1. Radiology – The National Context Current and anticipated challenges Hamish McRitchie Radiology Programme Subject Matter Expert

2. Case study p.2 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

3. Case study p.3 Miss D Transferred to Glasgow
ITU bed Glasgow Royal Infirmary
Bronchio alveolar lavage
Acute eosinophilic pneumonia
High dose steriods
Recovered
Housekeeping
Fire drills – any planned
Fire exits – where are they?
Toilets – where are they?
Tea/Coffee at specific points in the day

4. 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

5. 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
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

6. The Current Radiology context – Technical Landscape
PACS
Stores and shares images and more recently reports
RIS
Manages report creation, archiving and amendment
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

7. c.2000 Live modalities; CR/MRI/CT/US etc
300 Diagnostic Workstations
c ward based users

8. 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
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

9. 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
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

10. 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)
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

11. Scottish Radiology Information Systems (RIS)
No national RIS
Carestream
HSS (CRIS)
Trakcare
(Soliton)
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

12. Chosen architecture

13. 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
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

14. 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
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

15. Working as a team Current arrangements are ad hoc
Individual bilateral arrangements
Remote reporting
Access to “foreign RIS”
report – cut and paste
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

16. Capacity shortfall In sourcing Remote reporting
Access to “foreign RIS”
report – cut and paste
Out sourcing
Push images
Relevant priors
Previous reports
Clinical information
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

17. Future Radiology Barriers and Dependencies
Technical
Contractual
Governance HR
Clinical
Quality assurance – imaging and reporting
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.

18. Reporting in PACS a potential game changer
Radiology reporting within the National PACS system may now be possible
Unsustainable service
High Level of unfilled Radiologist and Radiographer Vacancies
Increasing Demand and unlikely to change due to increase in population numbers and aging population
Inability to meet waiting times
Increasing costs on outsourcing, Waiting List Initiatives Session
Drivers in no1 above mean we have to design a new service. We have a mandate under the banner of Shared Services and have the backing of The CEs. Huge opportunity to design what the future looks like
3. We need to identify what success will look like and therefore what the critical success factors will be.