PACS, RIS and related developments in the United Kingdom Dr Keith Foord Consultant Radiologist Conquest Hospital,East Sussex, UK (Secretary, UK Royal College of Radiologists PACS and Teleradiology Group and Board Member, EuroPACS) PACS 2003 Velkommen til hyggelige og lærerike konferansedager i Trondheim! Nasjonal PACS/RIS-konferanse 12. og 13. februar 2003 i Trondheim

United Kingdom Population* (millions) Total 59.8 England 50.0 Scotland 5.1 Wales 2.9 N. Ireland 1.7

UK NHS national NHSnet – the largest private Intranet in the world. NHS Information Authority - very tight security guidance

VPN (private) – SW London project VPNs (DSL with encryption) Dedicated WAN - Glasgow BT Metro VPN – Wales ‘DAWN2’ (or over short distances BT LES - LAN Emulation Circuit) NHSIA unhappy with security issues with ADSL except for point to point transmission between networks or in Virtual Private Networks - VPNs

NHS I.T. Provider history 1.Although NHS is a national health service, free to citizens at the point of use, I.T. very fragmented as there was a political history of minimising central control in England from More centralised systems were maintained in Scotland, Wales and Northern Ireland. 3.Unique 10 digit NHS number only just available for all citizens. 4.Attempts to co-operatively co-ordinate from 1998 to 2002 failed. Allocated resources did not reach hospitals as the money was able to be diverted at an intermediate level to meet other political objectives in NHS service delivery More vigorous, but commercial, control now being re- asserted to move as rapidly as possible – Objective is to be able to freely exchange clinical information around the UK.

Major Patient Administration or Hospital Infomation system providers in UK Share of known installed market

Major RIS system providers in UK Share of known installed market *RADIS installed in all Welsh hospitals **NIRADS installed in all N Ireland hospitals

PACS sites PACS in development Wide area PACS project initiation

Major PACS system providers in UK Share of known installed market

Long distance teleradiology projects in Scotland to support remote areas Wales – national ‘DAWN’ VPN Sussex Cancer Network web based project Hospitals with teleradiology facility for emergency use Every UK hospital has at least a video link to its regional neurological centre for emergency neuro CT etc.

Major Teleradiology system providers in UK Share of known installed market

So how is control being re-asserted?

Sussex Cancer Network East Sussex Hospitals Surrey and Sussex Strategic Health Authority

Strategic Health Authority Now responsible for IT in its area. Appointing ‘Prime Consortium’ to take over existing contracts and provide new IT services, including VPNs Will be in place from late 2003 There will be more focussed IT provision in the strategic area and less choice for and less variation, between hospitals. Each prime consortium may have only one or two PACS/RIS provider companies

Applies to 23 Strategic areas of England DOES not apply to: Scotland Northern Ireland or Wales Who have national Strategic coordinating bodies already as part of ‘devolved’ government

National Diagnostic Imaging Messages Project (DIMP)  There approx. 600 imaging departments in the UK, the majority of these departments have Radiology Information Systems (RIS) sometimes these systems are integrated as part of a Patient Administration System (PAS).  In the UK there are almost 9000 GP practices and virtually all have computerised information systems.  DIMP to ensure all hospitals and GPs will be routinely exchanging structured electronic messages for Radiology results by the end of 2003 (but not images)  The message will use a UK profile of the HL7 V2 messaging standard implemented in XML over eSMTP.  A discrete list of diagnostic imaging investigations coded in both Read Codes and SNOMED CT will be developed - uniquely identifying the examination to which the report pertains.

East Sussex Hospitals What about local developments in East Sussex Hospitals? Population 450, ,000 imaging investigations per year

1991 Regional Radiology Committee discusses PACS - Conquest Hospital to act as test bed SE Thames RHA Scientific Office leads - a Regional development project Contract signed with ‘Simis Medical Imaging’

Single CR segment Hub DSADSI CT NM Digitisers PACS/RIS Unix Devices Radiologists Sun Sparc PACS viewers ISDN PC i/f External Sun Sparc PACSviewers Video PC i/f Mac i/f Sun Sparc i/f RAID ODs 2 x 100 Mbs CR Sun Sparc review RIS Terminals 1994

1997 Specify new triplicated CR DICOM system Lease 3 x Philips AC3 3 x ‘Easyvision RAD’ workstations also networked to fluoro and angio units Continuing PACS re-specification work

Hospital 10/100Mbs ethernet RIS Switched Hub Switched Hub IP ‘ping’ ASCII unidirectional Bespoke protocol VLAN Switch/ Route Controller USITs x 3AC3 CR x 3 DICOM IP ‘ping’ ASCIICRconnectivity Late 1997

Conquest Hospital, U.K. early 1999 installation agreed Archive Manager Lumisys 75 with QA Station StudyServer TM With Fibre RAID Bexhill Hospital Key User station Radiology Segment Workstations Picker Polaris MR Siemens AR/T CT PACS Broker Linked to RIS / /CIS/HIS Philips EV RAD Philips PCR Siemens ICON Nec Med Philips new DSI Philips V3000 Ultrasound PC Link PACS Web Server Hospital Intranet Key User DICOM Servers Key Users C Arms with IAMs Picker W/S Lumisys 150* with QA Station Dry Laser DICOM Printing DLT nTByte Archive RAID DICOM Print server Philips DSI 100 plus Intranet / CIS users RIS Server CIS/HIS Server

2001 ‘Management merger’ with Eastbourne. Joint IT department formed. Joint PACS Project Board Documents re-done to reflect two main hospitals and DVD archiving problems with Agfa Basix mini-PACS Tender for new CR for Bexhill Hospital E’B obtain charitable fund money - go to tender for their elements of new full PACS plus 2 additional CR units Sunquest taken over by Misys

2002 Philips Compano CR/ Kodak DICOM printing installed at Bexhill Hospital 36Mbs ‘line-of-sight’ microwave wireless linkage between Conquest and Eastbourne Hastings extends Philips CR lease at Conquest to includes 4 th and new 5 th CR - for CR mammography Hastings installs Ferrania Web Server (allows Query/Retrieve from local RAID and Eastbourne archives) Eastbourne place contract with Agfa for DICOM/Web PACS plus 2 additional CRs. Web Server allows Query/Retrieve from Hastings RAID Hastings tenders for DICOM printing network, selects Agfa Hastings tendering for PACS which will allow DICOM query/retrieve from Eastbourne archives and increase existing server and RAID/SAN archive capacity across the units.

Cross site PACS Separate systems but DICOM query/retrieve between? Same system, enhance link bandwidth and servers and RAID/SAN capacity? What to do about different PAS and RIS systems? Local big RAIDs, shared/local SAN storage?

Eastbourne Hospital installations agreed 2002 Radiologists Workstations Siemens MR Siemens CT PACS Broker Linked to RIS AGFA CR Nec Med DSI Siemens Angio Ultrasound PAXport Balanced PACS Web Server Trust Intranet W/S Lumisys 75 with QA Station Dry Laser DICOM Printing MOD Archive DICOM Print server 1000 plus Intranet / CIS users RIS Server Balanced PACS Web Server Hastings Workflow manager Dtabase manager PAXport Archive workflow MOD Manager RAIDS SAN

Bexhill Hospital CR & Conquest Hospital, Digital Image and Web installations 2003 Bexhill Hospital Picker Polaris MR Siemens AR/T CT Philips EV Philips PCR New DICOM Nec Med Philips new DSI Philips V3000 Trust Intranet Picker W/S Dry Laser DICOM Printing DICOM Print server Philips DSI Web users RIS Server CIS Server DICOM Print server Dry Laser DICOM Printing Radiology users Philips Compano CR PAS Server NM viewer Eastbourne Ultrasound DICOM link Image Web Server RAID Archive workflow RAIDS SAN

OBJECTIVE2003 Seamless, cross site PACS

Thank you for asking me to Trondheim