PACS, RIS and related developments in the United Kingdom Dr Keith Foord Consultant Radiologist Conquest Hospital,East Sussex, UK (Secretary, UK Royal College.

PACS, RIS and related PACS, RIS and related developments in the developments in the

United KingdomUnited Kingdom

Dr Keith FoordConsultant Radiologist

Conquest Hospital,East Sussex, UK

(Secretary, UK Royal College of Radiologists PACS and Teleradiology

Group and Board Member, EuroPACS)

PACS 2003   Velkommen til hyggelige og lærerike konferansedager i Trondheim!                         Nasjonal PACS/RIS-konferanse 12. og 13. februar 2003 i Trondheim

United Kingdom Population*(millions)  Total 59.8 Total 59.8

England 50.0 England 50.0 Scotland 5.1Scotland 5.1 Wales 2.9Wales 2.9 N. Ireland 1.7N. Ireland 1.7

UK NHS national email

[email protected]

[email protected]

NHSnet – the largest privateIntranet in the world.

NHS Information Authority- very tight securityguidance

VPN (private) – SW London project

VPNs (DSL with encryption)

Dedicated WAN - Glasgow

BT Metro VPN – Wales ‘DAWN2’ (or over short distances BT LES

- LAN Emulation Circuit)

NHSIA unhappy with security issues withADSL except for point to point transmissionbetween networks or in Virtual Private Networks - VPNs

NHS I.T. Provider historyNHS I.T. Provider history1. Although NHS is a national health service, free to citizens at

the point of use, I.T. very fragmented as there was a political history of minimising central control in England from 1994 - 1998.

2. More centralised systems were maintained in Scotland, Wales and Northern Ireland.

3. Unique 10 digit NHS number only just available for all citizens.

4. Attempts to co-operatively co-ordinate from 1998 to 2002 failed. Allocated resources did not reach hospitals as the money was able to be diverted at an intermediate level to meet other political objectives in NHS service delivery.

5. 2003 - More vigorous, but commercial, control now being re-asserted to move as rapidly as possible – Objective is to be able to freely exchange clinical information around the UK.

Major Patient Administration or Hospital Infomation system providers in UK

Share of known installed market

2%

19%

8%

2%

10%

15%8%

2%

8%

6%

2%4%

2%2%

2%4%

4% 2%

In house

HBO/McKesson

EDS

Oracle

iSOFT

Torex

Inhealth

GE

System C

Northgate

HE

McDonnel

IDX

Siemens

Cerner

Elan

Meditech

Sema

Major RIS system providers in UKShare of known installed market

1%

23%

9%

7%

20%

13%

1%3%1%3%

4%

9%1%3%1%1%

MeditechTorexMisysRADIS*HBO/McKessonHSSDialogueNIRADS**WiseIn houseSystem CHEDétenteiSOFTIDXNorthgate

*RADIS installed in all Welsh hospitals**NIRADS installed in all N Ireland hospitals

PACS sites

PACS in development

Wide area PACS project

Wide area PACS projectinitiation

Major PACS system providers in UKShare of known installed market

14%

15%

8%

5%3%5%

17%

3%

22%

5% 3%

Agfa

Siemens

Storcomm

Ferrania

Philips

Merge

Kodak

Radworks

GE

Fuji

In house

Long distance teleradiology projects in Scotland to support remote areas

Wales – national

‘DAWN’ VPN

Sussex CancerNetwork webbased project

Hospitals withteleradiology facilityfor emergency use

Every UK hospital has at least a video link to its regional neurological centre for emergency neuro CT etc.

Major Teleradiology system providers in UK

Share of known installed market

21%

9%

19%

13%

4%

2%2%

4%

7%

7%

2%2%

2% 4% 2%

Torex

GE

Winrad

Kodak

Agfa

BT

Pukka-J

Storcomm

RADIN/Ferrania

Siemens

Toshiba

In house

Vidar

Merge

Mysterian

So how is So how is control being control being re-asserted?re-asserted?

Sussex Cancer Network

East Sussex Hospitals

Surrey andSurrey andSussex StrategicSussex StrategicHealth AuthorityHealth Authority

Strategic Health AuthorityStrategic Health Authority

Now responsible for IT in its Now responsible for IT in its area.area.

Appointing ‘Prime Consortium’ Appointing ‘Prime Consortium’ to take over existing contracts to take over existing contracts and provide new IT services, and provide new IT services, including VPNsincluding VPNs

Will be in place from late 2003Will be in place from late 2003

There will be more focussed IT provision in the strategic There will be more focussed IT provision in the strategic area and less choice for and less variation, between area and less choice for and less variation, between hospitals. hospitals. Each prime consortium may have only one or two Each prime consortium may have only one or two PACS/RIS provider companiesPACS/RIS provider companies

Applies to 23 Strategic areas of EnglandApplies to 23 Strategic areas of England

DOES not apply to:

Scotland

Northern Ireland

or Wales

Who have national Strategic coordinating bodies already as part of ‘devolved’ government

National Diagnostic Imaging Messages Project (DIMP)

There approx. 600 imaging departments in the UK, the majority of these departments have Radiology Information Systems (RIS) sometimes these systems are integrated as part of a Patient Administration System (PAS).

In the UK there are almost 9000 GP practices and virtually all have computerised information systems.

DIMP to ensure all hospitals and GPs will be routinely exchanging structured electronic messages for Radiology results by the end of 2003 (but not images)

The message will use a UK profile of the HL7 V2 messaging standard implemented in XML over eSMTP.

A discrete list of diagnostic imaging investigations coded in both Read Codes and SNOMED CT will be developed - uniquely identifying the examination to which the report pertains.

East Sussex Hospitals

What about local What about local developments in East Sussex developments in East Sussex Hospitals?Hospitals?

Population 450,000220,000 imaging investigations per year

19911991• Regional Radiology Committee

discusses PACS - Conquest Hospital to act as test bed

• SE Thames RHA Scientific Office leads - a Regional development project

• Contract signed with ‘Simis Medical Imaging’

Single CRsegment

Hub Hub

Hub

DSA DSI

CT

NM

Digitisers

PACS/RISUnix Devices

RadiologistsSun Sparc

PACS viewers

ISDN PC i/f

External Sun Sparc PACSviewers

VideoPC i/f

PC i/f

Mac i/f

Sun Sparc i/f

RAID ODs

2 x100MbsCR Sun Sparc

review

RISTerminals

19941994

19971997• Specify new triplicated CR DICOM

system

• Lease 3 x Philips AC3

• 3 x ‘Easyvision RAD’ workstations also networked to fluoro and angio units

• Continuing PACS re-specification work

Hospital 10/100Mbs ethernet

Hospital 10/100Mbs ethernet

RIS

SwitchedHub

SwitchedHub

IP ‘ping’

ASCII unidirectional

Bespoke protocol

VLAN Switch/Route

Controller

USITs x 3AC3 CR x 3

DICOM

IP ‘ping’

ASCII

CRCRconnectivitconnectivityy

Late Late 19971997

Conquest Hospital, U.K. Conquest Hospital, U.K. earlyearly 1999 1999 installation installation agreedagreed

Archive Manager

Lumisys 75with QA Station

StudyServerTM

With Fibre RAID

Bexhill Hospital

Key User station

Radiology Segment Workstations

Picker Polaris MRSiemens AR/T CT

PACS BrokerLinked to RIS / /CIS/HIS

Philips EV RAD

Philips PCR

Siemens ICONNec Med

Philips new DSI

Philips V3000

Ultrasound

PC Link3M 3M3M

PACSWeb Server

Hospital Intranet

Key User DICOMServers

Key Users

C Arms with IAMs

Picker W/S

Lumisys 150*

with QA Station

Dry LaserDICOM Printing

DLT nTByte Archive

RAID

DICOMPrint server

Philips DSI

100 plus Intranet / CIS users

RISServer

CIS/HISServer

20012001• ‘Management merger’ with Eastbourne. • Joint IT department formed. Joint PACS Project

Board• Documents re-done to reflect two main hospitals and

DVD archiving problems with Agfa Basix mini-PACS • Tender for new CR for Bexhill Hospital• E’B obtain charitable fund money - go to tender for

their elements of new full PACS plus 2 additional CR units

• Sunquest taken over by Misys

20022002• Philips Compano CR/ Kodak DICOM printing installed at Bexhill

Hospital• 36Mbs ‘line-of-sight’ microwave wireless linkage between Conquest

and Eastbourne • Hastings extends Philips CR lease at Conquest to includes 4th and new

5th CR - for CR mammography• Hastings installs Ferrania Web Server (allows Query/Retrieve from

local RAID and Eastbourne archives)• Eastbourne place contract with Agfa for DICOM/Web PACS plus 2

additional CRs. Web Server allows Query/Retrieve from Hastings RAID • Hastings tenders for DICOM printing network, selects Agfa• Hastings tendering for PACS which will allow DICOM query/retrieve

from Eastbourne archives and increase existing server and RAID/SAN archive capacity across the units.

Cross site PACSCross site PACS

• Separate systems but DICOM query/retrieve between?

• Same system, enhance link bandwidth and servers and RAID/SAN capacity?

• What to do about different PAS and RIS systems?

• Local big RAIDs, shared/local SAN storage?

Eastbourne Hospital installations agreed Eastbourne Hospital installations agreed 20022002

Radiologists Workstations

Siemens MRSiemens CT

PACS BrokerLinked to RIS

AGFA CR

Nec Med

DSI

SiemensAngio

Ultrasound

PAXport

Balanced PACSWeb Server

Trust Intranet

W/S

Lumisys 75with QA Station

Dry LaserDICOM Printing

MOD Archive

DICOMPrint server

1000 plus Intranet / CIS users

RISServer

Balanced PACSWeb ServerHastings

WorkflowmanagerDtabase

manager

PAXport PAXport

Archive workflow MOD Manager

RAIDS

SAN

Bexhill Hospital CR & Conquest Hospital, Digital Bexhill Hospital CR & Conquest Hospital, Digital

Image and Web installations Image and Web installations 20032003

Bexhill Hospital

Picker Polaris MRSiemens AR/T CT

Philips EV

Philips PCR

New DICOMNec Med

Philips new DSI

Philips V3000

Trust Intranet

Picker W/S

Dry LaserDICOM Printing

DICOMPrint server

Philips DSI

Web users

RISServer CIS

Server

DICOMPrint server

Dry LaserDICOM Printing

Radiology users

Philips Compano

CR

PASServer

NMviewer

Eastbourne

Ultrasound

DICOM link

ImageWeb Server

Web ServerRAID

Archive workflow

RAIDS

SAN

OBJECTIVEOBJECTIVE

20032003

Seamless, Seamless, cross site cross site PACSPACS

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