PACS A difficult implementation Richard Miles MRCP FRCR Derriford Hospital Plymouth.

PACS

A difficult implementation

Richard Miles MRCP FRCR

Derriford Hospital Plymouth

Commercial and In Confidence

Introduction

Scope of the implementation Resources What went well What went badly Complications Recovery


Scope of implementation

Derriford Hospital


Scope of implementation


Pre LSP PACS Situation Limited PACS -Agfa

– CT, Ultrasound, Some Plain X-Ray

Inadequate Viewing Facilities

Obsolete Radiology Information System


Health Community connectivity

Data store& RIS


Examinations & staff

Derriford & community hospitals 300,000 examinations per year

Radiologists 25 SPR 47 Radiographers 80


Community Hospitals

X 6Modalities with direct connectionModalities

using plates

CR readerX 10

Plates

Reporting workstations

X 41Web PACS

(PC)Other

WorkstationsRadiology Academy

Workstations

RIS terminal(PC)

PACSPACSRISRIS

Remote data store

Local data store

N3 connection

2 x printers


Modalities

Include:16 CR plate readers3 CT scanners2 MRI scanners25 ultrasound scanners4 gamma cameras4 angio suites10 fluoro rooms

In all over 130 modalities and workstations-costs excessive for some modalities


Key milestones

Aca

dem

y G

o Li

ve

Hos

pita

l Go

Live

Nov 05Sept 05 Jan 06 Mar 06 May 06 Jul 06 Sept 06 Nov 06Jul 05

CR

IS U

pdat

e

Tru

st B

oard

app

rova

l

RIS

mig

ratio

n

&

Opt

imis

atio

n vi

sit

Pro

ject

Com

plet

ion


Training

Ris- 300 main users- ended up as 800

Web Pacs- 2000 e-learning/presentations

Pacs – 50+


Challenges

Large implementation Data migration Critical clinical implications Change management challenge Challenges related to the contract


Internal Audit

Management structure

Trust Board ISIG

Project Board

Project team meetings

PlymPfiT

Clinical User Group

PARB


Project work structure


Core resources

PACS Project board

Project TeamProject lead

Project technical leadClinical Lead

Admin support

Radiology IT 1 specialist IT radiographer

0.6 deputy1 admin support


What went well

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 WebPACS is well liked and trouble free


What also went well

Migration of data from old RAD/Agfa system

But at a cost

12 weeks of the project technical lead’s time Significant planning resource Forced big bang deployment of CRIS and PACS


What went badly

CRIS referrer list seriously deficient CRIS Rollout labour and time intensive Resource mapping was made more complex by our

system design


Training and technical support

Suppliers unprepared for a hospital of this size and complexity

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

Inadequate system support from supplier after implementation- little activity until we really shouted– No provision for support in contract– Fujitsu Help desk extremely time consuming and frustrating


CRIS a beta release?

Slow speed of system due to CRIS– Log in times averaged 10mins Audited 7th Sept

with community log in times of 45mins– Reporting Initially much slower than old Agfa

PACS system, reporting efficiency reduced by approximately 30%.


CRIS login times

0

10

20

30

40

50

60

Time in minutes

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37

User

CRIS Login and 1st Task

task 1

Log on


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

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 Workflows inadequately thought through

– Due in part to lack of integrated training– Should have done more work on this ‘in house’ before go live


More issues

Lack of sharing of problems and solutions with other hospitals

Problems with connecting peripheral sites to Derriford Image sharing with other hospitals


Complications

Real clinical risk Serious impact on reporting throughput Split studies in CT and ultrasound Workstations incorrectly setup not automatically

displaying doppler ultrasound images


Ultrasound and CT Audit

50 sonographer ultrasounds all 2nd reported by Radiologist reviewed– 35 had split studies– 4 had radiologist reports that were incomplete – 3 no clinical impact 1 possible clinical impact


CT Audit

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


Recovery

Weekly Clinical Governance meeting with CE and Medical Director

Galvanised assistance from suppliers– Resolution of numerous technical issues– Fujitsu operational analysis July 30th

Reallocated internal resources – Increased reporting capacity– Strengthen the Radiology IT team


GP Film reporting status

0

50

100

150

200

250

300

350

400

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

weeks since go live

unre

port

ed e

xam

s

12-Jul

18-Jul

03-Aug

10-Aug

17-Aug

24-Aug

07-Sep

as at 12sepas at 16Nov


LSP optimisation visit 18th-21st Sept

GE/Kodak/HSS representatives Workplace training throughout the directorate Kodak assessment of dose and process issues Resolution of many outstanding system integration

problems


Unresolved issues

Image sharing- unresourced– WebPACS sharing

• Truro/Torbay/Exeter/Barnstaple/Bristol

• Non NHS image sharing?

Any questions?

PACS A difficult implementation Richard Miles MRCP FRCR Derriford Hospital Plymouth.

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