PACS A difficult implementation Richard Miles MRCP FRCR

PACS A difficult implementation Richard Miles MRCP FRCR Derriford Hospital Plymouth Commercial and In Confidence

Introduction n Scope of the implementation n Resources n What went well n What went badly n Complications n Recovery Commercial and In Confidence

Scope of implementation Derriford Hospital Commercial and In Confidence

Scope of implementation Commercial and In Confidence

Pre LSP PACS Situation n Limited PACS -Agfa – CT, Ultrasound, Some Plain X-Ray n Inadequate Viewing Facilities n Obsolete Radiology Information System Commercial and In Confidence

Health Community connectivity Data store & RIS Commercial and In Confidence

Commercial and In Confidence

Examinations & staff Derriford & community hospitals 300, 000 examinations per year n Radiologists 25 n SPR 47 n Radiographers 80 n Commercial and In Confidence

Community Hospitals X 6 Modalities using plates Modalities with direct connection Plates N 3 connection CR reader X 10 RIS Remote data store Local data store PACS RIS terminal (PC) 2 x printers Reporting workstations X 41 Commercial and In Confidence Radiology Academy Workstations Other Workstations Web PACS (PC)

Modalities n Include: 16 CR plate readers 3 CT scanners 2 MRI scanners 25 ultrasound scanners 4 gamma cameras 4 angio suites 10 fluoro rooms In all over 130 modalities and workstations-costs excessive for some modalities Commercial and In Confidence

Jul 05 Sept 05 Commercial and In Confidence Nov 05 Jan 06 Mar 06 May 06 Jul 06 Sept 06 Project Completion Optimisation visit CRIS Update RIS migration & Hospital Go Live Academy Go Live Trust Board approval Key milestones Nov 06

Training n Ris- 300 main users- ended up as 800 n Web Pacs- 2000 e-learning/presentations n Pacs – 50+ Commercial and In Confidence

Challenges n Large implementation n Data migration n Critical clinical implications n Change management challenge n Challenges related to the contract Commercial and In Confidence

Management structure PARB Trust Board Project Board Internal Audit Project team meetings Commercial and In Confidence ISIG Clinical User Group Plym. Pfi. T

Project work structure Commercial and In Confidence

Core resources PACS Project board Project Team Project lead Project technical lead Clinical Lead Admin support Commercial and In Confidence Radiology IT 1 specialist IT radiographer 0. 6 deputy 1 admin support

What went well n n n n Project roll out to schedule despite tight time scale Project delivered within budget Phased roll out maintaining imaging capacity Dedicated implementation team Support from, networks, estates, and hospital IT Equipment scoping close to requirements Web. PACS is well liked and trouble free Commercial and In Confidence

What also went well n Migration of data from old RAD/Agfa system But at a cost 12 weeks of the project technical lead’s time n Significant planning resource n Forced big bang deployment of CRIS and PACS n Commercial and In Confidence

What went badly CRIS referrer list seriously deficient n CRIS Rollout labour and time intensive n Resource mapping was made more complex by our system design n Commercial and In Confidence

Training and technical support n Suppliers unprepared for a hospital of this size and complexity n Inadequate system training from supplier – No integrated training on the whole system prior to implementation led to many problems particularly related to workflows and generation of unspecified and split examinations – Training given was much too long before go live date n Inadequate system support from supplier after implementationlittle activity until we really shouted – No provision for support in contract – Fujitsu Help desk extremely time consuming and frustrating Commercial and In Confidence

CRIS a beta release? n Slow speed of system due to CRIS – Log in times averaged 10 mins Audited 7 th Sept with community log in times of 45 mins – Reporting Initially much slower than old Agfa PACS system, reporting efficiency reduced by approximately 30%. Commercial and In Confidence

CRIS login times Commercial and In Confidence

Internal difficulties Size of Radiology IT team much too small – Overwhelmed by technical problems and requests for training/support following implementation – CRIS roll out much more time consuming than expected n Lack of understanding of size and complexity of PACS project – Level of support from clinicians outside radiology variable during the difficult early days following roll out, expectations perhaps unrealistic – Needed more contribution from users inside and outside radiology n Workflows inadequately thought through – Due in part to lack of integrated training – Should have done more work on this ‘in house’ before go live Commercial and In Confidence

More issues Lack of sharing of problems and solutions with other hospitals n Problems with connecting peripheral sites to Derriford n Image sharing with other hospitals n Commercial and In Confidence

Complications Real clinical risk n Serious impact on reporting throughput n Split studies in CT and ultrasound n Workstations incorrectly setup not automatically displaying doppler ultrasound images n Commercial and In Confidence

Ultrasound and CT Audit n 50 sonographer ultrasounds all 2 nd reported by Radiologist reviewed – 35 had split studies – 4 had radiologist reports that were incomplete – 3 no clinical impact 1 possible clinical impact Commercial and In Confidence

CT Audit n 50 unspecified CT examinations reviewed – All 50 had split examinations – 49 reports were regarded as complete, with radiologists clearly having sought out the additional images – 1 study which had pelvic images in a separate file was deficient Commercial and In Confidence

Recovery n Weekly Clinical Governance meeting with CE and Medical Director n Galvanised assistance from suppliers – Resolution of numerous technical issues – Fujitsu operational analysis July 30 th n Reallocated internal resources – Increased reporting capacity – Strengthen the Radiology IT team Commercial and In Confidence

GP Film reporting status Commercial and In Confidence

LSP optimisation visit 18 th-21 st Sept GE/Kodak/HSS representatives n Workplace training throughout the directorate n Kodak assessment of dose and process issues n Resolution of many outstanding system integration problems n Commercial and In Confidence

Unresolved issues n Image sharing- unresourced – Web. PACS sharing • Truro/Torbay/Exeter/Barnstaple/Bristol • Non NHS image sharing? Commercial and In Confidence

Any questions? Commercial and In Confidence