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PACS, RIS and related developments in the United Kingdom

PACS, RIS and related developments in the United Kingdom. Dr Keith Foord Consultant Radiologist Conquest Hospital,East Sussex, UK (Secretary, UK Royal College of Radiologists PACS and Teleradiology Group and Board Member, EuroPACS).

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PACS, RIS and related developments in the United Kingdom

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  1. PACS, RIS and related developments in the United Kingdom Dr Keith Foord Consultant Radiologist Conquest Hospital,East Sussex, UK (Secretary, UK Royal College of Radiologists PACS and Teleradiology Group and Board Member, EuroPACS) PACS 2003   Velkommen til hyggelige og lærerike konferansedager i Trondheim!Nasjonal PACS/RIS-konferanse 12. og 13. februar 2003 i Trondheim

  2. United Kingdom Population*(millions) Total 59.8 England 50.0 Scotland 5.1Wales 2.9N. Ireland 1.7

  3. NHSnet – the largest private Intranet in the world. NHS Information Authority - very tight security guidance UK NHS national email firstname.familyname@hospital.nhs.uk keith.foord@esht.nhs.uk

  4. NHSIA unhappy with security issues with ADSL except for point to point transmission between networks or in Virtual Private Networks - VPNs VPN (private) – SW London project VPNs (DSL with encryption) Dedicated WAN - Glasgow BT Metro VPN – Wales ‘DAWN2’ (or over short distances BT LES - LAN Emulation Circuit)

  5. NHS I.T. Provider history Although NHS is a national health service, free to citizens at the point of use, I.T. very fragmented as there was a political history of minimising central control in England from 1994 - 1998. More centralised systems were maintained in Scotland, Wales and Northern Ireland. Unique 10 digit NHS number only just available for all citizens. Attempts to co-operatively co-ordinate from 1998 to 2002 failed. Allocated resources did not reach hospitals as the money was able to be diverted at an intermediate level to meet other political objectives in NHS service delivery. 2003 - More vigorous, but commercial, control now being re-asserted to move as rapidly as possible – Objective is to be able to freely exchange clinical information around the UK.

  6. Major Patient Administration or Hospital Infomation system providers in UKShare of known installed market

  7. Major RIS system providers in UKShare of known installed market *RADIS installed in all Welsh hospitals **NIRADS installed in all N Ireland hospitals

  8. PACS sites PACS in development Wide area PACS project Wide area PACS project initiation

  9. Major PACS system providers in UKShare of known installed market

  10. Long distance teleradiology projects in Scotland to support remote areas Hospitals with teleradiology facility for emergency use Every UK hospital has at least a video link to its regional neurological centre for emergency neuro CT etc. Wales – national ‘DAWN’ VPN Sussex Cancer Network web based project

  11. Major Teleradiology system providers in UKShare of known installed market

  12. So how is control being re-asserted?

  13. Surrey and Sussex Strategic Health Authority East Sussex Hospitals Sussex Cancer Network

  14. Strategic Health Authority Now responsible for IT in its area. Appointing ‘Prime Consortium’ to take over existing contracts and provide new IT services, including VPNs Will be in place from late 2003 There will be more focussed IT provision in the strategic area and less choice for and less variation, between hospitals. Each prime consortium may have only one or two PACS/RIS provider companies

  15. Applies to 23 Strategic areas of England DOES not apply to:Scotland Northern Ireland or Wales Who have national Strategic coordinating bodies already as part of ‘devolved’ government

  16. National Diagnostic Imaging Messages Project (DIMP) • There approx. 600 imaging departments in the UK, the majority of these departments have Radiology Information Systems (RIS) sometimes these systems are integrated as part of a Patient Administration System (PAS). • In the UK there are almost 9000 GP practices and virtually all have computerised information systems. • DIMP to ensure all hospitals and GPs will be routinely exchanging structured electronic messages for Radiology results by the end of 2003 (but not images) • The message will use a UK profile of the HL7 V2 messaging standard implemented in XML over eSMTP. • A discrete list of diagnostic imaging investigations coded in both Read Codes and SNOMED CT will be developed - uniquely identifying the examination to which the report pertains.

  17. What about local developments in East Sussex Hospitals? East Sussex Hospitals Population 450,000 220,000 imaging investigations per year

  18. 1991 • Regional Radiology Committee discusses PACS - Conquest Hospital to act as test bed • SE Thames RHA Scientific Office leads - a Regional development project • Contract signed with ‘Simis Medical Imaging’

  19. ODs RAID PACS/RIS Unix Devices DSA DSI Radiologists Sun Sparc PACS viewers Video PC i/f Sun Sparc i/f ISDN PC i/f Hub Hub Single CR segment CT 2 x 100 Mbs Mac i/f 1994 CR Sun Sparc review PC i/f NM Hub Digitisers External Sun Sparc PACSviewers RIS Terminals

  20. 1997 • Specify new triplicated CR DICOM system • Lease 3 x Philips AC3 • 3 x ‘Easyvision RAD’ workstations also networked to fluoro and angio units • Continuing PACS re-specification work

  21. CR connectivity Late 1997 AC3 CR x 3 USITs x 3 ASCII Bespoke protocol Hospital 10/100Mbs ethernet Switched Hub IP ‘ping’ IP ‘ping’ Switched Hub DICOM RIS ASCII unidirectional VLAN Switch/ Route Controller

  22. Conquest Hospital, U.K. early1999 installation agreed Siemens ICON Nec Med Philips V3000 Philips new DSI Ultrasound Picker Polaris MR Siemens AR/T CT C Arms with IAMs Philips DSI Philips PCR PC Link Picker W/S Lumisys 150* with QA Station Philips EV RAD Key User DICOM Servers StudyServerTM With Fibre RAID Lumisys 75 with QA Station PACS Broker Linked to RIS / /CIS/HIS RIS Server CIS/HIS Server DLT nTByte Archive Key Users Archive Manager RAID DICOM Print server PACS Web Server Key User station Radiology Segment Workstations Bexhill Hospital Dry Laser DICOM Printing HospitalIntranet 100 plus Intranet / CIS users

  23. 2001 • ‘Management merger’ with Eastbourne. • Joint IT department formed. Joint PACS Project Board • Documents re-done to reflect two main hospitals andDVD archiving problems with Agfa Basix mini-PACS • Tender for new CR for Bexhill Hospital • E’B obtain charitable fund money - go to tender for their elements of new full PACS plus 2 additional CR units • Sunquest taken over by Misys

  24. 2002 • Philips Compano CR/ Kodak DICOM printing installed at Bexhill Hospital • 36Mbs ‘line-of-sight’ microwave wireless linkage between Conquest and Eastbourne • Hastings extends Philips CR lease at Conquest to includes 4th and new 5th CR - for CR mammography • Hastings installs Ferrania Web Server (allows Query/Retrieve from local RAID and Eastbourne archives) • Eastbourne place contract with Agfa for DICOM/Web PACS plus 2 additional CRs. Web Server allows Query/Retrieve from Hastings RAID • Hastings tenders for DICOM printing network, selects Agfa • Hastings tendering for PACS which will allow DICOM query/retrieve from Eastbourne archives and increase existing server and RAID/SAN archive capacity across the units.

  25. Cross site PACS • Separate systems but DICOM query/retrieve between? • Same system, enhance link bandwidth and servers and RAID/SAN capacity? • What to do about different PAS and RIS systems? • Local big RAIDs, shared/local SAN storage?

  26. RAIDS Archive workflow MOD Manager SAN Eastbourne Hospital installations agreed 2002 Nec Med Siemens Angio DSI Ultrasound Siemens MR Siemens CT AGFA CR PAXport W/S PAXport PAXport Lumisys 75 with QA Station PACS Broker Linked to RIS RIS Server MOD Archive Dry Laser DICOM Printing DICOM Print server Workflow manager Hastings Dtabase manager Balanced PACS Web Server Balanced PACS Web Server Radiologists Workstations Trust Intranet 1000 plus Intranet / CIS users

  27. RIS Server RAIDS Archive workflow Web Server RAID Image Web Server SAN Bexhill Hospital CR & Conquest Hospital, Digital Image and Web installations 2003 New DICOM Nec Med Philips V3000 Philips new DSI Ultrasound Picker Polaris MR Siemens AR/T CT Philips DSI DICOM link Philips PCR Picker W/S Philips EV Philips Compano CR CIS Server NM viewer PAS Server DICOM Print server DICOM Print server Dry Laser DICOM Printing Bexhill Hospital Dry Laser DICOM Printing Radiology users Trust Intranet Eastbourne Web users

  28. OBJECTIVE 2003 Seamless, cross site PACS

  29. Thank you for asking me to Trondheim

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