The adoption of Picture Archiving and Communication Systems (PACS) by the NHS and other healthcare providers has transformed the diagnostic imaging field in the UK. On Target asked NHS Connecting for Health and two leading suppliers of PACS technology what the digital revolution means for clinicians, patients and the medtech industry.
A changing view
Dr Erika Denton, Medical Director for the national PACS programme and the Department of Health’s lead for diagnostic imaging, explains how digital technology is transforming these areas of the NHS.
NHS Connecting for Health (NHS CfH) is supporting the NHS in delivering the National Programme for IT (NPfIT), which aims to provide better, safer care to patients via new computer systems and services that link GPs and community services to hospitals.
A key aim of NPfIT is to give healthcare professionals access to patient information safely, securely and easily, whenever and wherever it is needed. By creating a multi-billion pound infrastructure, NPfIT will enable clinicians and other NHS staff to increase the efficiency and effectiveness of patient care.
Saving time and space
PACS allows medical images such as X-rays and scans to be stored and viewed electronically. Health professionals can compare new and previous images instantly, viewing them on screen. This is especially good news for patients with long-term conditions, because consultants can quickly and easily monitor changes in the patients’ condition by comparing new images with old.
PACS delivers more efficient imaging and diagnostics processes for patients, improving the quality and speed of their treatment. Images no longer need to be transported by hand, meaning fewer delays caused by hard-copy film images being lost or misplaced. PACS is thus helping to achieve a maximum 18-week wait from referral to the start of treatment.
National PACS progress
While some trusts already had PACS, and others were looking to acquire the system, there was no real momentum for implementing PACS nationally prior to NPfIT. Since the PACS programme began in 2004, it has worked closely with the strategic health authorities, individual trusts and IT service providers to ensure that trusts can experience the benefits of PACS as quickly as possible.
NPfIT has deployed the necessary resources to drive PACS forward nationally, secured contracts with local service providers at competitive, market-driven prices and supported clinical engagement by working closely with practising clinicians and the relevant professional bodies.
The final trust to receive PACS as part of NPfIT was Leeds Teaching Hospitals Trust on 10 December 2007, marking the completion of a three-year process that has seen 127 trusts across England receive PACS.
In the coming months the programme is planned to move forward on a number of fronts, such as improved sharing of images and reports across trusts and regions, links with independent sector treatment centres, and the extension of PACS into new clinical specialties.
Scanning the horizon
Aside from PACS, a number of policy drivers will influence the development of imaging services in the near future. These include:
• The Stroke Strategy – this requires all patients with a suspected stroke who may benefit from thrombolisis to have a CT head scan within an hour. For those with a possible transient ischaemic attack, imaging with diffusion-weighted MR is recommended within 24 hours. These changes will have a major effect on the imaging workforce, particularly out of hours. Suppliers will probably be looking to support training of imaging staff to acquire and report these images.
• The Cancer Reform Strategy – there is a commitment to move to digital mammography for screening. This has implications for equipment suppliers and PACS storage.
• Care closer to home – diagnostic imaging services located in primary care or in polyclinics will change the face of imaging. More basic equipment will probably be purchased in the community, with high-end equipment remaining in secondary and tertiary care.
• Hand-held ultrasound – the advent of smaller devices brings ultrasound into mainstream diagnostics in the hands of the non-radiologist/ radiographer workforce. It is likely that in the coming years, all doctors will have some ultrasound skills.
The big picture
Rob Musson, Business Director at Eizo, discusses the application of PACS to NHS and private healthcare systems.
The move from film to a digital environment is happening across the medical profession, and to varying degrees in many countries across the developed world. However, what some hospitals have missed – partly or in a few cases completely – reminds me of the age-old saying: “You can’t be a part-time virgin!”
Translated into PACS, once an image is originated digitally it will remain digital and need to be viewed electronically by anyone who needs access to it, whether for clinical diagnosis or a progress review.
Displays suitable for clinical diagnosis have to meet tough criteria and will need ongoing quality control to ensure they are set up correctly. Many hospitals plan their PACS around a networked system using diagnosticquality displays. What they miss, however, is that a fully networked hospital will allow users access to images from anywhere on the network. This means that any member of staff who has been authorised to access the images can do so anywhere, including from workstations that do not have diagnostic-quality displays.
The challenge, therefore, is to plan for the wider adoption of PACS with a strategy that puts the education of users alongside a strategic deployment of the correct grade of displays designed to meet the user’s needs at each location.
Eizo realised early on that hospitals would need different displays to meet the clinical and budgetary needs of these various groups of users, and developed a full range of displays for this purpose.
However, this was only part of the story. As the demand for PACS grows, so does the need to ensure that quality standards are maintained at all locations around the hospital campus. It would be easy to recruit and pay for a group of technicians to perform regular quality checks on a milk round, but that is costly and the records need to be maintained and accessed to provide reports when necessary. To help with this, Eizo developed a product that pulls all the records from each workstation into a central database that can be accessed by anyone with appropriate security and access to the network. The Eizo engineers built an interface to couple this to the client software that runs on every workstation using Eizo monitors.
With this software the hospital can manage its entire PACS real estate, checking how its assets are performing against its quality control criteria. Some Eizo monitors have new additional features that can predict the life expectancy of the backlights, based on current usage. This allows a hospital to schedule its service rather than wait to receive a call from an irate doctor who has just been informed by a technician that they can’t use their workstation. It means having a display that can predict when it will need a major service.
The move from film to a digital environment is happening across the medical profession. However, what some hospitals have missed – partly or in a few cases completely – reminds me of the age-old saying: “You can’t be a part-time virgin!”
Eizo has recently started to work with the PACS team at Spire Healthcare, who realised from the outset how a PACS network can grow as the users start to reap the benefits of going digital. Knowing this, the Spire Healthcare team took a step back from the routine and planned for the future, taking the time to develop and categorise the users across the hospital network.
They then came up with a specification for each type of user. This took into consideration all of the user’s aspects and their particular department and discipline. They categorised these to form several workstation specifications. They also realised the importance of user buy-in, involved a cross-section of their user community, and developed the training plans alongside the rollout plans.
With PACS, factors such as compatibility with current IT platforms’ support for open standards are just as important as clinical parameters when making a choice of diagnostic display vendor.
Working together with Carestream (who provided their PACS software) and the medical team at Eizo, they were able to build in a quality control package to provide the essential monitoring and recalibration remotely, obviating the need for additional technicians.
This holistic approach to a large PACS rollout saves money when compared to the piecemeal approach that can result from starting small and adding as budgets and user acceptance grow.
A new paradigm
Richard Wilks, Sales Manager for Specialist Displays at NEC Display Solutions, discusses the implications of PACS for diagnostic imaging companies.
The ‘Connecting for Health’ PACS programme has revolutionised the diagnostic imaging sector since its launch three years ago. Almost all hospitals in England now have instant digital access to images that are created on a range of modalities, from CT and MRI to plain film. Consultant radiologists can create their diagnosis more quickly and accurately, with the results being instantly accessible to consultants, surgeons and nurses.
Until the introduction of PACS, on-site processed and duplicated film would be kept in vast storage areas and could be easily lost or destroyed. Now reporting rooms, operating theatres, A&E departments, intensive care units and clinics have all been fully equipped with pre-calibrated LCD flat panel displays that give a level of viewing quality not previously available to the clinicians.
Selling PACS technology
NEC is one of the largest manufacturers of LCD technology used in the production of diagnostic displays. NEC has produced a broad range of image-viewing LCD products from 19-inch to 65-inch displays, allowing NHS Trusts to deploy a single manufacturer’s products in all departments that require access to PACS.
NEC has developed a strong portfolio of quality assurance and quality management software for all displays, which allows Trusts to meet clinical governance guidelines and significantly reduce their ongoing maintenance costs. Through sponsorship and exhibiting at radiology specialist groups, forums and Trust open days, NEC has enabled clinicians and IT staff to make informed decisions over their choice of PACS display vendor.
The PACS revolution has narrowed the gap between IT and radiology. In the past, traditional film-based diagnostic systems were chosen primarily by consultant radiologists and imaging directorates with little or no input from the IT department. With PACS, factors such as compatibility with current IT platforms’ support for open standards are just as important as clinical parameters when making a choice of diagnostic display vendor. NEC has simplified the purchasing process and reduced initial cost outlay for NHS Trusts by offering industry-standard technology that is marketed using simple IT terminology.
Improving patient experience
NEC is helping to shape how technology is used in the NHS. For example, in cancer centre networking, NEC’s large-format LCD and projector technology (deployed by NEC’s video-conferencing partners) allows consultants and patients to keep in touch with each other without needing to travel, which significantly reduces costs and frees up consultants’ time.
As hospitals compete for patients, NEC’s digital signage LCD displays improve the customer experience in hospital through real-time patient information and touch screen-based interactive way-finding. NEC has introduced a range of affordable display solutions specifically for PACS, allowing IT departments to deliver quality-assured digital images wherever they are required in the hospital.