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 Neelam Dugar
posted on Wednesday, October 28, 2009 - 12:05 pm
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The Meeting on Friday was a big success.
We would like to thank all the speakers who contributed to the success of the meeting.
We would also like to thank our sponsors from the supplier community who help to support the the meeting (so that we can keep the delegate fee to a minimum)
We would also like to thank Adele and Katie for the admin support provided for the meeting.
Last but not least is thanks to all delegates who attended the meeting. Without the attendence at the meeting by delegates (both from user and supplier community), we would not be able to continue our bi-annual meetings. We do need you there delegates, so please do continue to support the Group.
Many of you attended via Webex. I heard some comments about we allowing people to come in free via Webex, whilst charging others. We need to be clear that if we did not get adequate interest for attendance at venue, we will not be able to hold the meetings in the first place.
I will be posting speaker presentations soon after I have got permission. |
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| Neelam Dugar
posted on Tuesday, November 03, 2009 - 06:35 am
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This was a ground breaking meeting in my view. The message was loud and clear--we need to move to an open standards based EPR, harnessing the investment on the exsisting Clinical IT systems in NHS. Phil Morris stated in his presentation we need to move from "Rip and Replace" to the concept integration with use of standards.
2 important concepts are required if we are to move to an integrated health record which is patient centric
1. EPR based on the international document and image standard---XDS and XDS-I of IHE.
XDS has a paper notes analogy--it does not matter what size or colour of your paper--provided it has the meta-data---patient ID, type of document (ECG, lab result, clinic letter etc), it can be filed in the notes.
2. Context Sharing or Context Synchronization or Desk-top Integration
The question asked from the floor--Why XDS. The answer was that currently XDS is being supported internationally by many many (?100) global vendors. Currently there seems no other standard that seems to be competing with XDS.
Now for presentations from the speakers. |
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| Neelam Dugar
posted on Tuesday, November 03, 2009 - 06:43 am
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EPR: Clinical requirements of radiology department: Richard Harries (NHS)
Richard spoke about the Humber XDS Project surrouding the need to support MDTMs with neend for documents like Clinic Letters discharge summaries, operation notes, radiology and pathology reports and images. He introduced the concept of XDS meta-data. |
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| Neelam Dugar
posted on Tuesday, November 03, 2009 - 06:49 am
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Clinical Workflows and EPR—Neelam Dugar (NHS)
I introduced a pictoral vision of the workflows of different departments using EPR. My message to all is that an integrated Patient Centric EPR can be achieved by
1. Harnessing existing investment on Clinical IT systems
2. Move to XDS based open standards EPR
3. Context Synchronization |
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| Neelam Dugar
posted on Tuesday, November 03, 2009 - 07:04 am
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EPR and Interoperability Standards (for PACS and RIS)—Dave Harvey (IHE-UK)
Dave discussed concepts of Clinical IT from a technical perspective:
1. Differences between data architecture:
Structured/Unstructured, Centralised/Distributed, Published/Mined, and Document-based/Data-based
2. Type of standards:
Open vs Custom vs Proprietary
3. What does the standard define?
Content vs Messaging vs Content + Messaging
and comparisn between HL7, DICOM, CDA, XDS etc.
A pragmatic suggestion from Dave "Take a long-term view and avoid
vendor lock-in" |
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| Neelam Dugar
posted on Tuesday, November 03, 2009 - 07:12 am
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Open Standards EPR using XDS Registry—Harm-Jan Wessels (Forcare)
Harm-Jan explained that whilst XDS could be used for producing an EPR for a single Hospital, using the same standard one could with ease enable image and document sharing between enterprises. He showed us many on-going real world XDS projects. The importance of this standard is its scalabilty. |
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| Neelam Dugar
posted on Wednesday, November 04, 2009 - 08:12 am
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PACS and open standards EPR---Robin Breslin (Fujifilm)
Robin gave an excellent presentation about the evolution of PACS over the years, to meet users requirements. He emphasised the need for standards so that meeting users' needs, and allow suppliers to work together.
Robin stated that users are going to want a web-like experiance with EPR (which they are so familiar with). I think he is right. XDS has the possibilty of providing this. Context linking was a very familar phenmomenon on the web, as he described in his presentation. |
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| Neelam Dugar
posted on Wednesday, November 04, 2009 - 08:22 am
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| Ian Judd has been listening to us the users! HSS is the first major UK based supplier which develops Clinical IT products specifically to support NHS workflows, who have adopted XDS already within their product. They are ready to be part of an XDS based EPR with their product. Well done HSS and Ian! |
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| Neelam Dugar
posted on Wednesday, November 04, 2009 - 06:02 pm
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Ophthalmology images/Medical Photography and open standards EPR—Mark O’Herlihy (Visbion)
Mark was given the difficult task of discussing how we could integrate other images (for example ophthalmology, medical photography etc) into EPR. We have often discussed on this forum about whether display application for radiology images (Radiology PACS display) was adequate for display of other clinical images. It was clear from Mark's presentation that requirements for display of opthalmology images was very different to Radiology. So we need to keep that in mind, rather than force our opthalmology/other departmental colleagues to use our radiology PACS.
Use of DICOM coverters to DICOMise the images being sent from ophthalmology cameras, ECG machines etc.
Use XDS to make these images available as part of EPR alongwith other medical images and medical documents |
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| Neelam Dugar
posted on Wednesday, November 04, 2009 - 09:27 pm
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Clinical letters System and open standards EPR—Tom Rothwell ( Medisec)
Those of you who do not know Medisec (Document Management system for clinical letters), they are a SME which has been developing software for NHS for a very many years. Margaret and myself were looking for a supplier who had a product which produced medical documents, but did not have grand designs for producing a monolithic EPR, and thus we approached Medisec.
Tom admitted that he did not know much about XDS, but was keen to understand inter-operability standards which which would help include clinical letters produced in Medisec as a departmental system, become part of the bigger integrated EPR. After hearing the talks earlier, he was convinced about XDS.
I think we need to influence both users and suppliers. |
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| Neelam Dugar
posted on Wednesday, November 04, 2009 - 09:42 pm
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Integrated Health Record and Context Synchronization—User –John Skinner (NHS)
John high-lighted the issues that plagued secondary care NHS IT. Even a complex Cerner EPR could not meet the requirements of their renal departmental workflow. Hence, he acknowledged that there would always be a requirement of specialist departmental system even if a Trust did implement a monolithic EPR. Hence, it was important to ensure that these specialist departmental systems did not become isolated data silos, but contributed to an integrated health record.
Context Sharing and Single Sign on was key towards moving to a patient centric integrated health record which was inclusive of specialist departmental systems. Integrated Health Record and Context Synchronization—User –John Skinner (NHS)
Context sharing.pdf (933.1 k) |
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| Neelam Dugar
posted on Wednesday, November 04, 2009 - 09:53 pm
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Integrated Health Record and Context Synchronization –Supplier—Phillip Morris (Carefx)
Phillip gave a very graphical representation of the problems which exist with Clinical IT around the world.
He very eloquently said that we need to move from "rip and replace" and move the focus to DATA + CONTEXT = WORKFLOW.
We all are aware that improved workflow is directly proportional to increased productivity and efficieny and cost-effectiveness. By simply getting context sharing 32 steps within reporting process could be reduced to 9 by simple automation and context sharing.
CCOW is the HL7 standards for context sharing. |
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Many thanks, Neelam, for your comments on the individual presentations.
You may well have in mind to gather the comments together and post an overall report on the meeting, perhaps with general comments and conclusions. If you do so, I expect that would be very welcome to many people, and would form a useful, concise reference document for the future.
Thanks again.
John. |
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Thanks John. I will endeavour to put together a summary/report of the meeting with comments and conclusions.
Clinical IT Innovation – Building partnerships: User perspective—Margaret Cosens (NHS)
This was the most inspirational presentation of the day. Thank you Margaret. I loved the analogy about the geese "People who share a common direction and sense of community can get where they are going quicker and easier because they are travelling on the thrust of each other." Trusts and all our suppliers need to collaborate if we are to get it right.
Margaret is right, we NHS users need to build relationships with our suppliers and it needs to be based on trust. The aim should be long-term relationships. We need to learn by "listening" to what each other is saying. There is advice here for both supplier and user community.
Clinical IT Innovation – Building partnerships: User perspective—Margaret Cosens (NHS)
Building partnerships.pdf (395.9 k) |
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Clinical IT Innovation – Building partnerships; Supplier perspective—David Coverley
David presented how McKesson PAS and RIS had been developed through years of pioneering efforts through enhancement driven by NHS customer requests , NHS customer feed-back and user Group involvement and maintaining an enhancement register. To remind ourselves, this innovation was at times of meagre NHS Clinical IT budgets. Due to supplier and customer partnership product development was very rich functionally. However, due to the LSP threat and rumours of "free RIS for all" McKesson embarked on an exit strategy for PAS and RIS. |
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Clinical IT Innovation – Building partnerships; Supplier perspective—Brent Walsh (McKesson)
Brent brought relayed the same message as Margaret and David, but with a global touch to it. Aim of suppliers should be to try and retain their customers and listen to them.
Slide 8 was a realistic and important slide. The message to me was very clear that if you do not have direct discussions with you developers --i.e. a number of middle men ---the suggestion/request you make as a user, and the product you may get maybe poles apart, and the supplier would have spent a lot of development time and money developing the wrong thing. The lesson here is that good direct communication with our developers is key to good and useful innovation.
In my view, the last 7 years NHS IT has stagnated because we have driven our innovative developers away with our "rip and replace policy" and developed a huge management overhead rather than real IT developers in UK. However, we will only see a return of Clinical IT innovation and return of our developers if we have a framework which allows for multiple innovative departmental systems contributing to an EPR. XDS provides such a framework.
Clinical IT Innovation – Building partnerships; Supplier perspective—Brent Walsh (McKesson)
mck95_02 UKRC v4.pdf (5549.1 k) |
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I am sorry about the repitition but I need to post these these presentations in this thread too.
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
a. NBSS
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.
YOUR SPECIFICATION IS KEY in my view:
1. Specify for desktop integration/Context Synchronization with NBSS, RIS and Radiology PACS
2. Specify for XDS-I for future proofing. |
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Breast Screening and PACS- Clinical User Perspective—Nick Hollings (NHS)Breast Screening and PACS- Clinical User Perspective—Nick Hollings (NHS)
NH BIR 09.pdf (133.4 k) |
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| Breast Screening and PACS—Supplier Perspective—Kevin Wilson (Pukka-J) |
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Breast Screening and PACS—NHS Supply Chain ---David BurnsBreast Screening and PACS—NHS Supply Chain ---David Burns
PACS mammo.pdf (53.6 k) |
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Nicola gave an excellent presentation on digital teaching libraies. There is a real requirement for this nationally. However, it MUST be easy to use for radiologists if they are going to be used. They need to be accessible from PACS clinical application and on their workstation.
The discussions from the floor moved to other medical images. I agree that radiology is not isolated with teaching and training needs. We need to have a wider outlook on this and look at how other images---ECG, endoscopy images, ,medical photographs can become part of teaching files. Once again the needs of a image and document standard ---XDS came up for discussion.
Are there teaching files that can be made from XDS standards? I do not think I know the answer to this. However, we hope to discuss this more at the next Group meeting. We hope to have a supplier perspective as well.
Radiology Teaching files – User Perspective—Nicola Strickland (NHS)Radiology Teaching files – User Perspective—Nicola Strickland (NHS)
Digital libraries.pdf (378.7 k) |
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| Jon Benham
posted on Tuesday, November 10, 2009 - 11:01 am
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I have set up a digital library at my Trust using free RSNA MIRC software which fulfils most of the requirements in Nicola's presentation.
Most importantly, it is possible to send images as well as some clinical history and diagnosis directly from the PACS workstation.
DICOM images are transmitted so there is no loss of image quality, and the DICOM header is anonymised (customisable).
The system is also capable of storing and displaying a wide range of file formats so could be used for other medical images also, and it is possible to have multiple storage services so could have separate storage for ECGs etc.
The system has a powerful search engine which will search using either free text or more detailed form.
User roles can be set for each case for viewing, editing and exporting cases.
I will be giving a short presentation on MIRC at the British Society of Thoracic Imaging (BSTI) meeting on 27th November.
Further information is also available at mircwiki.rsna.org
Jon Benham
City Hospital Birmingham |
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| I do apologise for the delay in putting together a Summary of the discussions on 23rd Oct. I have finally done this. I think this document provides a background for discussions of the next meeting on the 19th March, which is on PACS Replacements. |
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PACS & Teleradiology Group Autumn Meeting 
PACS and open standards EPR---Robin Breslin (Fujifilm)