Transcript Conquest Hospital, UK

PACS, RIS and related
developments in the
United Kingdom
Dr Keith Foord
Consultant Radiologist
Conquest Hospital,East Sussex, UK
(Secretary, UK Royal College of
Radiologists PACS and Teleradiology
Group and Board Member, EuroPACS)
PACS 2003
Velkommen til hyggelige og lærerike konferansedager i Trondheim!
Nasjonal PACS/RIS-konferanse 12. og 13. februar 2003 i Trondheim
United Kingdom Population*
(millions)
Total 59.8
England 50.0 Scotland 5.1 Wales 2.9 N. Ireland 1.7
NHSnet – the largest private
Intranet in the world.
NHS Information Authority
- very tight security
guidance
UK NHS national email
[email protected]
[email protected]
NHSIA unhappy with security issues with
ADSL except for point to point transmission
between networks or in
Virtual Private Networks - VPNs
VPN (private) – SW London
project
VPNs (DSL with encryption)
Dedicated WAN - Glasgow
BT Metro VPN – Wales ‘DAWN2’
(or over short distances BT LES
- LAN Emulation Circuit)
NHS I.T. Provider history
1. Although NHS is a national health service, free to citizens at
the point of use, I.T. very fragmented as there was a political
history of minimising central control in England from 1994 1998.
2. More centralised systems were maintained in Scotland,
Wales and Northern Ireland.
3. Unique 10 digit NHS number only just available for all
citizens.
4. Attempts to co-operatively co-ordinate from 1998 to 2002
failed. Allocated resources did not reach hospitals as the
money was able to be diverted at an intermediate level to
meet other political objectives in NHS service delivery.
5. 2003 - More vigorous, but commercial, control now being reasserted to move as rapidly as possible – Objective is to be
able to freely exchange clinical information around the UK.
Major Patient Administration or Hospital
Infomation system providers in UK
Share of known installed market
In ho use
HB O/M cKesso n
4%
2%
2%
2%
4%
2%
EDS
4% 2%2%
Oracle
19%
iSOFT
To rex
Inhealth
GE
6%
8%
2%
8%
System C
No rthgate
HE
M cDo nnel
10%
2%
IDX
Siemens
8%
15%
Cerner
Elan
M editech
Sema
Major RIS system providers in UK
Share of known installed market
1%
1%
3%1%
1%
9%
23%
4%
3%
1%
3%
1%
9%
13%
7%
20%
*RADIS installed in all Welsh hospitals
**NIRADS installed in all N Ireland hospitals
Meditech
Torex
Misys
RADIS*
HBO/McKesson
HSS
Dialogue
NIRADS**
Wise
In house
System C
HE
Détente
iSOFT
IDX
Northgate
PACS sites
PACS in development
Wide area PACS project
Wide area PACS project
initiation
Major PACS system providers in UK
Share of known installed market
Agfa
5%
3%
Siemens
14%
Storcomm
Ferrania
22%
15%
Philips
Merge
Kodak
3%
8%
17%
5%
3%
5%
Radworks
GE
Fuji
In house
Long distance
teleradiology
projects in Scotland
to support remote
areas
Hospitals with
teleradiology facility
for emergency use
Every UK hospital has at
least a video link to its
regional neurological
centre for emergency
neuro CT etc.
Wales – national
‘DAWN’ VPN
Sussex Cancer
Network web
based project
Major Teleradiology system
providers in UK
Share of known installed market
Torex
GE
2%
2%
2%
4% 2%
Winrad
21%
Kodak
Agfa
7%
BT
Pukka-J
7%
9%
Storcomm
RADIN/Ferrania
4%
Siemens
2%
2%
Toshiba
4%
19%
13%
In house
Vidar
Merge
Mysterian
So how is
control being
re-asserted?
Surrey and
Sussex Strategic
Health Authority
East Sussex Hospitals
Sussex Cancer Network
Strategic Health Authority
Now responsible for IT in its
area.
Appointing ‘Prime Consortium’
to take over existing contracts
and provide new IT services,
including VPNs
Will be in place from late 2003
There will be more focussed IT provision in the strategic
area and less choice for and less variation, between
hospitals.
Each prime consortium may have only one or two
PACS/RIS provider companies
Applies to 23 Strategic areas of England
DOES not apply to:
Scotland
Northern Ireland
or Wales
Who have national Strategic coordinating
bodies already as part of ‘devolved’ government
National Diagnostic Imaging
Messages Project (DIMP)
 There approx. 600 imaging departments in the UK, the majority of
these departments have Radiology Information Systems (RIS)
sometimes these systems are integrated as part of a Patient
Administration System (PAS).
 In the UK there are almost 9000 GP practices and virtually all have
computerised information systems.
 DIMP to ensure all hospitals and GPs will be routinely exchanging
structured electronic messages for Radiology results by the end of
2003 (but not images)
 The message will use a UK profile of the HL7 V2 messaging standard
implemented in XML over eSMTP.
 A discrete list of diagnostic imaging investigations coded in both Read
Codes and SNOMED CT will be developed - uniquely identifying the
examination to which the report pertains.
What about local
developments in East Sussex
Hospitals?
East Sussex Hospitals
Population 450,000
220,000 imaging investigations per year
1991
• Regional Radiology Committee
discusses PACS - Conquest Hospital to
act as test bed
• SE Thames RHA Scientific Office leads
- a Regional development project
• Contract signed with ‘Simis Medical
Imaging’
ODs
RAID
DSA
PACS/RIS
Unix Devices
Radiologists
Sun Sparc
PACS viewers
DSI
Video
PC i/f
Sun Sparc i/f
ISDN PC i/f
Hub
Single CR
segment
1994
2x
100
Mbs
CR Sun Sparc
review
External Sun
Sparc PACSviewers
Hub
CT
Mac i/f
PC i/f
NM
Hub
RIS
Terminals
Digitisers
1997
• Specify new triplicated CR DICOM
system
• Lease 3 x Philips AC3
• 3 x ‘Easyvision RAD’ workstations also
networked to fluoro and angio units
• Continuing PACS re-specification work
CR
connectivity
AC3 CR x 3 USITs x 3
Late 1997
ASCII
Bespoke protocol
IP ‘ping’
Switched
Hub
Hospital
10/100Mbs
ethernet
IP ‘ping’
DICOM
RIS
ASCII unidirectional
Switched
Hub
VLAN Switch/
Route
Controller
Conquest Hospital, U.K. early 1999 installation agreed
Siemens ICON
Nec Med
Philips
V3000
Philips
new DSI
Ultrasound
Siemens AR/T
CT
Picker Polaris MR
C Arms with IAMs
Philips
DSI
Philips PCR
PC Link
3M
3M
Picker
W/S
3M
Lumisys
150*
with QA
Station
Key User DICOM
Servers
Philips EV
RAD
StudyServerTM
With Fibre RAID
Lumisys 75
with QA Station
PACS Broker
Linked to RIS /
/CIS/HIS
RIS
Server
DLT nTByte
Archive
Archive Manager
Key Users
RAID
r
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a
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I
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Key User station
PACS
Web Server
Bexhill Hospital
DICOM
Print server
DryView
3M8700
Radiology Segment
Workstations
ryView
3M8700D
Hospital Intranet
100 plus Intranet / CIS users
Dry Laser
DICOM Printing
CIS/HIS
Server
2001
• ‘Management merger’ with Eastbourne.
• Joint IT department formed. Joint PACS Project
Board
• Documents re-done to reflect two main hospitals and
DVD archiving problems with Agfa Basix mini-PACS
• Tender for new CR for Bexhill Hospital
• E’B obtain charitable fund money - go to tender for
their elements of new full PACS plus 2 additional CR
units
• Sunquest taken over by Misys
2002
•
•
•
•
•
•
•
Philips Compano CR/ Kodak DICOM printing installed at Bexhill
Hospital
36Mbs ‘line-of-sight’ microwave wireless linkage between Conquest
and Eastbourne
Hastings extends Philips CR lease at Conquest to includes 4th and
new 5th CR - for CR mammography
Hastings installs Ferrania Web Server (allows Query/Retrieve from
local RAID and Eastbourne archives)
Eastbourne place contract with Agfa for DICOM/Web PACS plus 2
additional CRs. Web Server allows Query/Retrieve from Hastings RAID
Hastings tenders for DICOM printing network, selects Agfa
Hastings tendering for PACS which will allow DICOM query/retrieve
from Eastbourne archives and increase existing server and RAID/SAN
archive capacity across the units.
Cross site PACS
• Separate systems but DICOM
query/retrieve between?
• Same system, enhance link bandwidth
and servers and RAID/SAN capacity?
• What to do about different PAS and RIS
systems?
• Local big RAIDs, shared/local SAN
storage?
Eastbourne Hospital installations agreed 2002
Nec Med
Siemens
Angio
DSI
Ultrasound
Siemens CT
Siemens MR
AGFA CR
PAXport
W/S
PAXport
PAXport
Lumisys 75
with QA
Station
ryView
3M8700D
DryView
3M8700
PACS Broker
Linked to RIS
RIS
Server
MOD Archive
RAIDS
Dry Laser
DICOM Printing
Archive workflow
MOD Manager
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Hastings
Balanced PACS
Web Server
Balanced PACS
Web Server
SAN
Radiologists
Workstations
Trust Intranet
1000 plus Intranet / CIS users
DICOM
Print server
Dtabase
manager
Workflow
manager
Bexhill Hospital CR & Conquest Hospital, Digital Image
and Web installations 2003
New DICOM
Nec Med
Philips
V3000
Philips
new DSI
Ultrasound
Siemens AR/T
CT
Picker Polaris MR
Philips
DSI
DICOM link
Philips PCR
Picker
W/S
Philips EV
Philips
Compano
CR
RIS
Server
DICOM
Print server
r
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a
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0
8
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NM
viewer
RAIDS
PAS
Server
DICOM
Print server
Archive workflow
CIS
Server
ryView
3M8700D
r
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g
a
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Dry Laser
DICOM Printing
Image
Web Server
Web Server
RAID
DryView
3M8700
ryView
3M8700D
DryView
3M8700
ryView
3M8700D
SAN
Bexhill Hospital
Trust Intranet
Radiology users
Web users
Dry Laser
DICOM Printing
Eastbourne
OBJECTIVE
2003
Seamless,
cross site
PACS
Thank you for asking
me to Trondheim