posted on Thursday, February 18, 2016 - 10:36 pm
I have been thinking about what NHS customers will be considering as a priority in their 2016-17 PACS replacements.
Reporting backlogs, clinical networks and NHS paperless agenda will be key drivers.
1. Flexible Home Reporting-PACS suppliers that support and enable flexible home reporting will be looked upon favourably--criteria for acceptable home reporting should be 45plain x-rays per hour. This could bring in some much needed extra reporting capacity from part-timers etc 2. Clinical Networks--access to images and reports across clinical networks (irrespective of the PACS vendor) is a critical need today. DICOM QR standard, consistent storage of NHS no, and Radiology reports made available as DICOM SR are key to this concept. (Access to images and reports across networks over PACS will technically allow reporting too via the RISEes) 3. Paperless NHS--XDS based VNA allows other specialty images and documents to be stored and indexed. This will play a significant role in the drive towards a paperless NHS.
Any other thoughts?
posted on Friday, February 19, 2016 - 09:51 am
I know theres a lot of discussion about home reporting just now, but I'm not convinced it will make a big impact in the near future -data transfer/ technology/ IG and cost issues still need some work.
What I do see as a 'biggie' is Business Intelligence- to know in real time, and be able to predict/ model services will become more important - we are seeing these developments in PAS systems and they need to come to radiology too (however that may be achieved).
Another piece of this is the 'so what?' factor. We produce lots of images and reports for patients but could do with a way of being able to clarify what value they add to the patients care. Whilst some will be obvious, veryone will be familiar with the scenario where its easier to perform a test/ scan than argue the merits/ benefits of a test with a referrer. This is important because radiology across the UK will probably never have the resources to meet the ever increasing demand out there. We do therefore need to ensure that the limited resources we have are being used in the best possible way..
I would suggest many departments are data rich but information poor.
The ability to share patient centred information across historically separate data systems is starting to happen and I know you have discussed that many times.
As for paperless, I suspect the issues are moer outside radiology than within....
Business Intelligence and Vetting Functionality are very important.
However, PACS is an image archive and image display--uses DICOM as the standard to achive this. IHE actors used in PACS 1. Image manager 2. Image Display
Business Intelligence is about demand and capacity analysis and predictions for 1. Machine/exam rooms 2. Operators--predominantly radiographers 3. Reporting Workstations 4. Reporters--predominantly radiologists Business Intelligence predominantly something a scheduling, exam completion and reporting system would do best. RISes are largely the systems used in NHS for these function and would be best suited for good business intelligence. Modern RISes are making huge strides in this area! I agree with your view that many departments are data rich but information poor. Extracting displaying business intelligence from data is key.
"everyone will be familiar with the scenario where its easier to perform a test/ scan than argue the merits/ benefits of a test with a referrer" Again we are talking about vetting functionality--which is a functionality of RIS in my view--as messaging standard is dependent on HL7. (RIS is an HL7 systems. PACS is a DICOM system. In very simple terms for distinction). I can tell you that on RIS, I as a radiologist, am able to edit/change an exam so that we always to the correct exam. I am also able to cancel an exam--Reason for cancellation is transmitted via HL7 ORM message in ORC16 back to Ordercomms/EPR/HIS. It is not uncommon for me to cancel an exam on RIS with the message--"Inappropriate request. Please discuss the case with the Duty Radiologist." Sometimes, they come back with more relevant history, other times the request is changed and many a times the exam is not done. Many a time whilst reporting an inpatient exam, I see that the same exam has been requested as an Outpatient and is due in 1-2 weeks. I can use the edit request function and instantly cancel the exam--and free up the space for another patient. Vetting and editing/cancelling functions requires good HL7 ORM messaging--and hence, I think this should be part of a RIS/RMS (Radiology Management System)
I think I will put Business Intelligence, Peer Review Feedback and Vetting Functionality in a thread for RIS replacements 2016-17
Given the network constraints especially for home reporting, PACS should support prefetching of the images and reports for current as well as for relevant prior exams. So that images are fetched on the system even before radiologist starts reading, thereby saving time for the user.
Prefteching should happen based on rules such as Emergency reads takes priority over the normal reads, SLA for study's TAT, etc.
We are looking at pre-cacheing studies on PACS workstations for home reporting. RIS would send intended reporter in OBR32 to PACS in the ORM message. PACS would store intended reporter in its database (maybe temporarily) PACS will look at Intended reporter, exam status (completed--NOT authorised/finalised), and log-in details of the radiologist to start the pre-caching on the workstation (with 1-2 relevant priors). Pre-cache would clear on the log-out. I do think this will work until appropriate broadband speeds of >100mbps are available in UK.
Clinical Networks Sharing--will I think be the most important factor in PACS replacement projects. Many Trusts may want to have independence of procurement rather than be forced into a decision made by a consortium--and yet be able to share images and reports with other Trusts within a clinical network.