Re-engineering Radiology services using PACS

Norfolk & Norwich University Hospital 1000 bed new build under PFI Designed to be filmless and “less paper” Opportunities –Mostly new equipment –PACS –More space –Process re-engineering

Status quo Film based systems Need for film file Sessional commitments –Ultrasound –CT / MRI –Interventional –Reporting

Changes enabled by department design Central department with functional areas –Designated reporting rooms CT/MRI suite with 4 scanners – single radiologist advising 9 general X-Ray rooms with central work area – duty radiologist advising

Changes facilitated by PACS Not restricted by films Work driven by request cards CT and MRI can be reported at any workstation Improved efficiency of clinical meetings Potential for reporting from worklists Reporting targets set Increased flexibility possible

The fate of the film file Scheduled for closure within 3 years PACS had immediate impact file activity Savings on staff costs Risks –Research –Medicolegal? –Patient management

Digitisation! The road to madness Do as little as you can Get on with it as soon as possible Stop doing it even sooner Get yourself an arsonist

Images in theatre Recognise the problem –Space –Lighting –Cleanliness Don’t be defeated by the Luddites Think laterally –Flat panel monitors on the wall –Project images on to a wall from data projector –Wireless mouse/keyboard Accept that you may need film initially

Hard copy strategy Only print hard copy if there is a good reason Bad reasons –“My boss wants it” –“ We won’t take the patient to theatre until we have it – if they die its your fault” –“We don’t have PCs with CD drives” –“Our network won’t access images from your web browser” –“Our medicolegal expert says he needs them”

Hard copy strategy Good reasons – –“I really will break your neck if you don’t”

The Impact of IT Single PMI Good interface with RIS Value of Requesting as well as Reporting Digital Dictation Voice Recognition reporting ing reports to clinicians Electronic transmission to GP systems

Failures Reporting rooms a disaster Department too small Requesting system developed much later than anticipated Electronic transmission of reports delayed

Successes Increased reporting efficiency –Plain radiographs –CT/MRI VR impacts –increased efficiency of report production –Fewer incorrect reports (potential to eliminate) Legible requests via Requesting system Improved delivery of reports More efficient clinical meetings PACS is simply BETTER