Improving Primary Care Access to Imaging Streamlining the Journey: How IT can help.
Day 2 - Tuesday 26th June 2012
14.30-15:30 D9
Service delivery Improving primary care access to imaging
UKRC
June 25th 2012
Keith Richardson, PACS Lead, NHS
North of England (NW)
keith.richardson@northwest.nhs.uk
Agenda
• Overview of approaches available , with
examples , to access diagnostic images in
primary care.
1. Traditional methods – copy and send, DICOM
Push
2. NHS Mail <20mb / NHS Secure File Transfer
System (sFTP) – push
3. Hub based e.g. Burnbank Image exchange
Portal , BBRad – push and pull
4. PACS Web Browser / Portal – direct access to
PACS
How IT can help – a range of approaches
1. Traditional methods
• Via printed films in packets
• Via CD, DVD or USB stick …
• Registered post , courier …often at
great expense and effort
• Use the patient or ambulance to
transfer images between
organisations and clinicians
• More easily mislaid and lost.
• Examples of high profile losses
• DICOM PUSH
How IT can help – a range of approaches
2. NHS Mail, sFTP
• Sending images as
attachments to NHS
Mail <20mb
http://www.connectingforhealth.nhs.uk/syst
emsandservices/nhsmail
For larger images
- NHS Secure File Transfer
System (sFTP) system
https://nww.sft.nhs.uk/
NHS Mail, sFTP- securely exchange
Patient Identifiable Data
• As NHS mail attachments
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•
•
24x7x365 service
up to 20mb (NHS Mail maximum)
secure email, calendar, directory, fax and SMS service
available for use, without charge to organisations, by
any and all NHS staff
• Via Secure File Transfer System
• data transfers between a minimum of 20MB (currently
NHS Mail maximum) up to 1GB.
• a web service designed to allow secure transfer of
data between NHS users.
3. Hub based – push and pull e.g.
Burnbank
Image Exchange Portal
Cypher IT
BBRad
http://www.image-exchange.co.uk/
http://cypherit.co.uk/products/bbrad/uses/
Over 266 Connected NHS Trusts
593 Nodes
6,134 Registered Users
Oxford Radcliffe use bbRad Cardiology
University Hospital of North
Staffordshire use bbRad
How IT can help – a range of approaches
4. PACS Web browser access
• Direct Web Access via the PACS Web Portal
• PACS Web browser over the NHS network (COIN or
N3)
• Authorised clinicians log on to their "local" acute
Trusts PACS, view PACS images reports directly
• Example:• PACS Web portal - Funded by NHS North West Informatics
• Developed maintained by Dr Rhidian Bramley, Clinical
Director of Radiology and Chief Clinical Information
Officer, The Christie Hospital in Manchester.
• Over 98.000 successful remote accesses in last 6 months
4. PACS Web Portal
• Remote web access via the image sharing portal
• Used to support clinical networks
https://pacsportal.northwest.nhs.uk/PWportalAbout.asp
Can set up a primary care staff including GP’s so they
can only access at patient level by entering either the
NHS number or patient first and surname.
They can't browse the whole PACS database.
Some examples of primary care access
1.
2.
3.
4.
5.
North Cumbria University Hospitals
Norfolk & Norwich University Hospital
NHS Cornwall
Pennine Acute Hospitals NHS Trust
Royal Liverpool & Broadgreen University
Hospital
6. Liverpool Out Of Hospital Service at Latham
Court
7. The Christie Hospital
• Have some primary care access via PACS web
browser – images and reports
• “Cottage Hospitals” Primary Care organisations and
GP led - Millom, Penrith, Keswick, Cockermouth,
Maryport, Workington & Health Centres
• Workington, Penrith, and Keswick have x-ray
facilities linked to RIS / PACS.
• PCT Community Dentist Team have access to web
PACS, majority of imaging done in Hospitals.
• Eden Valley Hospice have access to web PACS in
both the Hospice and in the health centres where
they provide Day Hospice Care.
• Have provided access to PACS via web browser
for non Trust staff since 2001.
• This is the only mechanism for community
Physios, MHT and community care staff to
view images.
• Have enabled the web links to outside users
including around 30 GP practices who's usage
is mixed, but often regular.
• Daily import of Path & x-ray reports.
• GPs look at PACS images if :
– They have a patient with them & it helps explain
the diagnosis
– Out of professional curiosity,
– If the result is significantly at variance with what
they were expecting or
– If they are waiting for an urgent result but it hasn't
appeared on their GP system yet but might be
attached to the PACS images.
– GPs hugely value being able to view PACS images
Nick Hollings
when required.
Examples
• GPs from Oldham, Bury and HMR PCTs have
access to Pennine PACS via the PACS web
browser method.
• Audit of GPs logins showed 39 GPs had used
PACS over 12 month period.
• 2 primary care organisations attached to RLBH
RIS/PACS to send in images and use PACS.
– The York Centre
– The South Liverpool Treatment Centre (formally
known as The Sir Alfred Jones Memorial Hospital
- Garston).
• Require access to RIS to event and report their work
& PACS to review their images.
• Also give PACS access to Liverpool Out Of Hospital
Service at Latham Court.
Liverpool Out Of Hospital Service at
Latham Court
• Intermediate care service
• Deal with patients in pre and post-acute
phase - admission prevention & discharge
facilitation
• “ … have found having access to PACS [web
browser] incredibly useful for many reasons.”
Senior Physiotherapist
Liverpool Out Of Hospital Service
Liverpool Out Of Hospital Service at Latham Court
Information gathering and transfer:
• “Unfortunately the handover to Latham
Court staff is not always timely or
comprehensive “ …. “Access to images allows
Latham Court staff to make more informed
clinical judgements regarding a patient’s
immediate management, until more
comprehensive information can be sourced
from the relevant department.”
Liverpool Out Of Hospital Service at Latham Court
Informing clinical assessment of patients
in the community:
• Therapists & nurses work to assess and manage
unwell patients in the community, in conjunction
with GP cover.
• Frequently, minimal information available regarding
recent investigations
• Ability to access results/reports greatly enhances the
detail of the clinical ‘picture’
• Patients may be unclear as to which investigations
have been carried out, so knowing what has been
done may reduce need for unnecessary further
imaging.
Liverpool Out Of Hospital Service at Latham Court
Informing rehabilitation potential:
• Imaging access is “particularly pertinent to
orthopaedic trauma cases. The
physiotherapists find that being able to
visualise any angulation/displacement etc
allows realistic goals to be set regarding
range of movement and function. “
Finally … useful for Teaching of junior
staff and students.
Christie GP Clinical Portal
• GP identity confirmed by practice manager and email
authentication on user registration
• Access limited to patients registered with the GP
practice.
• Developing single-sign-on web service with primary
care systems (EMIS)
• Landing page indicating recent activity on practice
patients
• Access to full trust patient record including radiology
reports
• Single-sign-on single click to view corresponding
images in PACS
Journey: How IT can help.
Summary
1. Traditional methods
2. For occasional transfer of images
– As email attachments
– CfH SFT system (secure file transfer)
3. Hub based e.g. Burnbank Image exchange
portal, BBRad
4. Direct web browser access . PACS Web
Portal
Improving Primary Care Access to Imaging Streamlining the Journey: How IT can help.
Questions?
More information
Dr Rhidian Bramley,
Clinical Director of Radiology, CCIO,
Christie Hospital,
rhidian.bramley@christie.nhs.uk
Keith Richardson, PACS Lead, NHS North of England (NW)
keith.richardson@northwest.nhs.uk
Additional slides included for
information
UKRC 2012, Manchester, 25-27 June
2012
Use of hubs to support Virtual
Clinical Workgroups - examples
• Cardiac & Stroke Networks in Lancashire &
Cumbria CT scans transfer via Burnbank IEP
including video conferencing
• The Greater Manchester and Cheshire
Cardiac Network transfer diagnostic
angiography images between Trusts ia via
Burnbank IEP for expert manipulation review by
Cardiologists at Manchester Heart Centre
• Walton Regional Neurology Network
Cardiac & Stroke Networks in Lancashire &
Cumbria CT scans transfer via Burnbank IEP
including video conferencing
IEP
Walton Regional Neurology Network
Teleradiology links for Transfer of PACS Images for urgent head injury cases – for expert
review by Neuro clinicians staff at Walton
Walton Centre for Neurology and Neurosurgery
Christie GP Clinical Portal
PACS web portal
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Funded by NHS North West
Developed by Dr Rhidian Bramley, The Christie Hospital
Provides primary and secondary care access to PACS
Online user registration and application form (N3 NHS)
Users authenticated by email and employer
Single-sign-on PACS access authorised by both employer and
trust providing access according to user role and clinical
requirement
• Patient search limited to individual patients by NHS number
and patient full name by default.
• Access limited to clinical images and reports
• Full audit trail of access > 20,000 successful user access per
month
GP Access to Diagnostics Improves Care
http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/12203780/gpaccess-to-diagnostics-improves-care
Imaging in Primary Care
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874516/
Primary Care Diagnostics
http://www.inhealthgroup.com/primary-care-diagnostics.php
Direct Access Diagnostic Tests
http://healthandcare.dh.gov.uk/direct-access-diagnostic-tests/
Diagnosing Cancer Earlier
http://www.dh.gov.uk/en/Healthcare/Cancer/Earlydiagnosis/index.htm
Random RCGP Report
http://www.rcgp.org.uk/news/press_releases_and_statements/cancer_diagnosis_report.
aspx
Improving GP Access to Diagnostics
http://info.cancerresearchuk.org/spotcancerearly/naedi/AboutNAEDI/ImprovingGPacces
stodiagnostics/