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

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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



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Derriford & community hospitals 300,000
examinations per year
Radiologists 25
SPR 47
Radiographers 80
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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
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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
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Jul 05
Sept 05
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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+
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Challenges
Large implementation
 Data migration
 Critical clinical implications
 Change management challenge
 Challenges related to the contract

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Management structure
PARB
Trust Board
ISIG
Project
Board
Internal Audit
Project team
meetings
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Clinical
User Group
PlymPfiT
Project work structure
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Core resources
PACS Project board
Project Team
Project lead
Project technical lead
Clinical Lead
Admin support
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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
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What also went well

Migration of data from old RAD/Agfa system
But at a cost

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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 implementationlittle 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
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
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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
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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
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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
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
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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?
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Any questions?