The direction of travel in the NHS is integrated care, and the heart of that should be an EPR, working hand in hand with a single, digital record of patient images. We have already seen that is a powerful thing.
University Hospitals of Morecambe Bay NHS Foundation Trust has been pursuing its digital vision since the late 1990s. It was the first acute trust in the north, midlands and east of England to adopt the Lorenzo EPR, now supplied by DXC Technology, and it installed its first picture archiving and communication system in 2007.
However, as Chief Information Officer Andy Wicks explains, it was only when it moved to a “second generation” PACS from Sectra that it was “really able to change the working environment” for radiologists and clinicians.
“A few years ago, I was working with colleagues in outpatients to remove paper from the patient record, and the penny really dropped that an EPR without images would not be complete,” he says.
“It is like having an encyclopaedia without pictures.
“So, around three years ago, when we were drawing up a business case to replace our PACS system, we included a vendor neutral archive and an enterprise imaging system in our plans. Sectra won that tender, and we went live in 2016.”
The clinical benefits of a second generation PACS
The Sectra enterprise imaging system is fully integrated with Lorenzo. As Sue Standing, a Diagnostic Systems Specialist at the Trust explains: “The integration is bi-directional. It allows the user to make electronic requests direct from Lorenzo into the Sectra system, with an icon that allows access to the images alongside the report.”
Emma Jackson, the Trust’s lead for digital imaging, adds that this “really helps at the point of care, because all the information is at hand”. Clinicians can also choose how to annotate and manipulate images, so, for example, if they want to view an image in 3D, they can do this without a technician having to support them.
Dr Sameer Shamshuddin, a Consultant Radiologist and Trust PACS lead, says this is very useful for surgeons who needed to carry out reconstructions. “It gives us a lot of confidence,” he says. “It is very helpful in understanding how the patient can benefit from surgery.”
Dr David Fisher, a Consultant in the Maxillofacial or Max-Facs team, said his access to images also helped him to support patients. “They can see a 3D image of their injury, they can see a 3D image of their head. It is also very good for planning. You can see how an injury has occurred, what forces have occurred; how those bones have moved and how they have to be moved back.”
I am not a tele-radiologist. I am a radiologist in an extended, virtual department.
Working in an extended, virtual department
The Trust has also created a facility to support multi-disciplinary team meetings, which enables patient information and images to be shared with all the clinicians attending – even if they are attending from different sites.
Colin Brown, the Trust’s Chief Clinical Information Officer, notes that this is essential for an organisation like UHMBT, which runs three major hospitals while serving a population spread across 1,000 miles of beautiful but often remote countryside.
“The Trust is spread across this big area, so we can have a group of clinicians in one hospital and a group of clinicians in another hospital, and there might be an expert in another place,” he says. “We can all share clinical information in the record and add images to inform the discussion that we need to have about patients.”
The Trust’s investment in modern technology has also enabled it to offer home-working to its radiologists; a boost for recruitment in a remote area. Consultant Radiologist Alasdair Taylor says he now works one day a week from home, using the Sectra PACS to report on images, and keeping in touch with colleagues using a chat function.
“I can keep in touch with colleagues throughout the working day. I can contact them, share images, share interesting cases, and get a second opinion,” he says. “I am not a tele-radiologist. I am a radiologist in an extended, virtual department.”
A new strategy for enterprise digital imaging
Wicks argues that the benefits the Trust has seen from putting radiology images into its Sectra PACS, and making them available through the EPR, will be replicated if other types of images are put into the system; and it now has a strategy to extend the approach to other departments.
To support the strategy, it has created a steering group and a new role – the lead for digital imaging post that Jackson now holds, which sits within its i3 – or informatics, information and innovation – department.
“Our wards are also very keen,” Wicks adds. “We have handheld devices – iPods – on the wards and they have cameras, so nurses could use them to photograph wounds, or pressure sores, and put them into Sectra. Then, they could ask for a second opinion, or share them with other members of the care team. It’s a massive opportunity for us.”
The move will support UHMBT’s ambition to reach level six and then level seven as seen on the HIMSS EMRAM digital maturity model. But the potential opportunities extend beyond the walls of its hospitals.
Other organisations within its integrated care service could also benefit, as could community services and GPs. Jackson explains: “At the moment, we can give access to our PACS to clinicians working in neighbouring trusts, but they have to log into our system.
“We are working to integrate systems. The gold standard is that clinicians can be logged into their own system and view an image from another site in that system. Cross-Trust image-viewing and reporting is very much the vision.”
Time for new thinking across the NHS
Wicks argues that CIOs and their CCIO colleagues at other trusts should be thinking the same way. The key shift, he says, is to stop thinking about the PACS as a radiology department system, and to start thinking about it as an enterprise image management platform.
“With Sectra, we can mirror what we have done with the EPR, which is to create a single platform, with role-based access, with the potential to be integrated with the other systems in use cross the ICS,” he says.
“The direction of travel in the NHS is integrated care, and the heart of that should be an EPR, working hand in hand with a single, digital record of patient images. We have already seen that is a powerful thing.”