access to medical imaging for research in scotland the role, … · 2012-09-25 · access to...

Access to medical imaging for research in ScotlandThe role, possibilities and limitation of the National PACS

Hamish McRitchie

(Consultant Radiologist)

Chair Clinical Advisory Group

Scottish National PACS Project

National PACS

Background

Origins of the National PACS (1)

Drivers

• Early 2000,s

• Glasgow had a data storage problem

• They were spending a fortune on film

• The CT and MRI scanners were producing digital data

• Plain film equipment needed replaced (CR was coming)

• GGHB explored the possibility of a PACS solution


Drivers

• GGHB looking after 2-3 million people

• 60% of the Scottish health budget

• The thought of GGHB spending a fortune on PACS concentrated minds at SEHD

• A national procurement was considered


Executive input

• 2003-2004

• Scottish Executive (Malcolm Chisholm)

• SEHD (Charlie Knox, Alan Hyslop)

• GGHB PACS expanded into a national procurement

• Operational Requirement / Business Case generated largely within GGHB

• Input from the RIS/PACS reference group, NSS, Scottish Healthcare Supplies to give comfort that the solution was nationally applicable


The Kerr Report

National PACS

Procurement

Procurement (1)

• GGHB team

• Representatives from Scottish Radiology

• Radiographic management

• NSS

• Scottish Healthcare Supplies

• To make a recommendation to SEHD

Procurement (2)

• Formal procurement started

• Financial criteria excluded many companies

• Presentations from suppliers

• Round of site visits• Presentations from suppliers

• Decision• Negotiations (preferred supplier, Kodak)

• Contract

Interestingly _ _ _ _

• A Scottish Executive spokesperson told EHI:

• "The introduction of PACS in NHS Scotland enables the delivery of a range of benefits to patients. Clinicians will be able to access images taken at stages along pathways and readily access relevant patient records. This will streamline care and speed up diagnosis and treatment.

• "PACS offers the opportunity for radiology reporting to be done remotely, utilising telemedicine and potentially facilitating much more flexible working of radiologists who will be able to access images on a 24-hour, seven day a week basis. It challenges traditional radiology reporting structures and encourages organisational review and reconfiguration of imaging services across health communities for maximum efficiency."

Thus showing some confusion about the

difference between PACS, RIS and Telemedicine

National PACS drivers

and specification

summary

Drivers for the National PACS

Summary

• Service delivery drivers

• Service improvement drivers

• Economic drivers

• Political strategic drivers

• No academic drivers

• No research drivers

Output based specification for the

National PACS summary

• Service delivery based

• Developed in Glasgow to meat GGHB requirements

• Checked against wider service needs

• No University input

• No consideration research requirements

Preparation for the

National PACS

Prerequisites of a national

system (1)

• All acquisition devices producing digital images

• Unique patient identification number (CHI)

• Every image acquired using a competent RIS

• All modalities running off RIS derived worklist

• No coincident accession numbers from different hospitals

• CR call off contract

• CHI as the primary identifier

• Replacement RIS systems at 6 Health Boards (Carestream RIS)

• Hospital prefix on accession numbers

Prerequisites of a national

system (2)

• Ability to transmit large data volumes locally

• Ability to transmit large data volumes over a distance

• System resilience

• System support

• Disaster recovery

• Upgraded local networks

• Upgraded N3 network

• Data duplication

• 24/7 system support

• Mirrored data stores

National PACS

organisational

arrangements

Current National PACS

organisational structures

Scottish Government Health

Department - PolicyScottish Government eHealth – Strategy

and Corporate GovernanceNSS - Project Implementation

Health Boards - Project Implementation

Benefits realisationQuality of care

Cost / Efficiency

Remits: General arrangements

• Overall PACS Programme Arrangements

• The PACS Programme and its projects forms part of the eHealth Programme in NHS Scotland.

• NSS is responsible for the programme delivery of PACS in conjunction with Health Boards.

• PACS Programme Structure

• This structure separates governance into; executive board, clinical governance, user management and quality assurance.

How is it all being run?N a tio n a l P A C S P ro g ra m m e B o a rdC h a ir / E x e c u t iv e ; D r F ra n c e s E l l io t

P ro g ra m m e M a n a g e r : A la n F le m in gB u s in e s s C h a n g e M a n a g e r : T B A

R o b in W r ig h t, G M IM & T L a n a rk s h i re - e H e a l th L e a d s C h a ir , IT L e a d e rs h ip

M a r t in E g a n , D ire c to r e H e a lth , L o th ia n - Q A L e a d & C h a ir Q M GR o n A n d e rs o n , D i re c to r IM & T , N S S - N S S L e a d

J im C ro m b ie , D i re c to r o f D ia g n o s t ic s , N H S G G & C - N H S D ire c to r

D r B r ia n R o b s o n , C l in ic a l D ire c to r , IM & T , N S S - C l in ic a l D ire c to r N S SD r H a m is h M c R i tc h ie , C h a ir o f C l in ic a l A d v is o ry G ro u p - C l in ic a l L e a d

S G H D L e a d , D ire c to r o f e H e a lth

L o c a l H B S tra te g y & B u s in e s s

C h a n g e P ro c e s s e s

L o c a l H B P A C S

P ro je c t B o a rd

C l in ic a l A d v is o ry

G ro u p

C h a ir : D r H a m is hM c R itc h ie

T e c h n ic a l Q M G :

M a r t in E g a n

D e p lo y m e n t P ro je c t

T e a mA la n F le m in g

J im K y d dJ o h n M c D o n a ld

U s e r G ro u p

C h a ir : A l la nS o m e rv i l le

Remits: PACS Board

Terms of Reference

1 Establish strategic direction for PACS

2 Approve the programme plan and monitor overall progress on plan.

3 Monitor the commitment of central finance for the programme.

4 Receive regular reports on the progress of the programme from the programme manager (s).

5 Receive regular reports from the clinical advisory group.

Structures and remits

• Organisational structures

– Research not represented

• Remit of the PACS Board

– The needs of research not currently considered

National PACS

architecture and data

storage

Modalities

RIS

HL/7Integration

Archive

Manager

SAN

Utility

Storage

Local DICOM

ACCESS POINT

Rapid

Online

Web Server

New Images to Data CentreContinuous During The Day

Pre-fetched Images from Data CentreOvernight

Local Hospital configuration

Carestream10

PACS

Data CentreModality Worklists

National PACS Architecture

12 months

RAID

Identical architecture PACS varied on a Small /

Medium / Large x 39

New Images

Pre-fetched Images

ArchiveManager

SAN

Utility

Storage

DR Data Centre

National PACS. What goes in?

• All image data that is acquired using an accession number generated by a RIS system

• Must be in DICOM format

– Either directly– Or in a DICOM envelope

• Must be indexed by a CHI number• No current limitation on data that meets these criteria

by volume

• If it is not patient data generated using an accession number and linked to a CHI number it does not go in

National PACS. Image retention

and compression.

• Images being retained for the life of the patient plus three years

• 2:1 lossless compression for all modalities

Data volumes generated over the 12 months

Cumulative No. of studies

Cummulative # studies

0

200000

400000

600000

800000

1000000

1200000

1400000

1600000

1800000

2000000

Sep-

06

Oct-

06

Nov-

06

Dec-

06

Jan-

07

Feb-

07

Mar-

07

Apr-

07

May-

07

Jun-

07

Jul-

07

Aug-

07

Sep-

07

Oct-

07

Nov-

07

Dec-

07

Jan-

08

Feb-

08

Mar-

08

Apr-

08

May-

08

Jun-

08

Jul-

08

Aug-

08

Sep-

08

XA

US

SR

RF

PX

OT

NM

MR

MG

HC

CT

DX

CR

Cumulative GB in Datacenter

Cumulative GB storage

0

5000

10000

15000

20000

25000

30000

35000

Se

p-

06

O

ct-

06

No

v-

06

De

c-

06

Ja

n-

07

Fe

b-

07

Ma

r-

07

A

pr-

07

Ma

y-

07

Ju

n-

07

J

ul-

07

Au

g-

07

Se

p-

07

O

ct-

07

No

v-

07

De

c-

07

Ja

n-

08

Fe

b-

08

Ma

r-

08

A

pr-

08

Ma

y-

08

Ju

n-

08

J

ul-

08

Au

g-

08

XA

US

SR

RF

PX

OT

NM

MR

MG

HC

CT

DX

CR

National PACS. Issues related to

data volumes (1) Costs

• Cost of storage

– Most of this relates to management and security rather than hardware

– Cost of data storage – £1.4m to date, projected to be £3.6m by end March 2010.

• Cost of networks

National PACS. Issues related to

data volumes (2) Functionality

• Data queues sending

– Local at hospitals

– Centrally at the archive

• Data queues retrieving

– Centrally at the archive

– Locally at the hospital

• Reduced local storage

• Network pressure

– N3

– Local networks

Measures to address data volume

issues currently being considered

• Limit the total amount of data that will be allowed per health board without additional cost

• Limit the amount of data that will be allowed per examination without additional cost

• Lossy compression of data in the central archive

– At ingest

– At 18 months

• Data deletion ? Seven years

The role of RIS in data storage.

• Generates the accession number

• Populates the modality worklist with DICOM header information

• Allows a report to be generated

• Holds the report – sends it to the PACS (DICOM structured reports)

• Responsible for all the information used to index the images

Limitations of the

National PACS

Limitations of the National PACS

(1) What goes in

• Designed around routine service delivery requirements

– System architecture/System rules/RIS related/Contractual/Cost structure

• If research image data fits it will go into the PACS

• If research image data does not fit it will not currently go in

– Non RIS indexed data

– Non CHI related data

– Non image data (raw data)

– Non patient data


(2) What does not go in

• High data volume per examination

• Non image data (raw data)

• Non patient data

• Non clinical diagnostic data

• Network upgrades for high data volume transmission

• Not within current costing structure – would require additional finance


(3) What is not costed

• Limitation of ingested data volumes (moves towards archiving reduced data sets)

• Compression on ingest

• Delayed compression (18 months)

• Data deletion


(4) Proposed changes

Possibilities for the future

Possibilities for the future

• The network is there and university departments are connected

• The archive is there and available as utility bulk data storage

• The interfacing is done

• Additional data could be stored within the system

– Once indexing is sorted

– Once the cost is funded

To use the PACS

• Define your requirements• Persuade

– Scottish Government

• Political• Managerial (civil service)

– Health service providers• NSS• Territorial Boards

• Negotiate the cost• Negotiate the service

• Influence the product design

Other points to consider

Data governance

• Caldicott guardian

– these are local roles (territorial board)

– usually DPHs

• CLO advice is that NSS is not the data controller in PACS but the Health Board is –NSS can only ever be the data processor on Boards behalf

Long term future

• What to do at

– End of contract

– Exit strategy

Thank you

access to medical imaging for research in scotland the role, … · 2012-09-25 · access to...

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