1. Laurence Sutton Dr Laurence Sutton. Consultant Radiologist Calderdale and Huddersfield NHS Trust. National Clinical PACS Lead NE Cluster Image Data Management.

2. Laurence Sutton Dr Laurence Sutton. Consultant Radiologist Calderdale and Huddersfield NHS Trust. National Clinical PACS Lead NE Cluster Secretary PACS Group EuroPACS Board Member UKRC Digital Imaging Committee

3. Laurence Sutton NHS CfH PACSNHS CfH PACS PACS Calderdale Royal Hospital Halifax,West Yorkshire April 2001

4. Laurence Sutton The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities in England) 23 TRUSTS 9 CLUSTER CONNECTION ONLY Intra and Inter cluster Data Sharing

5. Laurence Sutton Image Data Management in the Community PACS Environment: NHS CfH PACSNHS CfH PACS

6. Laurence Sutton Key Issues NHS CfH PACSNHS CfH PACS Entity Data Management.  Modality Data Management.  Local Data Storage.  Local Patient Workflows  Data transfer to another Entity RIS-PACS Integration. Strategic RIS. Cluster Data Store.  Data Integrity.  Ease of Access/Updating.  Data Retention Policies.  Storage Volume Solutions.  Image Data Sharing (Intra and Inter cluster).  Disaster planning

7. Laurence Sutton How do we ensure patient confidentiality and safety? NHS CfH PACSNHS CfH PACS

8. Laurence Sutton Key Issues NHS CfH PACSNHS CfH PACS General Issues.  Data Security  Data Integrity  Patient Confidentiality  Patient Consent.  Data Ownership General Information Governance Issues. Integration with the Spine,e.g. LRS.

9. Laurence Sutton What do we do with Image Data? NHS CfH PACSNHS CfH PACS Workflow and Patient flow analysis should tell us this.

10. Laurence Sutton What do we do with Image Data? NHS CfH PACSNHS CfH PACS Managing the Patient Pathway in a Healthcare community within the CCS Architecture.

11. Laurence Sutton NHS CfH PACSNHS CfH PACS Courtesy of Dr. Richard Fowler, Leeds General Infirmary

12. Laurence Sutton Managing the Patient Pathway in a Healthcare community within the CCS Architecture. NHS CfH PACSNHS CfH PACS

13. Laurence Sutton The Image/Patient Pathway NHS CfH PACSNHS CfH PACS 5 Large Geographically (Regionally) defined clusters. HCC Natural Pool of HCO in which the Majority of patient movements take place. Specialities may not be co-terminus. Experience indicates that the Majority of acquired Images once reported are never retrieved again. A secondary care provider exports <1% of acquired images to a Tertiary Centre A Tertiary Centre is a net importer of Images.

14. Laurence Sutton Managing Images and patient data in the CCS NHS CfH PACSNHS CfH PACS REQUEST FOR ASSESSMENT September 2005. CCS v HCC options.

15. Laurence Sutton Managing Images and patient data in the CCS NHS CfH PACSNHS CfH PACS REQUEST FOR ASSESSMENT SUMMARY RESPONSE RE FEATURES OF CCS

16. Laurence Sutton Managing Images and patient data in the CCS SUMMARY RESPONSE NHS CfH PACSNHS CfH PACS Requirement to support Patient Journey across boundaries. Challenges in sharing data across HCCs. CCSs not modelled around patient journeys. Fluid Nature of HCCs plus overlap of HCCs. Speciality variation.Tertiary centre part of several. HCC model more complex architecture(Image tracking)

17. Laurence Sutton Managing Images and patient data in the CCS NHS CfH PACSNHS CfH PACS High Level Advantages.  Reduced local store requirements.  Reduced multiplicity and sharing complexities.  Secure storage and ease of data management and access  Central Reporting,Facilitates workflow across entities.  Supports wider referral pattern in cluster  Integration with future NCRS

18. Laurence Sutton How long do we keep Images for? NHS CfH PACSNHS CfH PACS Review and Refine the current policies and recommendations

19. Laurence Sutton Retention Policies for Image and Image related Data. Acknowledgement to Dr.Stephen Davies RCR IT Subcommittee NHS CfH PACSNHS CfH PACS

20. Laurence Sutton Retention Policies for Image and Image related Data Management of the Request,Image and Report. Range of Statutes and Advice. ‘For the Record’ [HSC 99/053, WHC 00/71] "Using Electronic Patient Records in Hospitals: Legal Requirements and Good Practice" [HSC 98/153]. NHS CfH PACSNHS CfH PACS

21. Laurence Sutton Retention Policies for Image and Image related Data Apply to the NHS Independent Sector and Private Practice All Practitioners using Imaging Services. NHS CfH PACSNHS CfH PACS

22. Laurence Sutton Records Management: NHS Code of Practice (RMCoP) Report is the permanent record. –(Retention Schedules) Images are Transitory –(Local determination and Policy) Patient Data (RIS) now closely linked. Complete electronic workflow from order to report distribution. An Integrated Radiological Record. Cost of Storage.(Space and Methods). The Image Evidence. NHS CfH PACSNHS CfH PACS

23. Laurence Sutton Retention and Storage of Images and Radiological Patient Data. NHS CfH PACSNHS CfH PACS Request for Assessment February 2006 Impact on technical requirements To support the level of Functionality required To fulfil RCR Guidelines. Based on RCR Draft Document.

24. Laurence Sutton Retention and Storage of Images and Radiological Patient Data. NHS CfH PACSNHS CfH PACS RCR VIEW IMAGE AND REPORT SHOULD BE REGARDED AS THE SAME AND COMPLY TO THE SAME GUIDANCE REGULATIONS

25. Laurence Sutton Request for Assessment NHS CfH PACSNHS CfH PACS Images and Report the same and comply with guidance document. Robust Long Term Storage and Accessibility Image Data stored will reflect that which is normally sent Differential Retention Requirements/Study Tagging Compression of Data preferable to Deletion. Secure Environment with Backup

26. Laurence Sutton Finally. How much can you compress Image data by without loss of clinical value? NHS CfH PACSNHS CfH PACS The Canadian Association of Radiologists has endorsed lossy compression for primary reads. a 50:1 compression ratio is acceptable for large- matrix images, with 25:1 optimal. An acceptable ratio for small-matrix images is 20:1, with 10:1 optimal.