PACS implementation at the
Countess of Chester
Dr R Etherington, Clinical Director, Radiology
M 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 RIS
and 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 film s pulled for MDT Meetings Jan - April 05 - Percentage
of m issing Film s
35%
30%
25%
20%
15%
10%
5%
To
ta
l
G
yn
ae
Ly
m
ph
om
a
Va
sc
ul
ar
G
I
Ch
es
t
Pa
ed
ia
tr i
c
Ur
ol
og
y
Lu
ng
0%
Benchmarking:
Radiology turn around times
Av. Ordered to Signed (days)
2002/2003
2003/2004
2004/2005
2005/2006
2006/2007
20
18
Average in Days
16
14
12
10
8
6
4
2
0
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Months
Jan
Feb
Mar
Apr
May
Av Taken to Signed (days)
9
8
Average in Days
7
6
5
4
3
2
1
0
Jun
Jul
Aug
Sep
Oct
Nov
Months
Dec
Jan
Feb
Av Taken to Signed by Patient Type (days)
14
Average in Days
12
10
EM
8
GP
6
IP
OP
4
2
0
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Months
Jan
Feb
Mar
Apr
May
Admin staff costs
44000
42000
40000
38000
36000
34000
32000
30000
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct -06
Nov-06
Dec-06
Films and chemicals
30000
25000
20000
15000
10000
5000
Apr-06 May-06 Jun-06
Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06
6
Months
7
Ma
y
Ma
r
Ja
n0
No
v
Se
pt
Ju
ly
Ma
y
Ma
r
Ja
n0
Number of weeks
Waiting times by Modality
25
20
15
MR
CT
10
US
BE
5
0
Radiologist reporting
• Paperless reporting
from worklist on PACS
• Speech recognition
or
• Stand alone digital
dictation
Taken to Signed average
Speech Recognition
Non - Speech Recognition
8
Average wait in Days
7
PACS Go Live
6
5
4
3
2
1
0
Feb06
Mar06
Apr06
May06
Feb-07
Month
Mar-07
Apr-07
May-07
Draft to Signed average Feb-May 2007
2.5
2
1.5
SR users
Non SR users
1
0.5
0
Feb
Mar
Apr
May
Percentage reported via Speech Recognition
Feb-May 2007
64
62
60
58
56
54
52
50
48
46
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