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PACS - Reaping the Benefits
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In this article we explain the opportunities offered by PACS solutions to the NHS and how your pre-implementation strategies can be crucial if you are to achieve the potential efficiencies and savings. We also look at what is next on the agenda for PACS in the NHS.
"...it has been estimated that the NHS wastes some £20m on inappropriate x-ray examinations." (Mason 2001)
PACS in the NHS
Once the remit of a medical doctor, requesting and reporting of images now lies outside this boundary with both nurses and allied health professionals taking a greater role in requesting and diagnosing from the resultant medical image. Ultimately, this image must carry the maximum diagnostic information to allow these professionals to carry out their roles and allow correct patient management pathways to be followed.
The current film method is argued to be time consuming, expensive and inefficient in comparison to Picture Archiving and Communication System (PACS) solutions used with Digital Radiology equipment.
The National Programme for IT promises to revolutionise the delivery of imaging procedures (Radiography) within health care using PACS.
ltimately, with the digital system this will enable the practitioner to ensure maximum diagnostic information is available on the image and to carry out the required post processing requirements, such as manipulating contrast and density and, if need be, apply an anatomical marker or measurements scale.
The resultant image can then be sent via PACS to the requester and stored in the archive for possible retrieval later. Subsequent manipulation of the image is possible should specifics need to be seen, such as the end of a catheter or naso-gastric tube.
The system will support the clinician in allowing image retrieval and viewing on any workstation. This is a major Improvement in patient care and streamlined administrative procedures, improving efficiency compared to the current plain film processes.
Considerable time is wasted by clinicians and other NHS staff tracing or waiting for patient images, time that could be more productive at a patient's bed side for example. The PACS system as part of the National Programme will allow the x-ray request to be sent electronically and the images to be received and viewed by the requesting clinician. This dramatically reduces the man hours spent on portering records and allows the clinical leads in the respective departments to manage their patient and images efficiently.
PACS Offers 25% Cost Saving
"Currently the processes involved in a Radiology request number approximately 59 whilst post PACS implementation and integration the number of steps required decreases to 9" (Huang 2004). This increases patient turnover in the Radiology department and reduces costs in areas such as service contracts, films and chemistry. "...at a volume of 90,000 studies per year there was an approximate savings of 25% in cost with PACS compared to film" (Huang 2004).
With such significant savings on offer, the correct pre-implementation strategies and consultation will prove essential to ensure they are achieved and the chances of any problems arising upon implementation reduced. This means supporting the departments and highlighting potential bottlenecks and pitfalls such as:
- Disaster recovery:
- Networks;
- Security; and
- Dicom performance.
PACS Pre-implementation Dependencies
The Connecting for Health business plan proposes that PACS will be available progressively to NHS organisations by 31 March 2007 via the Local Service Providers across England. Scotland, Wales and Northern Ireland are also progressing on their own PACS solutions. As a result, the pressure is on trusts to ensure pre-implementation dependencies are met including:
- Digital Imaging and Communications in Medicine "DICOM" - compliance with modalities;
- Technical evaluation of the local IT infrastructure including security, bandwidth and storage space;
- The production of local business cases and their approval by Strategic Health Authorities; and
- Soft organisational issues involved in PACS implementation such as on-going training, viewing procedures, process redesign and availability which contribute greatly to the final system and its ease of operation. hat's Next for PACS?
The benefits of a PACS system have far reaching effects beyond that of purely the Radiology department. The PACS revolution needs to consider all aspects of healthcare services where digital diagnostic images are required.
This will include non-Radiology diagnostic departments as well as areas like Accident & Emergency, Orthopaedics, Operating Theatres, Intensive and Coronary Care Units and individual wards and clinics. PACS as a storage and communications medium is easily capable of this; the challenge is to provide clinical information systems to manage the image needs across diverse clinical areas.
PACS solutions have the potential to offer a great many benefits including:
- 24/7 image retrieval;
- Easier access to images stored in archives;
- Faster image access for the users and reduced waiting times for image availability; and
- A reduction in the chances of procedures being cancelled due to non availability of images or the need for examinations to be repeated.
Furthermore, PACS affords the opportunity for genuinely new ways of working with multiple NHS and independent sector organisations collectively providing flexible diagnostic imaging services and rapid access to specialist centres.
"The Hong Kong Hospital Authority area supports 44 hospitals." (Huang 2004).
Diagnostic imaging is not the sole domain of the Acute Trust anymore, nor just the NHS. Increasingly, we are seeing diagnostic services provided across the whole array of NHS organisations and there is significant activity from the independent sector as well. To maximise PACS investment, collaborative models of service delivery need developing that embrace this mixed provider economy.
In all of these areas, technology is no longer a constraint to progress; it is a culture we have to address.
PACS Affordability Assessment
Oakleigh Consulting offers a supplier-independent PACS 'first cut affordability' assessment based on the experience gained from our on-going work in PACS deployment planning and business case development across the NHS and in Scotland.
The Assessment involves our consultants working with local Trusts to generate an initial view on the potential benefits and a 'shopping list' of PACS requirements.
Utilising our bespoke modelling tool we use this information, alongside available supplier pricing and financial contribution figures, to generate an early view on the likely affordability of PACS once capital charges, inflation and non-recoverable VAT are taken into account.
We can model solutions both within and between organisations as well as assist you on redesigning clinical processes to optimise the deployment of the technology.
If you have any questions about the subjects covered in this white paper or you would like to find out more about how Oakleigh Consulting could help your organisation, please contact us on 0161 835 4100 or email us.
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