Laurence Sutton

Dr Laurence Sutton.

Consultant Radiologist

Calderdale and Huddersfield NHS Trust.

National Clinical PACS Lead NE Cluster

Image Data Management.

Laurence Sutton

Dr Laurence Sutton.

Consultant Radiologist

Calderdale and Huddersfield NHS Trust.

National Clinical PACS Lead NE Cluster

Secretary PACS Group

EuroPACS Board Member

UKRC Digital Imaging Committee

Laurence Sutton

NHS

CfH

PACS

PACS Calderdale Royal Hospital

Halifax,West YorkshireApril 2001

Laurence Sutton

The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities in England)

23 TRUSTS

9 CLUSTER CONNECTION ONLY

Intra and Inter cluster Data Sharing

Laurence Sutton

Image Data Management inthe Community PACS

Environment:

NHS

CfH

PACS

Laurence Sutton

Key IssuesN

HS

CfH

PACS

•Entity Data Management.Modality Data Management.Local Data Storage.Local Patient WorkflowsData transfer to another Entity

•RIS-PACS Integration.•Strategic RIS.•Cluster Data Store.

Data Integrity.Ease of Access/Updating.Data Retention Policies.Storage Volume Solutions.Image Data Sharing (Intra and Inter cluster).Disaster planning

Laurence Sutton

How do we ensure patient confidentiality and safety?

NHS

CfH

PACS

Laurence Sutton

Key Issues

NHS

CfH

PACS

•General Issues.

Data SecurityData IntegrityPatient ConfidentialityPatient Consent.Data Ownership

•General Information Governance Issues.

•Integration with the Spine,e.g. LRS.

Laurence Sutton

What do we do with Image Data?

NHS

CfH

PACS

•Workflow and Patient flow analysis should tell us this.

Laurence Sutton

What do we do with Image Data?

NHS

CfH

PACS

Managing the Patient Pathway in a Healthcare community within the CCS Architecture.

Laurence Sutton

NHS

CfH

PACS

REVISIT INTERVALREVISIT INTERVAL

0

5

10

15

20

25

30

35

6 12 18 24 30 36 42 48 54 60 66 72 78 84

BOOKED

IMMED

%

PATIENTS

MONTHS

Courtesy of Dr. Richard Fowler, Leeds General Infirmary

Laurence Sutton

Managing the Patient Pathway in a Healthcare community within the CCS

Architecture.

NHS

CfH

PACS

Dr. Laurence Sutton

Long Term Storage2nd Copy

Online Storage

# o

f R

etr

ievals

Time (Years)

Digital

Film

10%

1 Year

Storage Management

Laurence Sutton

The Image/Patient PathwayNHS

CfH

PACS

•5 Large Geographically (Regionally) defined clusters.•HCC Natural Pool of HCO in which the Majority of patient movements take place.•Specialities may not be co-terminus.•Experience indicates that the Majority of acquired Images once reported are never retrieved again.•A secondary care provider exports <1% of acquired images to a Tertiary Centre•A Tertiary Centre is a net importer of Images.

Laurence Sutton

Managing Images and patient data in the CCS

NHS

CfH

PACS

REQUEST FOR ASSESSMENT

September 2005.

CCS v HCC options.

Laurence Sutton

Managing Images and patient data in the CCS

NHS

CfH

PACS

REQUEST FOR ASSESSMENTSUMMARY RESPONSE

REFEATURES OF CCS

Laurence Sutton

Managing Images and patient data in the CCS

SUMMARY RESPONSE

NHS

CfH

PACS

• Requirement to support Patient Journey across boundaries.

• Challenges in sharing data across HCCs.• CCSs not modelled around patient journeys.• Fluid Nature of HCCs plus overlap of HCCs.• Speciality variation.Tertiary centre part of

several.• HCC model more complex

architecture(Image tracking)

Laurence Sutton

Managing Images and patient data in the CCS

NHS

CfH

PACS

• High Level Advantages.

Reduced local store requirements.Reduced multiplicity and sharing complexities.Secure storage and ease of data management and

accessCentral Reporting,Facilitates workflow across

entities.Supports wider referral pattern in clusterIntegration with future NCRS

Laurence Sutton

How long do we keep Images for?

NHS

CfH

PACS

•Review and Refine the current policies and recommendations

Laurence Sutton

Retention Policies for Image and Image related Data.

Acknowledgement toDr.Stephen Davies

RCR IT Subcommittee

NHS

CfH

PACS

Laurence Sutton

Retention Policies for Image and Image related Data

• Management of the Request,Image and Report.

• Range of Statutes and Advice.

• ‘For the Record’ [HSC 99/053, WHC 00/71]

• "Using Electronic Patient Records in Hospitals: Legal Requirements and Good Practice" [HSC 98/153].

NHS

CfH

PACS

Laurence Sutton

Retention Policies for Image and Image related Data

• Apply to the NHS

• Independent Sector and Private Practice

• All Practitioners using Imaging Services.

NHS

CfH

PACS

Laurence Sutton

Records Management: NHS Code of Practice (RMCoP)

• Report is the permanent record.– (Retention Schedules)

• Images are Transitory– (Local determination and Policy)

• Patient Data (RIS) now closely linked.• Complete electronic workflow from order to report

distribution. An Integrated Radiological Record.• Cost of Storage.(Space and Methods).• The Image Evidence.

NHS

CfH

PACS

Laurence Sutton

Retention and Storage of Images

and Radiological Patient Data.

NHS

CfH

PACS

Request for Assessment

February 2006

Impact on technical requirements

To support the level of Functionality required

To fulfil RCR Guidelines.

Based on RCR Draft Document.

Laurence Sutton

Retention and Storage of Images

and Radiological Patient Data.

NHS

CfH

PACS

RCR VIEW

IMAGE AND REPORT

SHOULD BE REGARDED AS THE SAME

AND COMPLY TO THE SAME GUIDANCE

REGULATIONS

Laurence Sutton

Request for AssessmentN

HS

CfH

PACS

•Images and Report the same and comply with guidance document.

•Robust Long Term Storage and Accessibility

•Image Data stored will reflect that which is normally sent

•Differential Retention Requirements/Study Tagging

•Compression of Data preferable to Deletion.

•Secure Environment with Backup

Laurence Sutton

Finally.How much can you compress Image data by without loss of

clinical value?

NHS

CfH

PACS

The Canadian Association of Radiologists has endorsed lossy compression for primary reads.

a 50:1 compression ratio is acceptable for large-matrix images, with 25:1 optimal. An acceptable ratio for small-matrix images is 20:1, with 10:1 optimal.