Stockholm County Council

A shared image archive offers major advantages for healthcare providers and patients

Within Stockholm County Council (SLL), Sweden’s capital region, there are 2,000 healthcare providers—ranging from hospitals and district care centers to specialist clinics and private dentists. To date, there are ten hospitals providing radiology services, together generating 1.6 million radiology exams every year.

There are numerous benefits to gathering all radiology information in one service. Sharing patient information between care providers becomes less time-consuming—the data is accessible 24/7 and is only one simple search away. On top of this, you of course have considerable cost savings.

Niklas Anbratt, project manager at SLL

During 2016, SLL implemented a region-wide, cloud-based archive—Sectra VNA—where patient images and information from all radiology departments within the region will be stored. The Sectra VNA is integrated with the different healthcare providers’ existing RIS, PACS and journal systems. This will make it significantly easier and more efficient for the region’s healthcare providers to access patients’ complete radiology data—anywhere and at any time—regardless of where in Stockholm the patients were treated in the past.

A region where patients regularly visit different radiology services

In a region such as Stockholm, it is not uncommon for a patient to change or use multiple radiology services over time. Therefore, healthcare providers have been forced to spend a significant amount of time finding and requesting radiology images and information from their patients’ previous examinations. To access the information, images have been linked between different PACS, and answers have been sent via fax after they have been retrieved from the RIS. This has been especially problematic outside normal office hours.

“Before we implemented our shared VNA, a number of people within each healthcare provider worked full-time just finding radiology information,” says Gustav Alvfeldt at the department for e-health and strategical IT at SLL. “It became obvious that a more efficient way of meeting this need would save significant time for the staff and increase the quality of care for the patients—not least within cancer care, where the patient often has an extensive history and quick response times can be crucial.”

SLL concluded that a system enabling healthcare providers to quickly and easily access radiology information and images from other providers within the region would be a critical component for efficient care. A project to tackle this challenge was initiated in 2012, and SLL determined that, besides efficiency gains and increased quality of care, easier and more democratic access to information would also make it easier for new, private actors to establish a position in the market.

An IT project focused on clinical workflows

The project was driven in an open manner, both in terms of the staff involved and with respect to the vendors invited to discuss how the vision could best be realized. All ten radiology departments were invited to participate from the start.

“The foundation of the project is that the clinical operations have determined our direction from day one. We acted according to their wishes and requests throughout the project—and that’s how we will continue,” says Ann-Kristin Knutas, business solution manager at SLL. “It doesn’t matter how big the hospital is or whether it is private or council-controlled—the patient should always be offered the same quality of care. And everyone involved in the project has equal opportunity to make their voices heard,” Knutas continues.

The solution

The extensive pre-study and procurement processes resulted in the implementation of a region-wide service named BFT, to which all past radiology exams now are being migrated. The service is connected to the radiology departments’ own systems, allowing the radiologists to see which exams have been performed before and to access both images and reports, given the patient’s consent.

“There are numerous benefits to gathering all radiology information in one service,” says Niklas Anbratt, project manager at SLL. “Sharing patient information between care providers becomes less time-consuming—the data is accessible 24/7 and is only one simple search away. On top of this, you of course have considerable cost savings.”

Ann-Kristin Knutas concludes, “For us, the main advantages of this solution are that it’s future-proof, it takes patient integrity into consideration and it helps us increase the quality of care. We also see great opportunities to increase internal efficiency, due to the joint management and administration of the solution.”

System overview for the VNA at SLL

SLL procured a VNA—vendor-neutral archive—which Sectra now delivers as a cloud-based service. “One of the reasons for investing in BFT as a service was to give the VNA solution provider the opportunity to take overall responsibility for delivery,” Anbratt explains.

Implementing a long-term and future-proof solution was always part of the project team’s focus. There is a clear strategy to secure access to patient information over time—not just for ten years or so, but for the long run.

Anbratt continues, “Now we have the advantage of flexibility; since anyone can manage and take responsibility for the solution, we can change solution provider to whichever is best at the moment. We have a clear exit strategy in the contract—if we decide to replace Sectra as a supplier when the contract expires after 12 years, it will be a clean handover to the next supplier. No money involved, and all information can be transferred in a straightforward and secure manner.”


The needs and requests of the clinical operations will continue to determine the direction of the project going forward.

“To us, this is key for making everything function well over time,” says Knutas. “By raising different questions in the right forum, we create the prerequisites for more efficient administration.”

Expansion beyond radiology

In the future, SLL plans to evolve BFT to include other types of medical imaging, such as ultrasound, pathology and prenatal diagnosis. SLL also hopes to offer interactivity, where patients themselves can take pictures—for example, of liver spots—upload them to the service, and receive remote guidance.

“It’s exciting to see such a massive amount of interest in the solution. The service, which is anything but static, will definitely evolve over time. We’re already underway with functional imaging and cardiology,” concludes Anbratt.

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