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

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

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

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

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.

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.

c.2000 Live modalities; CR/MRI/CT/US etc 300 Diagnostic Workstations c.16000 ward based users

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.

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.

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.

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.

Chosen architecture

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.

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.

Working as a team Current arrangements are ad hoc Individual bilateral arrangements Remote reporting Access to “foreign RIS” Email 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.

Capacity shortfall In sourcing Remote reporting Access to “foreign RIS” Email 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.

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.

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.