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Archive through August 29, 200829-08-08  10:57 amPete Marsh20
Archive through September 17, 200817-09-08  09:51 amRichard Mann20
Archive through November 13, 200813-11-08  05:26 pmNeelam Dugar20
 Link to this message Keith Baldry  posted on Thursday, November 13, 2008 - 09:19 pm Edit Post Delete Post Print Post
Neelam - the continued use of cost savings from ending i=3Duse of film is, for many of us more forward-thinking trusts, entirely spurious - we had already largely migrated to a film-free environment, so have had to bear the exhorbitant costs imposed upon us through the CfH LSP PACS implementations with none of the assumed cost savings.

And, for breast screening services, we will have to maintain the film library, with it's associated overheads, for at least 6 years into the future anyway, because of the recall programme.
 Link to this message Neelam Dugar  posted on Thursday, November 13, 2008 - 11:05 pm Edit Post Delete Post Print Post
There are 2 significant issues that CFH need to deal with

1. Getting a sensible cost of storage. I would request all forum readers to please raise it at every meeting each of you attend. This is vitally important for the public as many of us would consider it mis- use of public funds.
2. API interfaces with other clinical systems. Pete mentions how with mature EPR systems, a API interface call is made from EPR to PACS. PACS is a part of a patients clinical record. There is a need to integrate with other relevant clinical systems. The important examples are
a. Results Reporting System( standalone/part of EPR/part of ordercomms)
b. Information Systems (RIS/CIS/NBSS etc)
c. Speciality software for image(3D/PET-CT/dental/cardiac ct/ct colon etc)
This is another area that LSPs want to force NHS into buy more expensive applications from them by their unwillingness to develop standard API interfaces with other products (non-lsp products). This has raised its head locally for us and we have asked Cfh to investigate this.

From a national perspective
1. There is an urgent need for Cfh to sort out data storage costs to prevent stagnation of NHS IT
2. Need to sort out the obstruction by lsps to integration between clinical applications for their own selfish commercial gains. In order to prevent the fragmentation of the nhs patient health record by lsps
 Link to this message Neelam Dugar  posted on Friday, December 05, 2008 - 09:27 pm Edit Post Delete Post Print Post
I continue to believe that the best clinical practice is to have a single image archive for radiology,mammography, cardiology.

However, I accept the points made by Simon,Pete, Richard and others regarding the LSP implementation of PACS in England
1. Enormous costs
2. Enormous storage costs
3. Huge integration costs with relevant clinical systems.
4. significant hardware costs for 5MP workstations.

The reason behind these problems are the negotiated contracts regarding
1. CDS--which does not provide any clinical; benefits
2. Storage costs do not mimic market rates
3. Workstations need to be bought from PACS suppliers
4. Single supplier monopoly.
5. No insistance on IHE integration.

Perhaps it is time with Screening Mammography to consider buying a separate PACS with strategic intention of moving all radiology to the new PACS once the LSP contracts end in 2013.

Trusts considering this should try and future-proof their investment
1. Ensure that future extra storage will reflect market prices
2. Choose SÖFTWARE ONLY PACS solution--Fuji Synapse, Agfa Impax 6 and many others (you can buy workstations from the open market)
3. CCOW standards to allow for integartion with other clinical applications (3D/Ortho-temp/OCM/RIS/CIS etc)
4. XDS-I for integration with other PACS solutions (neighbouring or national solutions)
5. Other ESSENTIAL IHE profiles to consider are
To see which vendors systems adhere to the IHE profiles
 Link to this message Neelam Dugar  posted on Thursday, December 11, 2008 - 01:14 pm Edit Post Delete Post Print Post
Possible Strategy to consider:

Buy a separate PACS for all mammography requirements (both Screening and Symptomatic). So that a reporting radiologist for symtomatic mammography has all the screening images available to him whilst viewing the symtomatic mammograhy. This is vital from a clinical/patient safety perspective.

Make sure that the Breast Imaging PACS that you buy fulfill the following criteria:
1. Can accept accession numbers and scheduling information from 2 or more information systems (NBSS, RIS--for symptomatic breast work, CIS-cardiology roll out in the future etc)
2. Can accept reports back from 2 or more information system (NBSS, RIS, CIS etc)
3. Desk-top Integration with NBSS and RIS will be required (insisting on CCOW for DTI will future-proof investment for other Information systems that maybe required to integrate like CIS)
4. Ensure that PACS Solution is able to deal with 2 Unique Identifiers--NHS Number and Local PAS/NBSS numbers. And it has the ability to put images into a single patient master jacket based on NHS number.
These are vital for considering a separate PACS for Mammography.

However, in order to future proof your investment and help minimise the trauma of moving your entire radiology imaging from the current LSP PACS to your Mammograhy PACS:
1. Insisting on XDS-I-It will future proof your investment regarding national image and report sharing (which I think is inevitable--although maynot be immenent and we maynot be the first country--due to obstructive contarcts)
2. Choose a SOFTWARE-ONLY PACS solution.
3. Ensure hardware costs for storage follow market trends (in your contract).
4. Ensure PACS supplier conforms to the following IHE profiles (as a minimum)
a. Scheduled Workflow
b. Patient Information Reconciliation.

By getting symptomatic mammography on your Breast Imaging PACS you will have sorted out integration with RIS. This will make you well ahead of the game for 2013, as RIS integration will be sorted out, and all it will mean is to direct your existing radiology modalities to send to Breast PACS rather than LSP PACS at the end of contarct(you will have the reporting workflow sorted as well).
 Link to this message Neelam Dugar  posted on Monday, December 15, 2008 - 03:08 am Edit Post Delete Post Print Post
It is important that the NBSS system also conforms to standards. This will proprietary interfaces with each PACS supplier for each Trust. If this issue is not taken seriously by CFH, public money will be wasted on huge number of expensive proprietary interfaces.

1. NBSS is a scheduling and reporting system like RIS.
2. Scheduling information needs to be shared with PACS and CR/DR modality
3. NBSS acts as a reporting system where reports are generated and stored.
4. Reports need to be shared with PACS and EPR/Results Reporting Systems etc.
5.Demographics need to be synchronised with the system that feeds it patient demographics.

1.Standardised method of sharing Scheduling Information is using Scheduled Workflow Profile of IHE. This way NBSS would be able to share scheduling information with any other clinical application that may need it.
2. Standardised way sharing reports (documents) is using the XDS profile of IHE.
3. Standardised way of keeping demographics synchronised between various clinical applications is by using Patient Information Reconciliation Profile of IHE.
4. Standardised way of desk-top integration between NBSS and PACS will be via CCOW.

It is upto the CFH team dealing with NBSS to insist on standardised methodology of integration with other clinical systems. It is in the best interests of public funds to adopt inter-operability standards rather than to pay for expensive proprietary interfaces.NBSS needs to conform to the following
1. SWF
2. PIR
3. XDS

It should not be suppliers who should be able to dictate what we in the NHS choose to buy. Suppliers should not be allowed to say " Supplier A is unwilling to work and integrate with Supllier B so you cannot buy this product". I have heard this happen and this is untenable. Dicom and IHE standrads have allowed us to buy our CT/MR/US etc scanners from any vendor without having to plead with the PACS supplier to "work with them".

Similar kind of of standardised "plug and play" information flow is required between
1. Scheduling Systems,
2. Ordering/Requesting Systems,
3. Reporting/Report/Document Display

At the Spring 2009 Meeting we will be looking Standards in context of Ordercomm, RIS and PACS. However, information flow is similar for NBSS/PAS/EPR etc as well.
 Link to this message Neelam Dugar  posted on Thursday, September 10, 2009 - 02:06 pm Edit Post Delete Post Print Post
We are again going to address the Breast Screening issue on 23rd Oct 2009 Meeting.

Nick Hollings will speak on the User perspective
Kevin Wilson (Pukka-J) will bring on the technical perspective, of providing a clinically safe solution.

The radiologist reporting screening mammography MUST have access to NBSS, PACS for screening mammography, and Radiology PACS on the same workstation (PC)
To implement a stand-alone PACS solution for Breast Screening safely, the solution MUST integrate with
1. NBSS and Breast Screening Mammography--with a desk-top integration for reporting (for safety and efficiency)
2. Radiology PACS--via Desk-top integration (NHS no. as context for synchronization): Sometimes, patient may have a previous symtomtatic mammogram which may be present on radiology PACS.

Similarly a radiologist reporting symtomatic mammograms on RIS and radiology PACS also needs access to
1. Desk-top integration between RIS and Radiology PACS
2. Desk-top Integration between Radiology PACS and Breast Screening PACS as well. This could be an alternative to pushing images from one PACS to another.

When we have an XDS based EPR--Desktop integration between EPR would be the way forward.

I understand that NHS supply Chain are looking at the the ability to provide NHS Trusts with options of buying from them. So choices for Breast Screening PACS will include
1. Independent OJEU
3. NHS Supplies Chain.

23rd Oct should be interesting for those who are looking at Digital Screening Mammography.
 Link to this message Neelam Dugar  posted on Sunday, November 01, 2009 - 10:26 am Edit Post Delete Post Print Post
We had a very interesting discussion on Breast Screening issue on 23rd Oct. Nick Hollings did an excellent presentation on Screening Mammography and PACS from a end user perspective. This bottom-up approach will allow Trusts to make the right decisions from the very start, and ensuring that long terms cost savings can be be obtained by increasing productivity of radiologists who are the end-users.

1. SINGLE INFORMATION SYSTEM: End users wish to have a single information for dealing with both symptomatic and screening images--Currently NBSS deals with Screening mammograms, whilst RIS deals with symptomatic mammograms. There are possible plans for NBSS to incorporate symptomatic mammograms in Jan 2010.
Alternatively, could RIS be used for reporting screening mammograms with messaging flows between NBSS and RIS (in the background). Anyone willing to explore this.

2. SINGLE WORKSTATION for REPORTING: Display of RIS and NBSS with desktop integration with Mammography PACS (and access to Radiology PACS). It was felt that all mammography (whether screening or symptomatic) should be displayed on the same workstation and PACS application alongwith access to RADIOLOGY PACS (which would store CT/MRI/NM which may be relevant).

Options are
A. Use the Existing Radiology PACS for mammograms with desk-top integration with NBSS and RIS.
B. Separate Mammography PACS for storage and display of Mammograms (both symptomatic and screening). This will allow for Trusts to choose PACS display with CAD functionality which is meet specific requirements of Breast Radiologists. However, this separate PACS for Mammograms MUST have desk-top integration (Context Synchronization with all 3
b. RIS and
c. radiology PACS.

Even though discussion were specifically around Mammography the discussions from the floor moved back to XDS and XDS-I. If you are buying a separate PACS systems look for an XDS-I compliant mammography PACS, so as to future proof your investment.

David Burns (NHS Supply chain) stated that they were a company who supports NHS Trusts with the procurement of Breast Screening PACS and gives them a choice.

Kevin Wilson (Pukka-J) put a supplier perspective, and there were 2 very strong messages there
1. Cost of Storage is very cheap now-adays
2. Context Synchronization with NBSS/RIS and Radiology PACS was technically possible, but as users we need to clearly specify in our specification. Only if we do specify this in our requirements, do we even have a chance of the supplier community delivering our requirements.

1. Specify for desktop integration/Context Synchronization with NBSS, RIS and Radiology PACS
2. Specify for XDS-I for future proofing.

I will post all breast screening related presentations on this thread.
 Link to this message Neelam Dugar  posted on Sunday, November 01, 2009 - 10:32 am Edit Post Delete Post Print Post
Breast Screening and PACS- Clinical User Perspective--Nick Hollings (NHS)

application/pdfBreast Screening and PACS- Clinical User Perspective
NH BIR 09.pdf (133.4 k)
 Link to this message Neelam Dugar  posted on Sunday, November 01, 2009 - 10:35 am Edit Post Delete Post Print Post
Breast Screening and PACS—Supplier Perspective—Kevin Wilson (Pukka-J)

application/pdfBreast Screening and PACS—Supplier Perspective
Pukkaj breast screening supplier prospective.pdf (441.4 k)
 Link to this message Neelam Dugar  posted on Sunday, November 01, 2009 - 10:39 am Edit Post Delete Post Print Post
Breast Screening and PACS—NHS Supply Chain ---David Burns
application/pdfBreast Screening and PACS—NHS Supply Chain
PACS mammo.pdf (53.6 k)
 Link to this message Neelam Dugar  posted on Tuesday, February 02, 2010 - 03:04 am Edit Post Delete Post Print Post
I know that many of you are looking at breast screening solution. I am also pleased to hear that there is finally some competition in the market and you have choice. Even LSPs have to compete!!! This is really good news.

When making a judgement about the breast screening PACS you may wish to consider the following issues from a patient centric perspective
A. When reporting a recent breast screening mammogram
1. Is there desktop integration/context synchronization with NBSS
2. Is there automatic display of previous mammograms on the right monitor
3. If the previous mammogram was done as symptomatic mammogram, will this display automatically
4. If there is need to review a bone scan/body CT/chest xray will this be accessible via a single mouse click

B. When reporting a symptomatic breast mammogram
1. Is there DTI with the information system (currently RIS as far as I know)
2. Is there automatic display of relevant prior--screening mammogram.
3. Is there access to Bone scan, CT body, chest xray by a single mouse click

From a patient perspective it does not matter where the images are stored, as long as images are available for review at the time of reporting.

However, if you do plan to use the 'free' CDS for storing screening mammography, make sure you get clarity from CFH contracting team in writing regarding the situation in 2013--are there going to be any costs for data migration.
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