Transcript Radiology * The National Context Current and anticipated

Radiology – The National Context
Current and anticipated challenges
Hamish McRitchie
Radiology Programme
Subject Matter Expert
p.2
Case study
Miss D
 Age 18
 Flu-like illness for 48 hours
 Progressive SOB
 Pleuritic chest pain
 No significant past history
 No drugs
 No allergies
 Erythromycin i.v.
 Hydrocortisone 100mg iv
 Chest opinion sought
(Inverness)
 CT scan (Borders General
Hospital)
 Decision to transfer
p.3
Case study
Miss D
 Transferred to Glasgow
 ITU bed Glasgow Royal
Infirmary
 Bronchio alveolar lavage
 Acute eosinophilic
pneumonia
 High dose steriods
 Recovered
Case study
Miss D
 Patient in Stornoway
(Western Isles
Hospital)
 Chest physician in
Inverness
 Radiological opinion in
Borders General
Hospital
 Patient received
definitive treatment in
ITU Glasgow Royal
Infirmary
The Current Radiology context
– Current challenges
•
Complex patient pathways
•
Radiologist/radiographer shortage
•
Subspecialisation
•
Out of hours / on call
•
Volume of work demand/capacity
•
The rise of cross sectional imaging
•
Out sourcing
•
Insourcing/waiting list work
The Current Radiology context
– Technical Landscape
•
PACS
Stores and shares images and more
recently reports
•
RIS
Manages report creation, archiving
and amendment
300 Diagnostic
Workstations
c.16000 ward
based users
c.2000 Live
modalities;
CR/MRI/CT/US etc
Scope and Reach of the Scottish
National PACS
•
All mainstream radiology images and reports
•
31 installations serve a further 20 satellite
clinics to make the reach all of NHS Scotland
•
Now storing all NHS Scotland’s mainstream
radiographic output – 3.5m studies and
reports per year
Daily uses of Image Sharing
•
Networked care patient movement
•
Emergency transfers – decisions to admit to tertiary
centres
•
On call
•
MDT work
•
Second opinion
•
Remote reporting (with RIS)
•
Golden Jubilee pre-loads tomorrow's lists with
referring sites images
Current PACS Contract
•
10 year Contract with Kodak (now Carestream)
– started January 2007
•
3 year optional extension
•
15 Health Boards in contract
•
31 individual sites live with Carestream PACS
•
Two national archive sites live (Atos)
Scottish Radiology Information
Systems (RIS)
• No national RIS
• Carestream
• HSS (CRIS)
• Trakcare
• (Soliton)
Chosen architecture
Scottish Radiology Information
Systems (RIS)
•
Carestream
•
Every Board has a RIS with single or multiple
Carestream PACS attached
•
No general way to report each other’s radiology
or amend an existing report
Working as a team
•
Emergency transfers – decisions to admit to
specialist centres
•
MDT work/refined report/updated report
•
Second opinion/second report/updated report
•
Remote reporting
Working as a team
•
Current arrangements are ad hoc
•
Individual bilateral arrangements
•
Remote reporting
o
Access to “foreign RIS”
o
Email report – cut and paste
Capacity shortfall
•
In sourcing
•
Remote reporting
o
Access to “foreign RIS”
o
Email report – cut and paste
•
Out sourcing
o
Push images
o
Relevant priors
o
Previous reports
o
Clinical information
Future Radiology
Barriers and Dependencies
•
Technical
•
Contractual
•
Governance
o HR
o Clinical
•
Quality assurance – imaging and reporting
Reporting in PACS a potential
game changer
Radiology reporting within the National
PACS system may now be possible