PACS Out Line Business Case
Download
Report
Transcript PACS Out Line Business Case
PACS
A difficult implementation
Richard Miles MRCP FRCR
Derriford Hospital Plymouth
Introduction
Scope of the implementation
Resources
What went well
What went badly
Complications
Recovery
Commercial and In Confidence
Scope of implementation
Derriford Hospital
Commercial and In Confidence
Scope of implementation
Commercial and In Confidence
Pre LSP PACS Situation
Limited PACS -Agfa
– CT, Ultrasound, Some Plain X-Ray
Inadequate Viewing Facilities
Obsolete Radiology Information System
Commercial and In Confidence
Health Community connectivity
Data store
& RIS
Commercial and In Confidence
Commercial and In Confidence
Examinations & staff
Derriford & community hospitals 300,000
examinations per year
Radiologists 25
SPR 47
Radiographers 80
Commercial and In Confidence
Community
Hospitals
X6
Modalities
using plates
Modalities
with direct
connection
Plates
Remote
data store
N3
connection
CR reader
X 10
RIS
Local data
store
PACS
RIS terminal
(PC)
2 x printers
Reporting
workstations
X 41
Commercial and In Confidence
Radiology
Academy
Workstations
Other
Workstations
Web PACS
(PC)
Modalities
Include:
16 CR plate readers
3 CT scanners
2 MRI scanners
25 ultrasound scanners
4 gamma cameras
4 angio suites
10 fluoro rooms
In all over 130 modalities and workstations-costs excessive
for some modalities
Commercial and In Confidence
Jul 05
Sept 05
Commercial and In Confidence
Nov 05
Jan 06
Mar 06
May 06
Jul 06
Sept 06
Project Completion
Optimisation visit
CRIS Update
RIS migration
&
Hospital Go Live
Academy Go Live
Trust Board approval
Key milestones
Nov 06
Training
Ris- 300 main users- ended up as 800
Web Pacs- 2000 e-learning/presentations
Pacs – 50+
Commercial and In Confidence
Challenges
Large implementation
Data migration
Critical clinical implications
Change management challenge
Challenges related to the contract
Commercial and In Confidence
Management structure
PARB
Trust Board
ISIG
Project
Board
Internal Audit
Project team
meetings
Commercial and In Confidence
Clinical
User Group
PlymPfiT
Project work structure
Commercial and In Confidence
Core resources
PACS Project board
Project Team
Project lead
Project technical lead
Clinical Lead
Admin support
Commercial and In Confidence
Radiology IT
1 specialist IT radiographer
0.6 deputy
1 admin support
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
Commercial and In Confidence
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
Commercial and In Confidence
What went badly
CRIS referrer list seriously deficient
CRIS Rollout labour and time intensive
Resource mapping was made more complex by our
system design
Commercial and In Confidence
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 implementationlittle activity until we really shouted
– No provision for support in contract
– Fujitsu Help desk extremely time consuming and frustrating
Commercial and In Confidence
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%.
Commercial and In Confidence
CRIS login times
CRIS Login and 1st Task
60
50
40
Time in minutes 30
task 1
Log on
20
10
0
1
3
5
7
9
11 13 15 17 19 21 23 25 27 29 31 33 35 37
User
Commercial and In Confidence
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
Commercial and In Confidence
More issues
Lack of sharing of problems and solutions with other
hospitals
Problems with connecting peripheral sites to Derriford
Image sharing with other hospitals
Commercial and In Confidence
Complications
Real clinical risk
Serious impact on reporting throughput
Split studies in CT and ultrasound
Workstations incorrectly setup not automatically
displaying doppler ultrasound images
Commercial and In Confidence
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
Commercial and In Confidence
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
Commercial and In Confidence
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
Commercial and In Confidence
GP Film reporting status
400
unreported exams
350
300
12-Jul
250
18-Jul
200
03-Aug
150
10-Aug
100
17-Aug
24-Aug
50
07-Sep
0
1 2
as at 12
sep
as3at 164
Nov
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
Commercial and In Confidence
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
Commercial and In Confidence
Unresolved issues
Image sharing- unresourced
– WebPACS sharing
• Truro/Torbay/Exeter/Barnstaple/Bristol
• Non NHS image sharing?
Commercial and In Confidence
Any questions?