First appeared in Health Service Journal, 10 June 2004
The use of digital imaging systems within the NHS has been on the verge of taking off for some years – but hasn’t. That is set to change this year when a combination of central initiatives dramatically unfreezes the potential for progress at a local level.
On 1 May, the National Programme for IT announced deals with GE Medical Systems to provide picture archiving and communications systems in three local service provider clusters, with Philips and Kodak with ComMedica winning one LSP contract apiece. The systems will be installed from this summer, with national coverage planned for completion in three years.
Meanwhile the government believes that progress on the 2008 access targets will be hampered by too little diagnostic capacity. Some time this month it is expected to announce it will buy in significant imaging service – up to 10 per cent of current NHS capacity. Intelligence understands that later in the summer the Department of Health, following a mapping exercise that ends this month, will launch a major procurement drive for dianostics.
Against this background, how are trusts gearing up for a step change in the way they handle images?
Southern Derbyshire Acute Hospitals trust has installed a £14.9 million linking electronic patient records with PACS (iSoft providing the former and GE the latter). The combined system came into use in March for radiology analysis and for collecting and scanning images across the whole trust. The trust’s new site will be filmless – one reason for the contract – and it aims to have two years’ worth of images when the first phase of building opens in 2006.
The trust’s EPR programme manager David Pearson says the main benefit is ‘workflow, speeding up the process’. Radiologists now find the patient, and the system retrieves the relevant images automatically, rather than having to find physical x-ray prints. Radiologists can record their verbal analysis on the system, to be typed later by a secretary. ‘You don’t have an issue with losing tapes – not that we ever do that – or a tape not recording well,’ Pearson says.
The trust plans to extend the joint system to higher pressure areas, including accident and emergency, the fracture clinic and the medical admissions unit, where doctors make initial analysis of images as well as referring them to specialists.
‘The biggest benefit is saving time,’ says Mr Pearson. ‘Records can be immediately available, wherever you are in the hospital. A single printed X-ray can only ever be in one place at any one time.’ This is particularly useful, given the trust’s current use of two hospitals, three miles apart.
The Leeds Teaching Hospitals trust completed its installation of its PACS system at Leeds General Infirmary, one of the trust’s two major hospitals, in December. ‘We’re using it on a daily basis,’ says Brenda Mostyn, PACS project manager. ‘We’ve rolled it out to A&E, which is now largely filmless, to intensive care, which is entirely filmless, and to our GP referral work, which is entirely filmless.
‘It’s hugely reliable. All our images are available within two seconds: the performance criteria we specified. That means any radiologist needing to report can sit at any workstation and crack on with it.’
Eventually every PC in the hospital will be able to show the images, although radiologists use specialist hardware for their reporting. Finally, ‘there’s no lost images any more’.
The computerisation allows images to be manipulated in ways not possible with film. For example, MRI or CT scans – of which there can be 300 images for the latter, in a head, neck and chest scan series – can be presented in a cine-loop animation, or turned into a three-dimensional model using software the trust has bought from Voxar, which can then be rotated.
One issue – for other trusts as well as Leeds – is how the National Programme’s announcement will affect existing systems. ‘We’re waiting to hear how that will pan out with the LSP,’ says Ms Mostyn. She points out that the plan is to replace legacy PACS: ‘One thinks of legacy systems as old, but my legacy system is 12 weeks old, and there’s life in the old dog yet.’
Advanced imaging does attract caution from some clinicians, even pioneers. Richard Hayward, a consultant paediatric neurosurgeon at Great Ormond Street Hospital for Children trust, started his neurosurgery training in the early 1970s at Atkinson Morley’s hospital in Wimbledon (now a ward at St George’s Healthcare trust in Tooting) with one of the first computerised imaging machines, built by EMI. The machine in question is now in London’s Science Museum.
In an article last year for the British Medical Journal (link), he coined the acronym VOMIT, for Victims Of Modern Imaging Technology, for those who are given a scan despite no, or very slight, symptoms, which then finds an anomoly. They then suffer great worry until they are cleared, which would never have happened before widespread scanning. ‘I think that the benefits outweigh the downside, but all advances in technology bring advances in problems,’ says Hayward.
Box: Remote control?
Imaging work is an activity with the potential to be parcelled off to the private sector. In theory, radiologists’ work could be done anywhere in the world.
In practice, hospitals are wary. David Pearson of Southern Derbyshire Acute Hospitals trust says that there are other considerations. The trust’s combined electronic patient record/picture archiving and communications system could tackle staff shortages in a different way, he says, by allowing remote working for radiologists or consultants, from home or elsewhere.
Great Ormond Street Hospital’s Richard Hayward says outsourcing is not the way to proceed. ‘The most cost-effective way of using the technology, certainly in the UK, is for imaging techniques and equipment to be sited within health service facilities.’
Box: Breaking even
Great Ormond Street Hospital for Children trust’s new imaging system is ‘revenue neutral’, according to IT consultant James Mosley, a picture archiving and communications system specialist who worked on its installation. The capital cost which was met by the hospital’s charitable foundation. The trust itself is ‘very cautious’ about the claim of revenue neutrality, stressing the benefits of convenience and instant access.
The PACS, provided and installed by Siemens Medical Systems, was completed in August 2003, and Mr Mosley says a number of savings have been generated. Film supplies costing £130,000 a year have been cut, although Mosley says a large general hospital could save twice this. Other savings include film processing machines which cost tens of thousands of pounds in maintenance, and the two or three staff needed for dark rooms, filing and distribution, who cost around £40,000 a year.
With PACS, images are not lost, and this cuts the number of repeated scans.
Mr Mosley says that a typical imaging system has a capital cost of around £1.5 million and maintenance costs of around £200,000 a year. He says there are other savings which are more difficult to calculate, such as savings in clinical staff time given the instant availability of images.
However, some trusts may not be able to realise the savings of dumping film if their buildings will not support the high-capacity data networks required.
At Leeds Teaching Hospitals trust, Brenda Mostyn says it is not yet clear whether savings will cancel out the cost of the new system.
‘The closer we can get to having it rolled out across the whole hospital site the more cost effective it becomes,’ she explains. ‘It is important the hospital has a good network as x-rays can be eight megabits in size, and a single mammographic study can be up to 64 megabits, with up to four required, while hundreds of MRI and CT scans can be required.’
‘You’re looking at a lot of data,’ she says. ‘So we’re not sure if we can go entirely filmless.’ She adds that, whilst cost effectiveness is important, the main benefit to the trust is the increased efficiency, improved patient safety and quality of treatment.
Copyright SA Mathieson 2004