pacs a difficult implementation richard miles mrcp frcr derriford hospital plymouth
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PACS
A difficult implementation
Richard Miles MRCP FRCR
Derriford Hospital Plymouth
Commercial and In Confidence
Introduction
Scope of the implementation Resources What went well What went badly Complications Recovery
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Scope of implementation
Derriford Hospital
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Scope of implementation
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Pre LSP PACS Situation Limited PACS -Agfa
– CT, Ultrasound, Some Plain X-Ray
Inadequate Viewing Facilities
Obsolete Radiology Information System
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Health Community connectivity
Data store& RIS
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Examinations & staff
Derriford & community hospitals 300,000 examinations per year
Radiologists 25 SPR 47 Radiographers 80
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Community Hospitals
X 6Modalities with direct connectionModalities
using plates
CR readerX 10
Plates
Reporting workstations
X 41Web PACS
(PC)Other
WorkstationsRadiology Academy
Workstations
RIS terminal(PC)
PACSPACSRISRIS
Remote data store
Local data store
N3 connection
2 x printers
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Modalities
Include:16 CR plate readers3 CT scanners2 MRI scanners25 ultrasound scanners4 gamma cameras4 angio suites10 fluoro rooms
In all over 130 modalities and workstations-costs excessive for some modalities
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Key milestones
Aca
dem
y G
o Li
ve
Hos
pita
l Go
Live
Nov 05Sept 05 Jan 06 Mar 06 May 06 Jul 06 Sept 06 Nov 06Jul 05
CR
IS U
pdat
e
Tru
st B
oard
app
rova
l
RIS
mig
ratio
n
&
Opt
imis
atio
n vi
sit
Pro
ject
Com
plet
ion
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Training
Ris- 300 main users- ended up as 800
Web Pacs- 2000 e-learning/presentations
Pacs – 50+
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Challenges
Large implementation Data migration Critical clinical implications Change management challenge Challenges related to the contract
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Internal Audit
Management structure
Trust Board ISIG
Project Board
Project team meetings
PlymPfiT
Clinical User Group
PARB
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Project work structure
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Core resources
PACS Project board
Project TeamProject lead
Project technical leadClinical Lead
Admin support
Radiology IT 1 specialist IT radiographer
0.6 deputy1 admin support
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What went well
Project roll out to schedule despite tight time scale Project delivered within budget Phased roll out maintaining imaging capacity Dedicated implementation team Support from, networks, estates, and hospital IT Equipment scoping close to requirements WebPACS is well liked and trouble free
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What also went well
Migration of data from old RAD/Agfa system
But at a cost
12 weeks of the project technical lead’s time Significant planning resource Forced big bang deployment of CRIS and PACS
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What went badly
CRIS referrer list seriously deficient CRIS Rollout labour and time intensive Resource mapping was made more complex by our
system design
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Training and technical support
Suppliers unprepared for a hospital of this size and complexity
Inadequate system training from supplier– No integrated training on the whole system prior to implementation
led to many problems particularly related to workflows and generation of unspecified and split examinations
– Training given was much too long before go live date
Inadequate system support from supplier after implementation- little activity until we really shouted– No provision for support in contract– Fujitsu Help desk extremely time consuming and frustrating
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CRIS a beta release?
Slow speed of system due to CRIS– Log in times averaged 10mins Audited 7th Sept
with community log in times of 45mins– Reporting Initially much slower than old Agfa
PACS system, reporting efficiency reduced by approximately 30%.
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CRIS login times
0
10
20
30
40
50
60
Time in minutes
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37
User
CRIS Login and 1st Task
task 1
Log on
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Internal difficulties
Size of Radiology IT team much too small– Overwhelmed by technical problems and requests for
training/support following implementation– CRIS roll out much more time consuming than expected
Lack of understanding of size and complexity of PACS project– Level of support from clinicians outside radiology variable during
the difficult early days following roll out, expectations perhaps unrealistic
– Needed more contribution from users inside and outside radiology Workflows inadequately thought through
– Due in part to lack of integrated training– Should have done more work on this ‘in house’ before go live
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More issues
Lack of sharing of problems and solutions with other hospitals
Problems with connecting peripheral sites to Derriford Image sharing with other hospitals
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Complications
Real clinical risk Serious impact on reporting throughput Split studies in CT and ultrasound Workstations incorrectly setup not automatically
displaying doppler ultrasound images
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Ultrasound and CT Audit
50 sonographer ultrasounds all 2nd reported by Radiologist reviewed– 35 had split studies– 4 had radiologist reports that were incomplete – 3 no clinical impact 1 possible clinical impact
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CT Audit
50 unspecified CT examinations reviewed– All 50 had split examinations– 49 reports were regarded as complete, with radiologists
clearly having sought out the additional images– 1 study which had pelvic images in a separate file was
deficient
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Recovery
Weekly Clinical Governance meeting with CE and Medical Director
Galvanised assistance from suppliers– Resolution of numerous technical issues– Fujitsu operational analysis July 30th
Reallocated internal resources – Increased reporting capacity– Strengthen the Radiology IT team
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GP Film reporting status
0
50
100
150
200
250
300
350
400
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
weeks since go live
unre
port
ed e
xam
s
12-Jul
18-Jul
03-Aug
10-Aug
17-Aug
24-Aug
07-Sep
as at 12sepas at 16Nov
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LSP optimisation visit 18th-21st Sept
GE/Kodak/HSS representatives Workplace training throughout the directorate Kodak assessment of dose and process issues Resolution of many outstanding system integration
problems
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Unresolved issues
Image sharing- unresourced– WebPACS sharing
• Truro/Torbay/Exeter/Barnstaple/Bristol
• Non NHS image sharing?
Any questions?
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