIONAL FUNCTIONS. • FUNDING. • PROCUREMENT • Accredited Products. • 2 Case Model. Financial and Managerial. • Financial and OBC Templates. • No need for OJEC Laurence Sutton

  17. Procurement • The National Programme is following a structured procurement process to select preferred suppliers, which includes: • issuing an advertisement in Official Journal of European Community (OJEC) • developing and issuing the Output Based Specification (OBS) • evaluating the response from the suppliers • negotiating contractual arrangements with suppliers Laurence Sutton

  18. THE 5 CASE MODEL • Strategic case – why is the procurement needed, what is the organisational context • Economic case – the value for money arguments and evidence • Financial case – can it be afforded? • Commercial case – the contract and the procurement process • Management case – delivering the project and its solution Laurence Sutton

  19. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Organisational Roles. • NPfIT- PACS Board. • OBS and PACS Specification. • Accreditation of PACS Products (Vendors). • Financial planning\Frameworks. • Test the robustness of proposed PACS implementations against the National standard. • Support PACS Implementations through Regional PACS Facilitators. (Business Case Planning) Supported and Advised by the PACS Clinical Advisory Board RCR PACS and Tele-radiology SIG Laurence Sutton

  20. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Organisational Roles. • REGIONAL CLUSTERS. TEAM • Regional Implementation Director • Regional PACS Facilitator • Regional Clinical Lead for PACS. • Will? Ensure Implementation is consistent with the National Plan. Develop a cluster wide strategy for RIMS. Co-ordinate the various SHA Business Cases. Prioritise these against other elements of ICRS and the broader elements of the National Programme. Co-ordinate Funding. Formulate\Negotiate\Award CONTRACT with the LSP. Laurence Sutton

  21. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Organisational Roles. • Strategic Health Authority • CIO • NPfIT Implementation Director • Clinical PACS Lead • PACS Project Manager. • Will? Evaluate Implementation Plans for Health Care Economy. Collate Trust business Cases for RIMS. Work with the RID to secure support and Funding. Implement and Manage Education and Change Management Programmes. Eventually co-ordinate Community Wide PACS Laurence Sutton

  22. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Organisational Roles. Form a Project Board Team Work with the SHA PACS Team And Regional Facilitator\Clinical Lead Develop a HOSPITAL WIDE RIMS Produce an Education Programme And Manage Change. • The Trust • Chief executive • Director of ICT • Director of Finance. • Director of Diagnostic Imaging. • Clinical PACS Lead • PACS Project Manager. • Will? Laurence Sutton

  23. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Organisational Roles. THE LOCAL SERVICE PROVIDER • Provide IT systems and services, in the five geographic clusters dividing England • Ensure that the national applications can be delivered locally • Ensure that both national standards and local business needs are met Laurence Sutton

  24. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! THE LSP AND NATIONAL PERSPECTIVE • Ideal implementation would be a cluster wide, Large Health Economy. • More realistically, SHA HE Wide. • ? Time scales. • Dependencies on other ICRS products • Geographical Scales, Big PACS depends on N3. • National View to balance the economies of scale with the available funding streams AND: • The degree of Readiness of trusts, organisations to assimilate new technology.ie to manage change. • Therefore expect relatively small incremental changes not Tidal Waves! PACS 1/3 roll out by December 2004 – completed December 2006 Laurence Sutton

  25. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Procurement and Implementation NATIONAL PROGRAMME RID PROCUREMENT Service Redesign MA Contracts\funding Strategic Planning SHA TRUSTS LSP SERVICE DELIVERY TURMOIL ENGAGEMENT OF END USERS. LOCAL DELIVERY Laurence Sutton

  26. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Modernisation Agency. • A National Framework for Service Improvement. • Restructured Clinically Led Patient Focused Services. • Workflow and Capacity Planning. • Agenda for change and the four tier structure. • Role of PACS, Radiology Management Systems to facilitate the above. • Benefits Realisation. Laurence Sutton

  27. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Products in the ICRS (Contract) CORE ADDITIONAL (PACS) FUTURE RING-FENCED FUNDING. NOTHING TO DO WITH PRIORITY. Laurence Sutton

  28. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! Products in the ICRS, PACS. Contracting Issues. • Core services. Programme can make firm orders for fixed prices. • Additional. Programme requires a firm price. Programme reserves the right to place an order. • Firm price means that some elements are fixed. Other prices are according to a rates schedule. • For PACS, pricing schedules are being developed along with discussions around How PACS services will be delivered and the Nature of the contracts between the Vendors, the LSPs and the Programme. • Sensitive Negotiations ongoing. Laurence Sutton

  29. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! The PACS Product. What is in. CR RADIOLOGY WORKSTATIONS. STORAGE SYSTEMS What is NOT DR (Why Not) PC\Monitors Outside Radiology LAN Education, Training. Laurence Sutton

  30. The PACS Product CAPITAL CAPITAL CHARGES REVENUE PACS SERVICE LSP ? MANAGED SERVICE. AFFORDABILITY GAP Laurence Sutton

  31. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! WHAT ARE WE SETTING OUTTO ACHIEVE? • Integrated Clinical Record Service. THE ICRS. Which includes RIS and PACS. • STANDARDISATION of Clinical Systems. • SCALABLE SYSTEMS Laurence Sutton

  32. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! WHAT DOES THIS MEAN FORTHE LSP? • Declare their modus operandi to achieve standardisation. • Time Scales. (100% by 2006) • Establish how they interact with the Clinical Community. Clinical Leadership. • How will they Manage Change? Laurence Sutton

  33. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! WHAT DOES THIS MEAN FORTHE LSP? Evolution by customisation Poor Change Management ? Objectives achieved over the Time scale. • Declare their modus operandi to achieve standardisation. • Two Routes • 1) • Interface and customise (Eventually Integrate) • Fix up systems across the cluster • Some eventual convergence to the standard • Broad brush evolution with many ‘Legacy’ systems. • Variable Time Scales. • Lots of quick fixes but is this the best route implementation wise to achieve success? Laurence Sutton

  34. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! WHAT DOES THIS MEAN FORTHE LSP? Controlled REVOLUTION Better Change Management Achieve Standardisation in an acknowledged Time Frame Easy to identify Lessons Learned. Share Best Practice Role Out proportional to the ability To absorb Change • Declare their modus operandi to achieve standardisation. • Two Routes • 2) • Select a group of early Implementers of a given size of Health Care Economy. • Agree an acceptable implementation approach (Partnership) • Pro-active approach to integration with a rapid migration to a common enterprise architecture. • The perfected Exemplar is used to Role out across the cluster. Laurence Sutton

  35. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!Quote of the Week. ‘The NHS programme is challenging,is risky and is ambitious: There is no point hiding this because it is.’ Peter Gershon; CE of the OGC in oral evidence to the house of commons Public Accounts Committee. Nov 2003 Laurence Sutton

  36. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!RISKS!? INNOVATIVE BIG NEED SIZEABLE CHUNKS PARALLEL PROCUREMENT AND IMPLEMENTATION PROCESSES Laurence Sutton

  37. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!RISK MANAGEMENT. EXPERIENCE. GOOD TEAM. SERIES OF PHASED PROJECTS. EVOLVING PROCESSES. EVOLUTIONARY NOT BIG BANG. MODULAR APPROACH. REVIEW PROCESSES. Laurence Sutton

  38. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments!BUT EVEN SO RISKS ? OF LSP IMPLEMENTATION OF PACS WITHOUT A CAREFULLY DEVELOPED LOCAL IMPLEMENTATION STRATEGIES FOR RIMS. Laurence Sutton

  39. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! WHAT DOES THIS MEAN FORUS? • Become very aware of the NPfIT-PACS. • Provide the Clinical Leadership in the CONTEXT of the ICRS Programme • Understand the Change Management required to achieve the Standards. • Re-assure colleagues that this is an inclusive process,bearing in mind that it us that create that environment. • Try and tame the detractors. • Once in a Life Time Opportunity. Laurence Sutton

  40. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! WHAT YOU NEED TO DO! • ORGANISE A PACS PROJECT TEAM. • DISCOVER WHO YOUR REGIONAL PACS FACILITATOR IS • HAVE A CLINICAL PACS LEAD IN THE TRUST. • ENSURE THAT THERE IS AN SHA CLINICAL LEAD FOR PACS • REMEMBER THAT THIS IS NOT JUST AN IT PROJECT!! Laurence Sutton

  41. DELIVERING PACS TO YOUR HOSPITAL Perspectives and Local Predicaments! WHAT YOU NEED TO DO! • EMBRACE THE OPPORTUNITIES. • GET WELL INVOLVED • MAKE THE ORGANISATIONAL CHANGES • SUCCESS NOW SUBSTANTIALLY DEPENDS ON YOU! • ASK • INVOLVE EVERYBODY. Laurence Sutton

  42. WHAT IS THE ROLE OF THECLINICAL LEAD FOR PACS? • Make sense of the National Programme and the Cluster Strategy. • Balance the processes of Procurement with the Needs of the Implementation Processes • Work with the SHA and Trusts to engage in an implementation strategy. • Seek the best possible solutions through the RID (Prioritisation) • Ensure that all stakeholders are involved at all times. • Feed back to the NCABs on issues on Implementation. • Shape the PACS Implementation for the whole community. • Involve all enthusiasts and Prime Movers. Remove the Turmoil in the Minds Of the Implementers Laurence Sutton

  43. PACS SYMPOSIUM.CALDERDALE ROYAL HOSPITAL. Everyone thinks of changing the world,but no one Thinks of changing himself. Tolstoy SUCCESS IS A JOURNEY AND NOT A DESTINATION. THANKYOU. Laurence Sutton

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