PACS implementation at the PACS implementation at the Countess of Chester Countess of Chester

Dr R Etherington, Clinical Director, RadiologyDr R Etherington, Clinical Director, Radiology

M Cosens, PACS Project ManagerM Cosens, PACS Project Manager

•2 sites

•110 Consultants

•130,000 Rad exams p.a.

Plan A 2004/5

• Kodak CR

• Kodak RIS (mandatory)

• ComMedica PACS

Plan B 2006/…

• Kodak CR

• HSS RIS (additional cost)

• GE PACS

• 100% deployment by end 2007

Countess Plan B

• Agreement for MEDITECH RISand GE PACS May 25, 2006

• Go Live July 24, 2006

Why MEDITECH’s ‘legacy’ system?

• Can deliver all 3 current CfH requirements for Radiology– PACS– Choose & Book– Electronic Reporting of Diagnostic Wait Times and Activity

• Front End Integration for whole hospital• Trust control of RIS information and management• Future UK Govt strategy re chosen applications

still unclear• No need to buy and implement another RIS

Business Case Benefits

Lower radiation doses through no repeat exams. Cleaner, safer working environment for Radiology staff. 100 sq m x-ray file room in CoCH general wing freed up.

(Worth £250k.) Saving on purchase and printing of conventional film Saving on future purchase and maintenance of film

processors, including environmental surcharges Saving on 7 whole time equivalent film filing clerk jobs X-rays available as soon as they are taken:

simultaneous access enables swifter diagnosis, decision on appropriate care, and formal reporting

no more lost or mislaid films - significant saving on clinicians’ time and fewer phone calls

Benefits Baselining

• Diagnostics impact almost all clinical care

• PACS – benefit needs extracting Streamline patient flow and work processes Opportunity to re-deploy space more effectively

• IT enabled change

• 3 + year programme

PACS baselining audits - examples

Audit of films pulled for MDT Meetings Jan - April 05 - Percentage of missing Films

0%

5%

10%

15%

20%

25%

30%

35%

Lung

Chest

Paedia

tric

Urolog

y GI

Gynae

Lym

phom

a

Vascu

larTot

al

Benchmarking:Radiology turn around times

Av. Ordered to Signed (days)

0

2

4

6

8

10

12

14

16

18

20

J un J ul Aug Sep Oct Nov Dec J an Feb Mar Apr May

Months

Ave

rage

in D

ays

2002/ 2003 2003/ 2004 2004/ 2005 2005/ 2006 2006/ 2007

Av Taken to Signed (days)

0

1

2

3

4

5

6

7

8

9

J un J ul Aug Sep Oct Nov Dec J an Feb

Months

Ave

rage

in D

ays

Av Taken to Signed by Patient Type (days)

0

2

4

6

8

10

12

14

J un J ul Aug Sep Oct Nov Dec J an Feb Mar Apr May

Months

Ave

rage

in D

ays

EM

GP

IP

OP

Admin staff costs

30000

32000

34000

36000

38000

40000

42000

44000

Apr-06 May-06 J un-06 J ul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06

Films and chemicals

5000

10000

15000

20000

25000

30000

Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06

Waiting times by Modality

0

5

10

15

20

25

Months

Num

ber

of w

eeks

MR

CT

US

BE

• Paperless reporting from worklist on PACS

• Speech recognition

or

• Stand alone digital dictation

Radiologist reporting

Taken to Signed average

0

1

2

3

4

5

6

7

8

Feb06 Mar06 Apr06 May06 Feb-07 Mar-07 Apr-07 May-07

Month

Ave

rag

e w

ait

in D

ays

Speech Recognition

Non - Speech Recognition

PACS Go Live

Draft to Signed average Feb-May 2007

0

0.5

1

1.5

2

2.5

Feb Mar Apr May

SR users

Non SR users

Percentage reported via Speech Recognition Feb-May 2007

46485052545658606264

Feb Mar Apr May

Countess queries

• Community links: electronic referral in / reporting out – demand for PACS?

The way ahead?

• Deliver integration to non-Radiology PACS

• Pioneer Government-stated wish for interface with private sector

• Deliver current government reporting and implementation requirements

• Respond flexibly to changing scene in the government approach to delivery of the National Program for IT in England

?

…Discussion