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 Link to this message Neelam Dugar  posted on Saturday, March 01, 2008 - 06:50 am Edit Post Delete Post Print Post
Dear All,
I have produced an options appraisal for radiology report sharing within NHS. It is in draft, and please could I ask for comments.

The options considered here are
1.USE OF DTS Service to Share Radiology Reports between NHS Trusts
2.LSP Central Archive to provide report sharing in addition to Image Sharing
3.Use of International Standards --- XDS profile of IHE to enable NHS Radiology Report Sharing.
application/octet-streamRadiology Report Sharing --options appraisal
Radiology Report Sharing.doc (34.8 k)
 Link to this message Neelam Dugar  posted on Thursday, March 06, 2008 - 01:45 pm Edit Post Delete Post Print Post
Dear All,

Based on comments received, I have updated the document with
1. Clinical Specification for requirements of radiology report sharing
2. a 4th option (Dicom SR)has been included.

Please do not hesitate to post if there are any inaccuracies or comments you may have.

Many thanks.
application/mswordradiology report sharing-update
Radiology_Report_Sharing.doc (44.5 k)
 Link to this message Neelam Dugar  posted on Wednesday, March 12, 2008 - 04:46 pm Edit Post Delete Post Print Post
Dear All,

I have updated the document following private messages to me. Could I please ask for you all to continue providing comments so that I can finalise this Options appraisal ASAP.

I am in process of writing up some updates from the meeting last week.

Thanks.
application/mswordRadiology report sharing-vesion3
Radiology_Report_Sharing3.doc (43.0 k)
 Link to this message Pete Marsh  posted on Wednesday, March 12, 2008 - 05:32 pm Edit Post Delete Post Print Post
The concept of a shared electronic record is about a complete record not just the radiology report. So plans for data sharing on a holistic way must consider all of the record not just the RIS report.

DTS transfer is a function that can and is provided outside of RIS functionality, use of agents such as interface engines and middlleware from companies like Anglia already provide this without recourse to RIS suppliers, although it helps if you do not have the skills locally.

LSP provision – the final report can and is stored in the PACS record and can be viewed as such. There may be an argument this is the safest way to share RIS reports since it definitely shows a link between the image and what the report author created.

Sharing RIS data can and is achieved with use of HL7 version 2 messages in a standards way, containing, demographics, order and result data. Along with versioning – prelim, final, amended and even abnormality flagging, used in some sites for cancer alerting.

Sharing RIS data should be considered as part of the operational process of providing a opinion on a image and confirming it where necessary. The clinical use of a shared electronic record should be more holistic and include all elements of a EHR.

I agree a standards based approach is the way forward, but existing standards are already in available, and are used.

We can never expect to have 100% cover and error free use of NHS Number, so systems have to be able to handle this condition.

Wirral and Chester are just in discussion about shared ordering from different EPR’s and Primary care using HL7 v2 messaging as a result of service commissioning changes, so hopefully we can demonstrate interchange of messaging and images in a pragmatic and safe way.


Pete Marsh MBE
Technical Director
Wirral Health Informatics Services
 Link to this message Pete Marsh  posted on Wednesday, March 12, 2008 - 05:35 pm Edit Post Delete Post Print Post
The concept of a shared electronic record is about a complete record no t just the radiology report. So plans for data sharing on a holistic way must consider all of the record not just the RIS report.

DTS transfer is a function that can and is provided outside of RIS functionality, use of agents such as interface engines and middlleware from companies like Anglia already provide this without recourse to RIS suppliers, although it helps if you do not have the skills locally.

LSP provision ? the final report can and is stored in the PACS record a nd can be viewed as such. There may be an argument this is the safest way to share RIS reports since it definitely shows a link between the image an d what the report author created.

Sharing RIS data can and is achieved with use of HL7 version 2 messages in a standards way, containing, demographics, order and result data. Along

with versioning ? prelim, final, amended and even abnormality flagging,

used in some sites for cancer alerting.

Sharing RIS data should be considered as part of the operational proces s of providing a opinion on a image and confirming it where necessary. The clinical use of a shared electronic record should be more holistic and include all elements of a EHR.

I agree a standards based approach is the way forward, but existing standards are already in available, and are used.

We can never expect to have 100% cover and error free use of NHS Number , so systems have to be able to handle this condition.

Wirral and Chester are just in discussion about shared ordering from different EPR's and Primary care using HL7 v2 messaging as a result of service commissioning changes, so hopefully we can demonstrate intercha nge of messaging and images in a pragmatic and safe way.

Pete Marsh MBE Technical Director Wirral Health Informatics Services
 Link to this message Richard Mann  posted on Wednesday, March 12, 2008 - 05:38 pm Edit Post Delete Post Print Post
Neelam,

Couple of comments with regard to option 2 (LSP Central Archive to provide report sharing using Dicom Structured Report) in your appraisal:

Point a) You say that LSP's are not required to share reports via the cluster archives. Is this really true? Did CfH sign up to a deal for images only? If so, is that because results are meant to be shared via PSIS (or whatever its called now)?

Point b)You say that RIS or an intermediate software will be required to convert existing radiology report to a Dicom SR for storage in the PACS Central archive. By existing do you mean historical reports - i.e. prior to local PACS implementation?

Point d)You correctly point out that Report Sharing will be limited to LSP cluster (and would not be good for patients who live at the LSP borders). This is will be problematic for images as well - and for trusts whose neighbours haven't committed to CfH PACS.

Point e) You say that the cluster archives will need to implement legitimate relationships which will be at an additional cost. Why will it cost us extra? If CfH design and implement a security framework (including Legitimate Relationships) then surely that shouldn't be at extra cost to trusts?

cheers,
Richard.
 Link to this message Ivan Brown  posted on Wednesday, March 12, 2008 - 06:58 pm Edit Post Delete Post Print Post
Richard,

I suspect that much of this image and data sharing problem comes out of the assertion by the LSPs involved in certainly the Southern Cluster demos that image and data sharing between Trusts and entities was outside the scope of what they were required to provide under NPfIT (remember them?) contract and now that is obvious to everyone that this will be not only advantageous but essential they see this as a way to increase contractual scope and capital and revenue to be earned from it.
 Link to this message Neelam Dugar  posted on Thursday, March 13, 2008 - 09:21 am Edit Post Delete Post Print Post
Richard and Ivan,
On 7th March meeting (an interesting meeting!) it became clear that LSPs (of all clusters) are NOT contractually required to provide even IMAGE sharing through the central archive. IF Image sharing is required by NHS, it will come at an extra cost (let us see what the cost of this will be, and how much CFH will be willing to pay the LSP for this!!!). We are disappointed to hear that the 35 million promise that was to be paid to LSPs for Central Archives was just to provide an off-site Dicom storage. It is disappointing to hear that the promises of a community PACS (if you took on an expensive LSP PACS solution) was not actually real!!!! However, as I said in the meeting, I think we need to move forward. We need to look at options appraisal for image sharing as well as report sharing.

Report sharing is definately not in the LSP scope as yet. Again let us see if CFH is going to give out the contracts (which are likely to be expensive) to LSPs to deliver option 2 ,or would be willing to consider other options like XDS, that are being adopted internationally.

I accept, for CFH the easiest option is option 2, entering into a contract (probably expensive) with LSPs to deliver the report sharing functionality. Option 3 requires more work on their part i.e. making the Spine compliant. Time will tell where CFH wishes to go.

Historical (pre-PACS reports) will not be dealt with option 2 (LSP Dicom Structured Report Solution) but in theory could be put accomodated by option 3 XDS solution.

There is no technical reason why non-LSP PACS cannot store imaging data in LSP central archive. Central archive are nothing fancy, but simple Dicom Stores. To send images to Central archive the local PACS need to do a Dicom send, and to retrieve images from the LSP store local PACS would need to a simple Dicom QR. However, LSPs may wish to prevent non-LSP PACS from using the Central Archive so that they can put pressure on these Trusts to adopt the expensive LSP PACS. However, in reality (now that imaging sharing is not a contractual requirement) there is no real benefit for non-LSP PACS Trusts to adopt an expensive PACS from the LSP.

Instaed of asking every LSP Cluster data store to adopt Legitimate Relationships (at a cost which will be a part of the cost of using the 5 LSP Cluster data store of image and report sharing) it is more future proof and cost effective to implement Legitimate relationship via the XDS model where legitimate relationship is adopted at the document registry level (a User in Trust A will only be able to call up images for the Joe Bloggs that are entered on the PAS of Trsust A but will not be able to call up the Joe bloggs for Trusts B, C, D etc)

Pete,
The local work done by you using DTS is commendable. However, I do think (for the reasons quoted on the document) it will not work at a national level.

Just to point out that XDS is not a new standard but uses HL7 v3 standard, and the documents stored in the document repository will be in CDA format (Clinical Document Architecture).

NHS is reliant on Local Trusts doing pilots which promote and share good practices which can be adopted by other Trusts. Keep up your good work and let us know how you get on with your EHR information sharing. I agree with you that radiology images and reports need to a part of EHR. Would like to talk to the PACS Group at the next Autumn meeting about "Radiology Images and Reports ---a part of an EHR implementation"? A lot of us would be keen to hear your views!

I also agree that we will NEVER have 100% NHS no. cover. We need to have systems to deal with this! XDS patient Identity Service does deal with this very well. However again Spine will need to be complaint with this.
 Link to this message Ivan Brown  posted on Thursday, March 13, 2008 - 12:36 pm Edit Post Delete Post Print Post
Neelam,

Well at least the LSPs are consistent about something for once!

I agree that we should move forward and XDS is the way to do this although I suspect that it will be resisted by LSPs who will much prefer a proprietary solution. That is business. At least one LSP representative asserts that they are "not a charity".

CfH must have the courage to stop the contracts delivering the NHS IT project into the embrace of a closed coterie of near-monopolists.

I agree that the spine MUST be consistent with IHE standards but this is not what the grape-vine tells me is likely to happen. Keep up the pressure!
 Link to this message Neelam Dugar  posted on Thursday, March 13, 2008 - 01:41 pm Edit Post Delete Post Print Post
Ivan,

LSPs are a business, and let us face that. They will try to get the best deal for their company (that defines a good business). However, NHS is the customer and we must not forget this. We should define what we need and make sure we get what we need.

For many years many of us have said here that monopoly suppresses innovation. I have seen this happen over the last few years. XDS does open up the market and allows PACS and RIS vendors to be interoprable without a monopoly (good for customer but bad for business) .

I have also opened up a debate for National Image sharing--options appraisalhttp://www.pacsgroup.org.uk/forum/messages/2/37359.html?1205415415.
Could I please request the Group to continue providing me with your comments.
 Link to this message Richard Mann  posted on Friday, March 14, 2008 - 09:08 am Edit Post Delete Post Print Post
So what meeting was this then?

As project manager for our trust I put the business case together, and a chunk of the benefits were around data sharing. We entered into an agreement with the LSP (brokered by CFH) on the back of this (I can well remember being told not to be so pessimistic about these benefits....).

The whole point of being locked into this crazy architecture with one years local cache was that the cds would be up and running and would enable data sharing. This is how the LSP and CFH sold their solution to us.

With every respect to this forum, if what you are saying is true I'm a little disappointed to be hearing this here. Surely we deserve some sort of official announcement and clarification from the LSP / CFH on this? Delivered directly to trusts?

Before moving on, I would say our trust is due a refund and an apology - it would appear we have been lied to. It also raises questions about the whole point of "upgrading" to the smartcard driven Impax V6.

Getting away from the politics/commercial stuff - am I the only person who thinks it is blindingly obvious that images and reports should live together? And that creating seperate systems/architecture for them is plain nuts?

I'm going for a lie down now.

regards,
Richard
 Link to this message Neelam Dugar  posted on Friday, March 14, 2008 - 09:33 am Edit Post Delete Post Print Post
Richard,
This was the Spring Group meeting on the 7th March 2008, last Friday (I can see from your comments you were unable to attend). The response from the floor was similar to yours. But we are, where we are! LSPs are contractually not required to provide data sharing via the central archive. The central Archive is merely an off-site Dicom Store. To enable image or report sharing, NHS/CFH will have to have to spend some more money.

But let us look forward. As a knowledgeable Group, let us provide options to enable LEGITIMATE data sharing. Let us try to ensure that the public get value for money this time.
 Link to this message Padhraic Conneally  posted on Friday, March 14, 2008 - 09:39 am Edit Post Delete Post Print Post
Will presentations be posted as before
 Link to this message John Parker  posted on Friday, March 14, 2008 - 11:00 am Edit Post Delete Post Print Post
HI Richard,

At the NE/EM PACS managers forum last year, we questioned why reports were not being sent/ stored in the CDS - for most radiology users (ie referers), its the most important part of the episode. It appears that this 'slipped by' everyone involved in drawing up the specification and subsequent contract. Maybe Lorenzo will fill this gap!

The most popular phrase we hear now is ' we are where we are' or similar variant, and everyone is now scrabbling around to make the best of an unsatisfactory job. I suspect this is what happens every time political pressure forces through change without sufficient consultation.

As for Smartcard PACS, all I can say is anyone contemplating this needs their heads examined. In its current form, its just not fit for purpose.
 Link to this message Neelam Dugar  posted on Sunday, March 16, 2008 - 01:23 pm Edit Post Delete Post Print Post
Padhraic,
I am collating the presentations from the speakers and will be publishing them soon.

John and Richard,
The response from the floor was similar to your response. I agree this is very unsatisfactory. Many of us warned about the way PACS was being implemented through the NPFIT (you can go back to many discussion regarding this on the forum), and questioned the VFM element of the contracts, in a monopoly enviornment. However, our voices fell on deaf ears. There is little any of us could have done individually. However, the one thing that the national programme did do for this Group was to bring us together (I am grateful to Rhidian for all the work that he has done and continues to do for the electroinc forum). It has brought together radiologists, radiograhers, IT technical staff and suppliers. Best practices have been brought to light and shared. We are a mature group now, let us use our combined expertise and try and steer the National PACS programme towards the right direction.

Let us as a Group put our specifications and Options Appraisal for
1. Image Sharing (now that it is no longer within existing LSP contract)
2. Report Sharing
3. PACS contracts post 2013
4. Clinical Specifications for Ordercomm for Radiology
I agree with John, it is daft to have image sharing but no report sharing. Please could I once again ask for people to comment on the Report and Image Sharing Options Appraisal (either publicly or private messages). Once complete, I would like to send the documents to CFH, RCR and SHAs.

It is possible that our Specifications will be ignored by CFH and SHAs completely. But we do not know unless we have tried.

John,
We are implementing smartcards from end of March (you are not the first person to tell me that I need my head examined!!! All in good spirit!)
 
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