learning from salisbury’s pacs/ris implementation
DESCRIPTION
LEARNING FROM SALISBURY’S PACS/RIS IMPLEMENTATION. Dr Shaun G McGee Consultant Radiologist and Lead Clinician Clinical Lead PACS/RIS Project Board. SALISBURY DISTRICT HOSPITAL. medium-sized acute trust 3* trust, Foundation Trust status applied for 637 beds - PowerPoint PPT PresentationTRANSCRIPT
PACS/RIS
LEARNING FROM SALISBURY’S PACS/RIS IMPLEMENTATION
Dr Shaun G McGeeConsultant Radiologist and Lead Clinician
Clinical Lead PACS/RIS Project Board
PACS/RIS
PACS/RIS
SALISBURY DISTRICT HOSPITAL
•medium-sized acute trust•3* trust, Foundation Trust status applied for•637 beds•regional plastics/maxillo-facial services•supra-regional spinal injuries/rehabilitation, burns, cleft lip/palate
PACS/RIS
Department of Clinical RadiologyPre PACS/RIS
• 10 established Consultants (9.3WTE) from 5/05• 120-130,000 examinations pa• 80-85% reporting coverage• All modalities except PET-CT• Office- or modality-based reporting• Report authorisation/verification in CT/MRI only• Kodak CR/mini PACS : Spinal Unit 1998• Satellite GP plain film facilities Fordingbridge/Shaftesbury
PACS/RIS
Department of Clinical RadiologyPre PACS/RIS : challenges
• Workflow
• Efficiency
• Clinical Governance
• Accommodation
PACS/RIS
Workflow
• Flexibility to adapt to changing patterns of demand
• Effect culture change : take Mohammed to the Mountain
PACS/RIS
Efficiency
• Reporting turnaround times often slow
• Timeliness of clinical reporting
• Relevance of clinical reporting
• Inefficiency = ↑ clinical risk
• Improvement essential for 31/62 day and 18 week targets
PACS/RIS
Clinical Governance
• Inherent risk in with slow reporting turnaround
• Large risk associated with unverified reports
PACS/RIS
Accommodation
• Shortage of office accommodation for 10 established consultants
• Opportunity to separate reporting process from specific office location
• Optimize use of available space
PACS/RIS
PACS/RIS as a driver for change
PACS/RIS
Preparation
• Enterprise-wide objective• Early involvement of key stakeholders• High-level PMB representation• Partnership : Radiology/IT/LSP• Key Appointments
– Project manager August 2004– PACS manager April 2005
PACS/RIS
Preparation
• Construction of dedicated 100GByte LAN (completed Jan 2005)
• Raising Awareness Programme(started Dec 2004)
• Scoping local hardware requirements
PACS/RIS
Raising Awareness : Objectives
• Give warning of imminent change
• Impart knowledge of new technologies
• Begin process of consultation and engagement
• Stimulate users to start to think about process changes necessary in PACS environment
PACS/RIS
Raising Awareness
• Multifaceted strategy– Talks/Lectures– Grand Round– Divisional/Department meetings– Q&A sessions– E-mail updates– Posters– Hands-on workshops
PACS/RIS
Raising Awareness
the old believe everything
the middle aged suspect everything
the young know everything
Oscar Wilde 1894
PACS/RIS
“Go Live”
• Originally planned for Mar 2005
• Deferred to May 2005
• Occurred 16th July 2005
Did we have any concerns?
PACS/RIS
Concerns prior to “go-live”
• Equipment still being delivered and configured in final 48 hours
• No dummy system in place – were we adequately trained?
• Separate trainers for RIS and PACS with no one individual for training on the integrated product
• Central data storage not ready : local RIS server required (provided by LSP)
• N3 links to satellite units …..etc
PACS/RIS
“Go-live” – Saturday 16th July 2005
Were all our ducks in a row? – we weren’t sure
PACS/RIS
“Go Live” – what happened next ?
“Fat man in a canoe”
PACS/RIS
“Go Live” – what happened next ?
• ↑ plain film workload• ↓ efficiency• myriad process issues• request forms not scanned• often no images in PACS• images on worklists when no report required• felt like meltdown just around the corner
PACS/RIS
Issues emerging after “go-live”
• Business processes/continuity/development
• Training
too little, too late, not “joined-up”
• Technical
loss of extend from RIS to PACS
PACS/RIS
Then what happened ?
• All day visit from FJA/GE/HSS
• Action plan to address technical/support/process/training issues
• Slow steady improvement now being seen
• Clinical benefits within department beginning to be realised
PACS/RIS
Clinical Reporting Pre-PACS/RIS
• Attendance registered on RIS• Hardcopy film from current examination• Old films retrieved and matched• Films and request form to Consultant for
tape reporting• Transcription and typed report production• Printed report despatched to referrer
PACS/RIS
Clinical Reporting post-PACS/RIS
• Reporting driven by worklists created in RIS• Worklists may be
generic/modality-specific/named/other• Request Card scanned into RIS when
examination booked in.• Images open in PACS and scanned request form
is simultaneously visible in RIS• Lost film/request forms no longer a problem
PACS/RIS
Benefits• Increased productivity in plain film reporting
sessions• Improved report turnaround times• More timely/relevant clinical reporting• More efficient clinico-radiological consultation• Improved running of MDT’s• Reduced clinical risk• Increased professional satisfaction
PACS/RIS
Accommodation : Changes
• Created dedicated reporting room from 2 existing Consultant offices
• 4 screened-off reporting workstations• Air-conditioned• Blacked-out• Quiet• ↓ coefficient of interruption
PACS/RIS
Workflow : changes
• Developing Duty Radiologist to deal with general enquiries/troubleshooting
• Separate this role from plain film reporting function to maximize governance/productivity benefits
• Flexible rostering of consultant time to match capacity and demand better
PACS/RIS
Where do we go from here?
• Build on existing achievements
• Introduction of voice recognition technology
• Work towards paperless imaging service
(Ordercomms planned for Autumn 2006)
PACS/RIS
Salisbury District Hospital : 4 months on
• Basically sound technology but still suffering regular loss of extend from RIS to PACS
• Local RIS data storage
• Still dependent on CD for image transfer between SDH and satellite units
• Issues around image transfer to tertiary care
PACS/RIS
If we had to do it all again……
NATIONAL PROGRAMME ISSUES
• seek clearer understanding of the contract, both in terms of equipment and business development support
• better training : ours has been inadequate with no single agent responsible for the integrated PACS/RIS product
• central RIS data storage: will it be achieved
PACS/RIS
If we had to do it all again……
NATIONAL PROGRAMME ISSUES
• Helpdesk support : cumbersome for non-technical issues
• N3
• Information Governance strategy
• Are the suppliers up to it on a national scale?
PACS/RIS
If we had to do it all again…….
LOCALITY ISSUES(1)
• Implement RIS first followed by PACS 2-3 months later
• Have a dummy PACS/RIS system for training at least 1 month before go-live
• If not available under contract, should have Business Process Re-engineering advisors for Radiology and other clinical areas
PACS/RIS
If we had to do it all again…….
LOCALITY ISSUES(2)
• Consider every aspect of life without the brown packet, including image transfer to/from other organisations
• Sufficient resources/time for training
• Realistic assessment of how much time all this requires, esp clinical leads
PACS/RIS
Where is the lifeWe have lost in living?Where is the wisdomWe have lost in knowledge?Where is the knowledge We have lost in information?
TS EliotChoruses form “The Rock”