1. Kent and Medway CIO Office PACS Programme Kent and Medway SHA PACS Implementation Tony Corkett Programme Director

2. Kent and Medway CIO Office PACS Programme Agenda Overview and Background to Kent and Medway Programme Management & Deployment Issues, Achievements & Deliverables Benefits to the Service Q&A

3. Kent and Medway CIO Office PACS Programme Kent and Medway Background Four acute trusts and 1 tertiary trust (from Surrey and Sussex) Approx. 3800 beds, 1.1m OPD attendances All trusts have been working together for a number of years on the proposal Greenfield Site Good clinical engagement across the SHA Supported by the SHA and the Health Informatics Service (HIS)

4. Kent and Medway CIO Office PACS Programme Kent and Medway –Four acute trusts and 1 tertiary trust (SySx) –~ 3800 beds; 1.1m Opt

5. Kent and Medway CIO Office PACS Programme Suppliers Fujitsu – Local Service Provider (LSP) HSS – Radiology Information System (RIS) GE – Picture Archiving and Communications Systems (PACS) Kodak – Computed Radiography (CR)

6. Kent and Medway CIO Office PACS Programme Innovative Solution Data Centre Architecture 7 PACS /RIS ‘domains’ (SHA based) Community Networks (COIN) Shared RIS Accessibility

7. Kent and Medway CIO Office PACS Programme How We Got Here Established a county wide approach –SHA, CEO buy in (Programme Board) –Clinical buy in (radiology, surgeons, medics and nurses) –HIS (Health Informatics Service) Programme Management –SHA-wide RIS codes and management –SHA-wide agreed work flow –Cross organisational support and sharing –Project support

8. Kent and Medway CIO Office PACS Programme

9. Kent and Medway CIO Office PACS Programme Project Team

10. Kent and Medway CIO Office PACS Programme Deployment Dartford and Gravesham –RIS 28/10/05, PACS 08/11/05 East Kent Hospitals –RIS 14/11/05 PACS 06/02/06 Maidstone and Tunbridge Wells Hospitals –RIS 28/11/05 PACS 06/02/06 Medway Hospitals –RIS 21/02/06 PACS 27/03/06 Queen Victoria Foundation Hospital –RIS April 2006 PACS June 2006

11. Kent and Medway CIO Office PACS Programme Deployment Model

12. Kent and Medway CIO Office PACS Programme GP Radiologist at Home Acute Community Tertiary

13. Kent and Medway CIO Office PACS Programme Challenges IG – how to share data Encryption routers RIS codes and standards Unique patient ID Viewing PACS images

14. Kent and Medway CIO Office PACS Programme Information Flows

15. Kent and Medway CIO Office PACS Programme Example of a network diagram

16. Kent and Medway CIO Office PACS Programme IG The RIS is a single domain Clinically very acceptable However until full functionality and audit trail in place does not record consent Data sharing protocol agreed by all Caldicott Guardians Staff training Non-consent work around

17. Kent and Medway CIO Office PACS Programme Encryption Routers Secure data from edge of trust network – for us this was the edge of the COIN However single point of failure ? Impact on traffic throughput What about data elsewhere?

18. Kent and Medway CIO Office PACS Programme RIS Codes and Standards Agreed at outset to follow a single approach across the SHA to RIS coding: –Username – national registration code –Ward names - NACS and then agreed format –Rooms – NACS and agreed format –Examination codes – national Old RIS data extracted to a wed hosted viewer

19. Kent and Medway CIO Office PACS Programme Unique Patient ID Needed a unique patient ID across the SHA for RIS (not aware of this until second site went live) Currently business flow operates on PAS numbers Initial response was to add a prefix to PAS to create a unique number in RIS across the SHA This would be added on interface entry to RIS and stripped on interface out of RIS to PAS The prefix however would be used in PACS NHS No. not sufficiently populated or manageable to use.

20. Kent and Medway CIO Office PACS Programme

21. Kent and Medway CIO Office PACS Programme

22. Kent and Medway CIO Office PACS Programme What Number do you use? PAS – PAS or NHS RIS - pre-PAS, RIS or NHS PACS – pre-PAS, RIS, NHS or accession Results – PAS or NHS Web Viewer Pre-PAS or Name CRS – CRS, old PAS, NHS, - launches accession no. search on data centre

23. Kent and Medway CIO Office PACS Programme Challenges Mapping out the correct ID process through all stages Not blocking any clinical benefits from access to data Maximising the use of the NHS No. Moving to a standard practice everywhere. Managing a single RIS instance across an SHA including national code updates (links to letters, appointments, PACS and order comms)

24. Kent and Medway CIO Office PACS Programme Deliverables 1 st SHA Wide Data Centre Solution On time In Budget Single Workflow SHA Wide RIS codes Legacy RIS viewer Information Sharing Protocol

25. Kent and Medway CIO Office PACS Programme Benefits from PACS

26. Kent and Medway CIO Office PACS Programme Benefits Approach / Strategy Benefits Realisation –Cash releasing –Qualitative/ service improvement –Community wide Service Redesign –Overall view –Alignment with ISIP Challenges and Constraints

27. Kent and Medway CIO Office PACS Programme K&M Approach Vision –Expensive toy or enabler to change? –Community Wide Agree Coding, Terminology and Workflow Explore SHA wide Imaging potential Develop Radiology Network -? –Utilise NPfIT Community of Interest Network (COIN)

28. Kent and Medway CIO Office PACS Programme Cash Releasing Benefits Conservative assessment Film and Chemicals Processor maintenance Staff (film management, secretarial) Stationary £26m (over lifetime of project)

29. Kent and Medway CIO Office PACS Programme Non Cash Releasing X-ray availability: –Reduces NHS cancellations (OPt, ops, scans etc) –Reduction in delayed discharges Faster diagnosis Fewer patient journeys Film searches –Junior doctors, estimated 45mins per day £19m (Over lifetime of project) (not shown in affordability gap)

30. Kent and Medway CIO Office PACS Programme SHA Wide Potential Generic radiology model –Agreed patient pathways –Community PACS –Standardised RIS reporting Pooled equipment usage On-call services Reporting pool Centralised film store Centralised maintenance contracts Joint training Joint recruitment and job descriptions Reduced locum costs

31. Kent and Medway CIO Office PACS Programme Realising the Benefits Beyond the Trust - Options Realisation of strategic benefits requires joint working across the health community True, and beneficial, joint working requires formal governance structures to be in place with links to other initiatives The implementation of PACS could facilitate the creation of a radiology “body” within Kent and Medway A formal Radiology Network could be put in place catering for the health economy A Radiology Network could be a: –Less formal group/body –Part managed network –A managed network structure

32. Kent and Medway CIO Office PACS Programme Network Options Federation NetworkMutual NetworkManaged Network Advice and guidance group Some central management of services All radiology services centrally managed Sharing best practice Centralised film archives Central training and education Pooled reporting Reporting Centres Teaching files During PACS implementation On completion of implementation With a matured PACS

33. Kent and Medway CIO Office PACS Programme Next Steps / Challenges Complete deployments Operational handover GP results reporting PACS web service Last few issues on performance and service management Integrate with other CfH Programmes Agree Approach & Strategy for Benefits Realisation Integrate Service Redesign with ISIP

34. Kent and Medway CIO Office PACS Programme Yesterday

35. Kent and Medway CIO Office PACS Programme Today

36. Kent and Medway CIO Office PACS Programme Thank You Any Questions