1. RCR PACSGroup Hillingdon The Southern Cluster: RIS/PACS Implementation Nearing completion Dr William Saywell MA, FRCR, Dip Med Inf Consultant Radiologist, Yeovil, Somerset Chairman, Southern Cluster PACS/RIS Clinical Reference Group

2. RCR PACSGroup Hillingdon QA in the pre-PACS era

3. RCR PACSGroup Hillingdon The Southern Cluster LSP – Fujitsu RIS – CRIS (Healthcare Software Systems) PACS – Centricity (GE) CRS – Millennium (Cerner)

4. RCR PACSGroup Hillingdon Progress so far:  Live Services: Ashford & St. Peter’s – RIS + PACS Brighton & Sussex– RIS + PACS Buckinghamshire– PACS Dartford & Gravesham – RIS + PACS East Kent – RIS + PACS East Somerset – RIS + PACS Gloucestershire – RIS + PACS Isle of Wight– RIS James Paget (EEM Cluster)– PACS Maidstone & Tunbridge Wells – RIS + PACS Medway– RIS + PACS Milton Keynes – PACS North Bristol– RIS + PACS North Hampshire – RIS + PACS Nuffield Orthopaedic Centre – RIS + PACS Oxford Radcliffe– RIS + PACS Plymouth (+ Academy)– RIS + PACS – Poole – RIS + PACS – Queen Victoria– RIS + PACS – Royal Cornwall– PACS – Royal Devon & Exeter– RIS + PACS – Royal Liverpool (NWWM ) – PACS – Royal Surrey – RIS + PACS – Salisbury – RIS (local) + PACS – Southampton– PACS + RIS – South Devon– RIS + PACS – Surrey and Sussex– Early CR – United Bristol– RIS – UHCW (NWWM) – RIS (local) + PACS – West Dorset – PACS – Winchester & Eastleigh– RIS + PACS – Worthing & Southlands– RIS + PACS – Coventry (PFI build)– PACS completion – Hthwd & Wexham Pk– Early CR PACS Cluster Data Store – in live use by 31 Trusts RIS Data Centre App & D/B – in live use by 7 SHAs

5. RCR PACSGroup Hillingdon  PACS equipment delivered and implementation proceeding at: Taunton and Somerset Isle of Wight Winchester Royal Devon & Exeter Heatherwood & Wexham Park United Bristol Surrey & Sussex Weston  PACS equipment on order for: RUHB North Devon Royal West Sussex due end of October

6. RCR PACSGroup Hillingdon Initial Meeting Final Config Bus Case Approval Place Order Receive &Stage Eqpt Install & Integrate Test & Accept RBBH, Portsmouth Prelim Config ** Early CR (P) PACS (R) RIS East Sussex, Frimley Park Swindon B’rnem’th, Go Live Deployment – Milestone Status – 23 rd October 2006 A & St. Peter’s BSUH Bucks D&G, East Kent East Somerset Gloucestershire Hthwd ** IOW (R) James Paget MTW, Medway Milton Keynes North Bristol North Hants Hw & Wx Pk (P) Royal W. Sussex Surrey & Sussex Weston (P) Bath, North Devon Hw & Wx Pk (R) Taunton & Somerset IOW (P) NOC ORH Ply’th Academy Plymouth Poole, QVH Royal Cornwall RDE Royal Liverpool RSCH Salisbury, Southampton Surrey & Sussex ** South Devon UBHT (R) UHCW West Dorset Winchester WASH Weston (R) United Bristol (P)

7. RCR PACSGroup Hillingdon Cluster Data Store Cumulative Images

8. RCR PACSGroup Hillingdon

9. RCR PACSGroup Hillingdon What's gone well? Commercial off-the-shelf products (COTs) All mature packages in themselves PACS-RIS link  HL7  One way only National Procedure codes Support for local data tables  users  referrers  locations etc

10. RCR PACSGroup Hillingdon What hasn't gone so well Initial connection and log-on times Obstetrics package  scope  set-up of data fields etc.  graph printing (slow!) and viewability (RIS only) Kodak CR doses Help Desk  Premature closure without resolution  sharing failure if multi-site  Third hand contact with suppliers

11. RCR PACSGroup Hillingdon Underlying problems We are not the customer  Purchased by CfH but used by us  Much less input from suppliers than if Trust purchased product directly  Much less training... Separate products running over N3  PACS local server (archived to CDC)  RIS runs on CDC via Java (but different version from C&B)  CRS runs on CDC via Citrix

12. RCR PACSGroup Hillingdon How to avoid problems In the military vernacular – remember the 6 Ps

13. RCR PACSGroup Hillingdon How to avoid problems In the military vernacular – remember the 6 Ps  Perfect

14. RCR PACSGroup Hillingdon How to avoid problems In the military vernacular – remember the 6 Ps  Perfect  Preparation

15. RCR PACSGroup Hillingdon How to avoid problems In the military vernacular – remember the 6 Ps  Perfect  Preparation  Prevents

16. RCR PACSGroup Hillingdon How to avoid problems In the military vernacular – remember the 6 Ps  Perfect  Preparation  Prevents  P*ss

17. RCR PACSGroup Hillingdon How to avoid problems In the military vernacular – remember the 6 Ps  Perfect  Preparation  Prevents  P*ss  Poor

18. RCR PACSGroup Hillingdon How to avoid problems In the military vernacular – remember the 6 Ps  Perfect  Preparation  Prevents  P*ss  Poor  Performance

19. RCR PACSGroup Hillingdon Don't make assumptions – CHECK ! Interfaces – weak link – check several times Data migration – probably best not to Hardware – headsets, foot pedals, handset, microphones all cheaper elsewhere Coding  Patient ID RIS – NHS No? PAS No? PACS – Above or accession number? Web viewer  Referrers, locations, RIS codes

20. RCR PACSGroup Hillingdon Unique patient ID – needs to be consistent across domain Usernames – National registration codes  GMC Number  PAMS reg Numbers  UKCC reg No RIS codes – national tables Location codes (wards, clinics etc) – NACS + agreed format Room codes – NACS + agreed format

21. RCR PACSGroup Hillingdon Clinical Engagement  Not a Radiology system Data tables in correct format Kit installed in correct place Training  Before go-live  but not too long before!  Clinical users given log-in access o/c of training  Floorwalkers available at go-live  Keep workload down in first few days

22. RCR PACSGroup Hillingdon Walk before running  Roll-out of filmlessness – Rad dept, A&E etc.  Make users want to be allowed in rather than forcing it upon them  Peer pressure  Paper vs. electronic workflow Talk to others  PACS Group fora

23. RCR PACSGroup Hillingdon Ongoing concerns Integration  only just entering this phase  1-way to PACS works OK but 2-way better  CRS to RIS currently limited, with major implications for order-comms Cerner CRS currently won't accept unsolicited results Not yet confirmed (though promised) that CRS and RIS/PACS will even run on same box

24. RCR PACSGroup Hillingdon Ongoing concerns Back office  For order-comms, all common data fields must be populated in exactly the same way in CRS/RIS  No common functionality to update together Spine Functionality  When?  What? Image sharing – a whole talk in itself!

25. RCR PACSGroup Hillingdon Transition – Implementation to service management Reconfiguration of CfH groups  Less related to implementation issues  Requirements Authority to manage requests for change across cluster (and NWWM) Relationships with suppliers (via Fujitsu)  HSS small and quite responsive to change  GE big and can only make NHS changes alongside its global development program

26. RCR PACSGroup Hillingdon Next Steps Security releases for RIS and PACS  To facilitate Legitimate Relationships and Role- Based Access (LR and RBAC)  Other functional developments to fulfil OBS requirements Better integration with CRS  Conflict checking?  Scheduling? Image and report sharing  Within cluster  across clusters

27. RCR PACSGroup Hillingdon Any Questions?