Global Worklist and the Connected PACS

Cheshire & Merseyside PACS sites

Dark blue crosses are Carestream sites, and light blue other PACS sites.

I will be taking part in two presentations at the European Society of Radiology’s ECR 2015 Congress, and each one will be related to the use of our Carestream Multisite Virtual PACS.

The first is a poster titled, “Establishing a regional on-call radiology service using a shared virtual PACS,” and was completed with co-workers K. Slaven, S. Dyce, and L. Anslow

Out-of-hours radiology has been delivered by radiology residents working on-call rotations in individual hospitals. As the intensity of work has increased, out-of-hours work has seriously impacted time spent during the day in the department. The need for compensatory rest has led to significant loss of training in what is already a relatively short training scheme.

Cheshire and Merseyside is a small but complex health economy in the North West of England. The system has the following facilities:

  • Seven acute hospitals
  • One tertiary cardiac hospital
  • One neurosciences centre
  • One tertiary paediatric centre
  • One cancer centre
  • One specialist obstetrics/gynaecology hospital

Six acute sites have resident radiology specialist registrars in rotations between four and nine in size.

None of the rotations were compliant with the European working time directive (EWTD). Four of the sites were on shared RIS/PACS, and the other two had PACS from different vendors.

The move to a shared global worklist (Vue Connect) and shared RIS has meant that the acquisition of images and reporting can be accomplished on separate sites. This also means that one resident can be on-call for more than one site at a time.

By combining the registrar workforce, we have been able to achieve compliance with the EWTD and significantly reduce the number of nights worked, hence allowing for a significant increase in training hours within the base  departments.

We are about to incorporate the last two acute sites. We have placed a Carestream agent on the last two sites, which allows image sharing seamlessly across all the sites including systems from other vendors. We plan to move to PACS-based reporting soon, so the residents will have a single workflow for their out-of-hours work, and to avoid having to work in three different PACS and three different RIS.

Our PACS has some unique features that makes this possible, and will be presented in the second presentation:

“Development of a shared multi-site virtual PACS”PACS - Cheshire & Mersyside

The co-authors for this presentation are S. Dyce, N. Pfirsch and S. Lomax.

As mentioned previously, Cheshire and Merseyside is a complex health economy. The previous system procured during the National PACS programme in England had PACS supplied by a single vendor in our region. However, image sharing was never a part of the programme and images had to be transferred by CD, DICOM push and latterly by a bespoke email-like system—the Image Exchange Portal.

There was a huge movement of patients from one acute site to another, or to specialist centres. Frequently, previous imaging was not available in a timely fashion, studies were reported in isolation, or even repeated when they could not be accessed. Regional multidisciplinary meetings were a massive effort to ensure all imaging was available for discussion, and image transfer was a huge overhead for all of our departments.

The goal was for all 10 trusts to have left the national PACS programme by June 2013 and this was achieved.

During procurement, we looked for a system that would behave as a single virtual PACS with seamless display of all current and prior studies. There was also a requirement to be able to view and report images from any site, and a requirement to support images from the two hospitals that had PACS from other vendors. A single mega PACS was a possible solution, but individual institutions wished to keep ownership of the images.

We selected our vendors based on these requirements:

  • Single master identifier – the NHS number
  • Acquisition and reporting are kept separated
  • Single instance of a study so annotations and reformats are applied to a single study
  • Seamless display of priors; the reporter could be unaware of the location of prior studies, but they appeared in local PACS

Carestream was chosen as a vendor that could support this workflow and deliver it in the six-month fixed timetable. The system was delivered before the cut-off date, and over 100TB of data was migrated into the system.

All of the above objectives were achieved, as well as the following:

  • Seamless multidisciplinary meetings with display of priors
  • Major reduction in overhead of image transfer
  • Specialist reporting e.g. paediatric, neuro is supported
  • Centralised on call centre for radiology residents
  • Significant Cost Reduction

The live presentation for “Development of a shared multisite virtual PACS,” will be given at ECR 2015 in SS 1805, on Sunday morning from 1030-1200.

Dr. Peter Rowlands, NHSDr Peter Rowlands, consultant radiologist at Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT).



Diagnostic Reading #17: Five Must Read Articles from the Past Week

Carestream logoThis Friday’s Diagnostic Reading includes articles from a busy week in radiology and health IT news. Topics this week include, the FDA and electronic medical records, improving patient safety, radiology IT downtime, outpatient imaging quality, and data security.

1) FDA Calls it Quits on Regulating Medical Device Data Systems- Radiology Business

The FDA has determined that technologies that receive, store or display data from medical devices do not need to be regulated. These medical device data systems are classified as Class I, which means they are low risk devices. The FDA noted that these devices are more important than ever and lifting regulations would be beneficial to achieving interoperability in healthcare systems.

2) Competing Hospitals Work Together to Share Data, Improve Patient Safety- FierceHealthcare

This article highlights the success that hospitals have had when collaborating to improve patient safety. From 2012 until 2015, a network of over 80 hospitals reduced serious safety occurrences in children by 70%. Hospital administrators note that safety is not a point of competition, but a necessity for every healthcare system.

3) Radiology IT Downtimes are Common, but Not Usually Serious- AuntMinnie

A study by the Journal of the American College of Radiology found that the use of several disparate machines and systems can cause downtime due to losing connection with each other. However, the study found that most IT issues can be dealt with in a timely manner and only 3% were considered to have a severe impact.

4) Outpatient imaging: Assessing the Performance of U.S. Hospitals- Health Imaging

Quality and efficiency are becoming points of emphasis in the imaging field. This article addresses the Hospital Outpatient Quality Reporting Program (OQR). The OQR is an incentive program that looks at the efficiency of healthcare systems when ordering certain imaging procedures. The author argues that it might be time for a new metric system—one that is better able to determine the quality of imaging.

5) Data Breach: What’s at Stake for Hospitals-Radiology Today

Thirty million patient records have been exposed through data breaches since 2009. While it is of utmost concern to eliminate data breaches, this article discusses important information for hospitals after experiencing a breach. Topics include notification requirements, financial repercussions and regaining patient trust.

Enterprise Distribution and Better Patient Care at Sunway Medical Center

Sunway Medical Center in Malaysia is a 350-bed medical facility with a large imaging department that handles more than 75,000 procedures every year and is expected to increase to over 100,000 per year in the near future.

The facility was looking to replace its legacy PACS system as it was hindering the efficient delivery of reports. With CARESTREAM Vue PACS, Sunway Medical Center was able to start using voice recognition, access prior patient data, and use clinical management and viewing tools.

With the installation of the PACS, as well as CARESTREAM Vue Motion zero-footprint image viewing, physicians were able to provide better patient care and discuss images right at the patients’ bedsides thanks to its approved use on iPads, iPhone 4s, Galaxy Note® and Galaxy S® III mobile devices.

Listen to the hospital’s complete story in the video below.

Diagnostic Reading #16: Five Must Read Articles from the Past Week

Carestream logoIt’s Friday and that means that it’s time for a new Diagnostic Reading. This week’s readings includes articles about hospital-physician interactions, radiology analytics, a road map for improving patient safety, and a discussion about imaging appropriateness.

1) Improving Hospital-Physician Engagement – Hospitals & Health Networks

Healthcare reform has made it more important than ever for administrators to engage with physicians. This article discusses the collaboration between health care leaders and physicians, and what can be done to improve their engagement. The author provides a road map of actions that can be taken by administrators and physicians in order to work better together.

2) Radiology Analytics: Bright Future, Dim Present – Diagnostic Imaging

This article addresses the current state of radiology and how the lack of analytics in the field has made it difficult to optimize patient care. Operational, financial and clinical analytics can be used to change the way that radiology is perceived and experts say that analytic tools can be the key to adapt to the new-look healthcare system. Additionally, it is noted that analytics can demonstrate the value that radiology brings to the table.

3) Global Patient Safety Improvement Effort Needed – FierceHealthcare

The World Innovation Summit for Health (WISH) released a report about preventable medical errors. Preventable medical errors are the third leading cause of death in the United States. This is also a global problem. WISH says that current safety initiatives are ‘too narrow.’ The report makes recommendations for global reform. These recommendations include developing a patient safety declaration and forming a committee, among others.

4)  Do Patients Really Demand Unnecessary Imaging Studies? – Radiology Business

According to a study published in JAMA Oncology, patients are not responsible for unnecessary medical imaging. The study found that even if patients request imaging or treatment, the physician most often acts as seen fit. In this study, physicians only complied with .14% of patient requests.

5) Fine Tuning Imaging Utilization – Health Imaging

This article talks about the issue of appropriate imaging. The author says that it is better not to take a broad view on imaging appropriateness. There is a disparity- some regions order less images than others. Rather, he says that interventions should be targeted at healthcare facilities with the highest rates.


Case Study: Clinical Collaboration Across the Enterprise

Reggio Emilia Hospital in Italy is an excellent example of an organized clinical workflow environment. With an annual IT budget making up 3% of total hospital management budget, the infrastructure it has connect 1,500 clients on the local-area-network (LAN), and serves of provide health IT wide-area network (WAN) made up of 1,800 additional clients.

Although it had a solid IT infrastructure, Reggio Emilia Hospital was still looking for a solution for an integrated clinical image repository and distribution system.

In the case study embedded below, you can read how the hospital worked with Carestream to implement an integrated clinical data repository, and how this solution was able to provide collaboration capabilities across the enterprise, no matter where the clinical specialty data was coming from across the network.

Diagnostic Reading #15: Five Must Read Articles from the Past Week

Carestream logo1) Preparing Radiology For Alternative Payment Models

The Department of Human Health Services (HHS) made an announcement about alternative payment methods. One thing that the report stated was that in 2016, 85% of fee-for-service reimbursements from Medicare will be based on quality or value. The article  goes on to talk about possible problems with this shift and what radiologists should do.

2) Radiology in India: Trends in Medical Imaging Technology

The growth of radiology in India has become a topic of discussion throughout the industry. This article details the radiology market in India. India has high level facilities with top-level x-ray equipment, but there are also villages that do not have access to simple x-ray technologies.

3) NEJM: Are Breast Density Notification Laws Actually Helpful?

Breast density laws are becoming more and more common across the U.S. and for good reason. In an article that may spark debate, Dr. Priscilla Slanetz wrote in the New England Journal of Medicine about the possible downsides of breast density notification laws. Slanetz noted that while these laws may be well-intentioned, they can raise the amount of unnecessary imaging and false positives in patients.

4) Patient Engagement ‘Taking a Backseat’ to Other HIT Priorities

A report from Chillmark Research has found that patient engagement is not the top priority for many healthcare systems. Though developing EHRs is a priority for some healthcare providers, they are typically not very user friendly. Items that might be addressed ahead of patient engagement are defining clinician networks and building analytics capabilities, among others.

5) Obama Budget Heats Up the Issue of Site-Neutral Healthcare Payments

President Obama’s new budget has caused debate– it would equalize Medicare rates for services provided in hospital outpatient departments (HOPD) and physician offices. This article addresses the causes for debate and the reasoning behind the new budget.

Imaging Portals Drive Patient Engagement and Satisfaction

A survey of 1,000 U.S.-based patients revealed that 83% believed that there is value in being able to access their medical images via a secure portal.

This may not come as a huge surprise as patient portal adoption continues to grow in the U.S. and throughout the world, but medical images are often left out of the portal mix. The benefits to providing this access to patients are numerous, with the most obvious being that patients are rightfully provided with the ability to engage with their healthcare providers, effectively empowering them with control over their own care.

In the white paper embedded below that was originally hosted on Healthcare IT News, the study referenced above is explained in further detail. In addition to the 83% of patients who said they would use a patient portal to access images, 76.5% said they would recommend such a portal to their family and friends, and 79.3% said said that they would return for future imaging exams to facilities that offered such a portal.

These types of findings not only give providers an idea of how their patients want information delivered to them, but also gives an idea of how bringing medical images into the patient portal mix can provide value to the overall business with a high number of returning patients, as well as recommending such facilities that provide this offering.

To learn more about the study, you can read the embedded version below, or download Imaging Portals: Driving Patient Engagement, Improving Patient Experience and Satisfaction via the link.

Innovating Technology to Drive Collaborative Care

Dr. Richard Duszak, MD, FACR, Vice Chair of Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, and Dr. Randall Stenoien, MD, CEO of Houston Medical Imaging, Founder of Innovative Radiology comment on how fragmented the healthcare delivery system is,  how collaborative care can combat this fragmentation and lead to better efficiency, and the need for radiologists to be an integral part of patient portals as more patients use and rely on them.

Diagnostic Reading #14: Five Must Read Articles from the Past Week

Carestream logoThe articles from this week’s Diagnostic Reading discuss the ONC‘s 2015 annual meeting, workplace management, necessary vs. unnecessary imaging, radiation dose limitation, recommendations HIMSS made to Congress, and an article about the growth of ultrasound in the imaging industry.

1) ONC’s 2015 Annual Meeting Roundup

About 1,200 health IT professionals attended the annual meeting, which was held this week in Washington D.C. Big announcements included: HHS investing in more HIE grants, more health IT cash available to providers, and the ONC will be getting more funding.

2) Lean Daily Management and the Gemba Walk in Radiology

This article describes Lean Daily Management (LDM) in hospitals and the benefits that LDM can bring to the workplace. Read about the gemba board, a method of noting and addressing current issues by using a simple, yet effective method.

3) Study Finds Growing Use of Emergency Imaging May be Justified

A study done by the Journal of the American College of Radiology has found that imaging has become more important to the emergency room because it can increase accuracy and efficiency. This article also attributes the increase of imaging, in part, to the increase of emergency patients in hospitals.

4) HIMSS Wants More Congressional Action to Spur Interoperability

The Healthcare Information Management and Systems Society (HIMSS) made four recommendations to Congress in order to move towards interoperability. These recommendations included, implementing standards for organization development, harmonizing reporting standards, enhancing privacy and security, and improving patient safety.

5) The Ultrasound Advantage

This article discusses the growing field of sonography. Ultrasound has broken into the imaging department with a variety of uses, with more uses being discovered. With ultrasound’s growth and adaptation, it is becoming an important tool in imaging departments across the world.

Diagnostic Reading #13: Five Must Read Articles from the Past Week

Carestream logoHere are five readings that you may have missed this week. Relationships between physicians and radiologists was a theme this week. The readings include, an examination of the costly problem of unnecessary care, using social media to drive patient engagement, two studies from the Journal of the American College of Radiology, and an article that tells the story of a new style of healthcare provision.

1) Medical Necessity and Unnecessary Care – the Full Story

This article addresses the costly problem of unnecessary care. According to the author, procedures that are not evidence based account for about 30% of total healthcare costs.

2) Using Social Media for Community Engagement: A Success Story

Social media is growing in just about every industry, healthcare is no different. Read about the benefits that social media use can offer healthcare providers and customers, and how its effective use can be the next step on the journey to encourage patient engagement.

3) Primary Care Doctors Say Imaging Improves Patient Care

An email survey conducted by the Journal of the American College of Radiology found that physicians depend on imaging to find results that are not otherwise available. An impressive percentage of physicians find imaging valuable to their job and that it helps them make better decisions.

4)  Interactive Radiology Reports Preferred by Referring Physicians

Another study by the Journal of the American College of Radiology revealed that physicians see benefits in using interactive radiology reports. The study found interactive reports improved understanding of radiology findings by correlating images to text reports and provided easier access to images while monitoring progression of a disease or condition.

5) ‘Direct Primary Care’ Shown to Please Patients and Reduce Costs, Including for Imaging

Insurance that covers unlimited visits to a primary-care for a monthly fee has proven to pay off in more than one way. While the system has satisfied patients across the board, it also cuts down on imaging and healthcare costs.