NHS Scotland National PACS

1. NHS Scotland National PACS

2. Today

3. Population 5.1 million Health budget of £14 billion NHS is 33% of the public expenditure of the Scottish government. eHealth expenditure £200million per annum Scotland is one of the first examples of a National radiology system. NHS Scotland

4. Scope & Reach

5. Dependencies

6. What we have • Common user interface across all hospitals with access to the same features and functionality • Managed storage service totalling 1 Petabyte, in mirrored National Image/Report Archive • 24,000 registered users • Installation of 350, 3MP monitor diagnostic workstations for use in radiology • Web-based image viewing in over 2000 wards

7. Chosen Architecture

8. Targets & Challenging Pathways

9. Benefits p.9 • The solution accepts all images • and all reports and makes them • available across the country. • Images available anywhere • Image manipulation • Less repeat exams • Improved workflows Urgent Transfers e.g. RTA, neurosurgery c. 100 per annum Support for multi professional Groups reviewing cases remotely Support for second opinion required in c. 10000 Per annum Transfer of images for national waiting list hospital 45000 per annum

10. Benefits Miss D • Patient in Stornoway (Western Isles Hospital) • Chest physician in Inverness • Radiological opinion in Borders General Hospital • Patient received definitive treatment in ITU Glasgow Royal Infirmary

11. Miss D • Age 18 • Flu-like illness for 48 hours • Progressive SOB • Pleuritic chest pain • No significant past history • No drugs • No allergies • Erythromycin i.v. • Hydrocortisone 100mg iv • Chest opinion sought (Inverness) • CT scan (Borders General Hospital) • Decision to transfer Benefits

12. Benefits Miss D • Transferred to Glasgow • ITU bed Glasgow Royal Infirmary • Bronchio alveolar lavage • Acute eosinophilic pneumonia • High dose steriods • Recovered

13. Further Benefits The gross benefits conservatively extend to • 10% reduction in re-examination • 100% reduction in film and chemical cost • Significant reduced time to treatment • Absorbing growing activity with existing radiologist establishment • Absorbing exponential data growth on existing infrastructure Plus hard to quantify benefits such as: • Reduced litigation • CT dose monitoring a by product of data collection – dose management now considered across the country • The difference in responsiveness and quality of care is also immense - hard to over estimate.

14. Challenges • Explosion in data production – next batch of 128 slice CT now in view • Cost pressures from data storage • Compression & life cycle management • Contract complexity • Disparity in RIS functionality and deployment

15. Lessons • Need for corporate commitment • Need for strong clinical support and leadership • Need for strong support from eHealth community • Scottish Government political support • Good governance models facilitate cross organisational working

16. The Future • New version of Carestream PACS being rolled out - Technology Refresh and V11 Upgrade (Global Worklists, Tunnelling and Streaming) – different platforms and new ways of working • National Licence for Volume Matching, Lesion Management • Same application now being rolled-out to Scottish Breast Screening Service • Cloud computing for the long term future • Image database of 17 million studies now a key part of Scottish Government inward investment strategy to attract commercial clinical research