Enterprise Imaging System Improves Medical Imaging Services within Cheshire & Merseyside

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Centralised reporting hub is foundation of enterprise imaging strategy.

By Dr. Peter Rowlands, Consultant Radiologist at Royal Liverpool & Broadgreen University Hospitals NHS Trust.

Managing medical data is a complex undertaking for any imaging facility, including ours. The Cheshire & Merseyside Trust is a particularly unusual area medically. We have many different hospitals – general and specialist – and the patient journey is complicated.

Fortunately, our shared enterprise imaging system is helping ensure that all images are online at all sites so that the patient can be imaged at one site and treated at others without interruption, and without having to transfer images around the region.

Reducing imaging barriers in the patient journey

In the past, patients often arrived at clinic without images being available, leaving the oncologist or surgeon unable to make any kind of decision. Images were continually imported between hospitals. At times, a patient had to undergo another scan, simply because the original was not available, exposing them to unnecessary further radiation and delays in treatment.

image of Cheshire & Merseyside hospital
An integrated enterprise imaging system helps remove some of the complexity when medical imaging services are provided at multiple sites.

For radiologists, challenges centred on the need to report studies that often required a comparison between current and previous scans. If those images were not available, there could be delays in making comparisons. At times, reports were made in the absence of previous images – a situation that is unsatisfactory both medically and for the patient outcome.

Today, patients can be scanned on one site, reviewed at another, and seen at a third without any need to move images around.

Moving to an integrated enterprise imaging system – without giving up local control

The foundation of our enterprise imaging strategy within the Cheshire & Merseyside Consortium is a regional model based on Carestream’s Vue Reporting and Enterprise Viewer solution. The model supports multiple local PACS systems, plus a single virtual PACS. This architecture allows facilities to have their own PACS in their own hospital – so they retain control of their own data, and have all of their own images on their site. But via the virtual PACS, they can report and see images from all sites as if it was a single physical system.

The virtual PACS – the hub – is based at Broadgreen Hospital with a second site at Aintree, where national trauma requirements require the physical presence of a Radiologist to provide instant opinion for trauma studies. Seven of the thirteen facilities within the Cheshire & Merseyside Consortium have access to the hub.

Carestream’s approach to enterprise imaging is extremely helpful at removing all of the barriers that were seen between our organisations. The architecture allows RIS and non-RIS sites to work in exactly the same way, using the same workflow, and receiving the same benefits of On Call and 24/7 reporting.

The Magic Combination is the synthesis of three modules, all native to the Clinical Collaboration Platform.

Enterprise imaging system fosters peer review and peer support

The hub is delivering valuable benefits for everyone using it. Trainees have a predictable, controllable work cycle. Equally important, they have peer support because they are now working in a team rather than being isolated with only a remotely located consultant to support them.

We now have a rota that allows a mix of senior and junior trainees for any particular night, so they can ask each other about scans and discuss whether one is needed. The senior trainee has more time to be consulted and to answer the question and help out. And a more senior colleague doesn’t have to be woken in the middle of the night!

The hub also has allowed us to introduce a very good system of peer review. All cases are reviewed by a senior radiologist within a timeframe – usually a few hours – so there is peer feedback to all of the trainees about all of their work. We’ve also established a discrepancy learning meeting, which has helped us to review difficult and extremely good diagnoses. This is a popular part of the system experience for trainees.

Streamlined rotas enhance cost savings

More streamlined rotas have enhanced cost savings, over and above the reduced cost of ownership of the regional PACS system itself. Previously, there was always a need for people to fill gaps in order to make sure that rotas were compliant. Today, expensive locums are no longer required because the rota allows for support within the system.

With four or five people on call, it is easier to cover absences and deal with the peaks and troughs of demand, allowing trainees and consultants to focus on other tasks – teaching, reading, and research – during relatively slow times.

In addition, compliance with the European Working Time Directive – another big driver for implementation –has been achieved. Trainees can be employed and given appropriate rotas and compensatory leave.

Patients come into the hospital 24/7 and require studies 24/7. We are pleased that our Carestream enterprise imaging system is giving us the ability to review and report those studies 24/7, helping to improve patient care. #enterpriseimaging #medicalimaging

Dr. Peter Rowlands, Consultant Radiologist at Royal Liverpool & Broadgreen University Hospitals NHS Trust.


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