Rapid access, better care: Sharing imaging across the NHS in Bristol

A matter of life and death?

Having access to the right information, in the right place and at the right time can be a matter of life and death, especially in hospital environments. But when it comes to imaging, clinicians and other healthcare professions can struggle to gain the rapid access to vital information that is needed to support important decisions.

In some trusts it can take hours or even days for clinicians and other healthcare professionals to get hold of imaging that is held in another hospital. Audit processes, forms and manual requests placed between third parties and different teams in different trusts are often needed in order to transfer a requested image or report, making the process slow; even more so if requests are put in out of hours or during periods of high demand.

The impact on patient care can be unacceptable and not only in urgent care scenarios. Some patients may have to wait weeks or even months to see the specialist who can help them, only to be told in the consulting room that a decision about their treatment cannot be reached or that advice on their condition cannot be given because the specialist cannot get access to the imaging needed at that point in time.

Trusts across the country still face bureaucratic and burdensome process like this today, preventing clinicians from delivering the best care possible. This is despite improvements in secure sharing that have been achieved though the Image Exchange Portal (IEP). But things are now starting to change for the better.

Liberating information: A move ahead in Bristol through IEP Connect and Share University Hospitals Bristol NHS Foundation Trust has been active in a group of trusts in its region, which are sharing imaging, reports and referrals in a way that now allows clinicians and other healthcare professionals instant access wherever and whenever they need it.

The trust was part of a pilot for Connect and Share, an extension to the IEP, which is used by every NHS trust in the country. The result is that clinicians and other healthcare professionals in Bristol are now able to use IEP Connect and Share to directly view radiology images including x-rays and MRI scans published by participating trusts, without having to request them from the hospital where they were made.

Since the introduction of IEP Connect and Share, clinicians have been seeking access in order to reduce unnecessary repeat imaging, reduce delays in treatment, and to enhance scheduling so that planned treatment can be carried out more quickly, whilst improving the quality of decision making.

“The power of Connect and Share for the NHS is that it allows users to quickly identify what data and imaging exists and gain rapid access to it,” says Paolo Zanoni, picture archiving communication system (PACS) manager at University Hospitals Bristol NHS Foundation Trust. “We now have a rapid review process, which provides clinicians with the information they need to make an initial decision for the treatment of patient. If they then need to make use of a specialist tool to further interrogate an image, they no longer need to go through two or three parties, they can access the data and imaging on demand.

“My admin team no longer needs to spend time handling data for people who can instead gain access to it right away. That is what clinicians wanted and it is liberating information in a secured audited network.”

With thousands of clinicians, medical secretaries, clinic administrators, and multi-disciplinary team (MDT) coordinators set to use the system at University Hospitals Bristol alone, the Connect and Share registry is also now being fed by North Bristol NHS Trust, Royal United Hospital Bath NHS Trust and The Royal National Hospital for Rheumatic Diseases, meaning much greater secure access to imaging than ever before.

“Clinicians rely on quick access to imaging or a report as part of their assessment, an essential stepping stone to treating the patient; they often only need to know the imaging is there and refer to it,” says Zanoni, who is also the chair of the Society and College of Radiographers Informatics Group. “Physiotherapists, for example need to see the alignment of a skeleton in order to know what to do next. A quick look is enough.

“A speech therapist will review swallowing disorders with physicians in detail, using powerful workstations and complex software packages. With the patient, they don’t need the full report and image to discuss the diagnosis and treatment. But ready access to images can make a great difference to the experience. They may need to tell their patient something delicate, for example that the patient may never eat solid food again. That is a terrible message but one which may save their life. To help the patient comply with that it is helpful to be able to show an image that lends authority. Human beings rely strongly on vision and may need to see something is for their benefit.”

The system is also there to help participating hospitals make the most of scarce specialists. “This is about maximising the potential of our most treasured resource—our skilled staff,” says Zanoni.

One example is how stroke patients can potentially be better cared for when their specialists have the right data and imaging available. For instance, if a stroke patient comes into a hospital and gets scanned, the specialist might not be in that hospital—they might cover a string of hospitals. Through the Connect and Share registry, that clinician can access imaging from wherever they are located and make timely and reliable decisions for the patient.

“At the point the patient comes in, the clinician needs to know whether to intervene or not and which intervention is required,” says Zanoni. “A stroke physician needs to get access to the review image set to point them in the right direction. They can do the detailed analysis after they have made the first decision. But that first decision, which needs to be made quickly, is crucial for the patient. That is what we are striving to achieve through rapid access to imaging.”

When staff do need to work with the full image to carry out detailed analyses, the Connect and Share registry allows for that as well. A protocol allows information to be dragged to a local IEP node and then routed to whichever tool the user wants to work with the image on.

A national solution moving beyond imaging

The full potential of IEP Connect and Share has not yet been reached. Though the technology is addressing an imaging requirement in the first instance, it is not bound to that. Charts, graphs and diagrams, for example, are often placed into a PDF format by healthcare professionals, which can be secure and universally accessible. “We are looking at publishing some of our reports that require graphical support into PDF and actually sending the PDF into the XDS registry,” says Zanoni.

“I am also looking at a mechanism where we have shared MDTs with other trusts. The MDT report will be published as a separate update so that it can go into the combined record. It is tracked and readily accessible to anyone, irrespective of its origin. But whoever produces it takes responsibility for that data. As a result, that data is more secure, accurate, and there are no uncontrolled copies that might work against the patients’ interest.”

Once the PDF concept has been introduced, a vast amount of other content could be shared via Connect and Share. “We will look at wider segments of the patient record, rather than only making the radiology data accessible. It is better if the radiology data is available in the context of other parts of the patient record,” says Zanoni.

The next level for sharing over the IEP

As an extension to the IEP, which is already deployed across every acute hospital in the country, IEP Connect and Share is built on the XDS data-sharing standard that has the potential to be scaled to a national solution for the NHS into the future. It can integrate with any PACS or radiology information system (RIS).

IEP Connect and Share builds on the trust’s existing technology and deployment is very fast. The system can be populated with information from a new trust within three weeks.

“Trusts cannot afford to rip and replace, but this is a very small addition to their existing infrastructure to gain a great deal of value,” says Zanoni.

“This is the best route forward for a national network. It is here, it is now, it is live and it works. I would recommend any trust to join in and start benefitting from this technology.”