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PACS, RIS and related PACS, RIS and related developments in the developments in the
United KingdomUnited Kingdom
Dr Keith FoordConsultant Radiologist
Conquest Hospital,East Sussex, UK
(Secretary, UK Royal College of Radiologists PACS and Teleradiology
Group and Board Member, EuroPACS)
PACS 2003 Velkommen til hyggelige og lærerike konferansedager i Trondheim! Nasjonal PACS/RIS-konferanse 12. og 13. februar 2003 i Trondheim
United Kingdom Population*(millions) Total 59.8 Total 59.8
England 50.0 England 50.0 Scotland 5.1Scotland 5.1 Wales 2.9Wales 2.9 N. Ireland 1.7N. Ireland 1.7
UK NHS national email
NHSnet – the largest privateIntranet in the world.
NHS Information Authority- very tight securityguidance
VPN (private) – SW London project
VPNs (DSL with encryption)
Dedicated WAN - Glasgow
BT Metro VPN – Wales ‘DAWN2’ (or over short distances BT LES
- LAN Emulation Circuit)
NHSIA unhappy with security issues withADSL except for point to point transmissionbetween networks or in Virtual Private Networks - VPNs
NHS I.T. Provider historyNHS I.T. Provider history1. Although NHS is a national health service, free to citizens at
the point of use, I.T. very fragmented as there was a political history of minimising central control in England from 1994 - 1998.
2. More centralised systems were maintained in Scotland, Wales and Northern Ireland.
3. Unique 10 digit NHS number only just available for all citizens.
4. Attempts to co-operatively co-ordinate from 1998 to 2002 failed. Allocated resources did not reach hospitals as the money was able to be diverted at an intermediate level to meet other political objectives in NHS service delivery.
5. 2003 - More vigorous, but commercial, control now being re-asserted to move as rapidly as possible – Objective is to be able to freely exchange clinical information around the UK.
Major Patient Administration or Hospital Infomation system providers in UK
Share of known installed market
2%
19%
8%
2%
10%
15%8%
2%
8%
6%
2%4%
2%2%
2%4%
4% 2%
In house
HBO/McKesson
EDS
Oracle
iSOFT
Torex
Inhealth
GE
System C
Northgate
HE
McDonnel
IDX
Siemens
Cerner
Elan
Meditech
Sema
Major RIS system providers in UKShare of known installed market
1%
23%
9%
7%
20%
13%
1%3%1%3%
4%
9%1%3%1%1%
MeditechTorexMisysRADIS*HBO/McKessonHSSDialogueNIRADS**WiseIn houseSystem CHEDétenteiSOFTIDXNorthgate
*RADIS installed in all Welsh hospitals**NIRADS installed in all N Ireland hospitals
Major PACS system providers in UKShare of known installed market
14%
15%
8%
5%3%5%
17%
3%
22%
5% 3%
Agfa
Siemens
Storcomm
Ferrania
Philips
Merge
Kodak
Radworks
GE
Fuji
In house
Long distance teleradiology projects in Scotland to support remote areas
Wales – national
‘DAWN’ VPN
Sussex CancerNetwork webbased project
Hospitals withteleradiology facilityfor emergency use
Every UK hospital has at least a video link to its regional neurological centre for emergency neuro CT etc.
Major Teleradiology system providers in UK
Share of known installed market
21%
9%
19%
13%
4%
2%2%
4%
7%
7%
2%2%
2% 4% 2%
Torex
GE
Winrad
Kodak
Agfa
BT
Pukka-J
Storcomm
RADIN/Ferrania
Siemens
Toshiba
In house
Vidar
Merge
Mysterian
Sussex Cancer Network
East Sussex Hospitals
Surrey andSurrey andSussex StrategicSussex StrategicHealth AuthorityHealth Authority
Strategic Health AuthorityStrategic Health Authority
Now responsible for IT in its Now responsible for IT in its area.area.
Appointing ‘Prime Consortium’ Appointing ‘Prime Consortium’ to take over existing contracts to take over existing contracts and provide new IT services, and provide new IT services, including VPNsincluding VPNs
Will be in place from late 2003Will be in place from late 2003
There will be more focussed IT provision in the strategic There will be more focussed IT provision in the strategic area and less choice for and less variation, between area and less choice for and less variation, between hospitals. hospitals. Each prime consortium may have only one or two Each prime consortium may have only one or two PACS/RIS provider companiesPACS/RIS provider companies
Applies to 23 Strategic areas of EnglandApplies to 23 Strategic areas of England
DOES not apply to:
Scotland
Northern Ireland
or Wales
Who have national Strategic coordinating bodies already as part of ‘devolved’ government
National Diagnostic Imaging Messages Project (DIMP)
There approx. 600 imaging departments in the UK, the majority of these departments have Radiology Information Systems (RIS) sometimes these systems are integrated as part of a Patient Administration System (PAS).
In the UK there are almost 9000 GP practices and virtually all have computerised information systems.
DIMP to ensure all hospitals and GPs will be routinely exchanging structured electronic messages for Radiology results by the end of 2003 (but not images)
The message will use a UK profile of the HL7 V2 messaging standard implemented in XML over eSMTP.
A discrete list of diagnostic imaging investigations coded in both Read Codes and SNOMED CT will be developed - uniquely identifying the examination to which the report pertains.
East Sussex Hospitals
What about local What about local developments in East Sussex developments in East Sussex Hospitals?Hospitals?
Population 450,000220,000 imaging investigations per year
19911991• Regional Radiology Committee
discusses PACS - Conquest Hospital to act as test bed
• SE Thames RHA Scientific Office leads - a Regional development project
• Contract signed with ‘Simis Medical Imaging’
Single CRsegment
Hub Hub
Hub
DSA DSI
CT
NM
Digitisers
PACS/RISUnix Devices
RadiologistsSun Sparc
PACS viewers
ISDN PC i/f
External Sun Sparc PACSviewers
VideoPC i/f
PC i/f
Mac i/f
Sun Sparc i/f
RAID ODs
2 x100MbsCR Sun Sparc
review
RISTerminals
19941994
19971997• Specify new triplicated CR DICOM
system
• Lease 3 x Philips AC3
• 3 x ‘Easyvision RAD’ workstations also networked to fluoro and angio units
• Continuing PACS re-specification work
Hospital 10/100Mbs ethernet
Hospital 10/100Mbs ethernet
RIS
SwitchedHub
SwitchedHub
IP ‘ping’
ASCII unidirectional
Bespoke protocol
VLAN Switch/Route
Controller
USITs x 3AC3 CR x 3
DICOM
IP ‘ping’
ASCII
CRCRconnectivitconnectivityy
Late Late 19971997
Conquest Hospital, U.K. Conquest Hospital, U.K. earlyearly 1999 1999 installation installation agreedagreed
Archive Manager
Lumisys 75with QA Station
StudyServerTM
With Fibre RAID
Bexhill Hospital
Key User station
Radiology Segment Workstations
Picker Polaris MRSiemens AR/T CT
PACS BrokerLinked to RIS / /CIS/HIS
Philips EV RAD
Philips PCR
Siemens ICONNec Med
Philips new DSI
Philips V3000
Ultrasound
PC Link3M 3M3M
PACSWeb Server
Hospital Intranet
Key User DICOMServers
Key Users
C Arms with IAMs
Picker W/S
Lumisys 150*
with QA Station
Dry LaserDICOM Printing
DLT nTByte Archive
RAID
DICOMPrint server
Philips DSI
100 plus Intranet / CIS users
RISServer
CIS/HISServer
20012001• ‘Management merger’ with Eastbourne. • Joint IT department formed. Joint PACS Project
Board• Documents re-done to reflect two main hospitals and
DVD archiving problems with Agfa Basix mini-PACS • Tender for new CR for Bexhill Hospital• E’B obtain charitable fund money - go to tender for
their elements of new full PACS plus 2 additional CR units
• Sunquest taken over by Misys
20022002• Philips Compano CR/ Kodak DICOM printing installed at Bexhill
Hospital• 36Mbs ‘line-of-sight’ microwave wireless linkage between Conquest
and Eastbourne • Hastings extends Philips CR lease at Conquest to includes 4th and new
5th CR - for CR mammography• Hastings installs Ferrania Web Server (allows Query/Retrieve from
local RAID and Eastbourne archives)• Eastbourne place contract with Agfa for DICOM/Web PACS plus 2
additional CRs. Web Server allows Query/Retrieve from Hastings RAID • Hastings tenders for DICOM printing network, selects Agfa• Hastings tendering for PACS which will allow DICOM query/retrieve
from Eastbourne archives and increase existing server and RAID/SAN archive capacity across the units.
Cross site PACSCross site PACS
• Separate systems but DICOM query/retrieve between?
• Same system, enhance link bandwidth and servers and RAID/SAN capacity?
• What to do about different PAS and RIS systems?
• Local big RAIDs, shared/local SAN storage?
Eastbourne Hospital installations agreed Eastbourne Hospital installations agreed 20022002
Radiologists Workstations
Siemens MRSiemens CT
PACS BrokerLinked to RIS
AGFA CR
Nec Med
DSI
SiemensAngio
Ultrasound
PAXport
Balanced PACSWeb Server
Trust Intranet
W/S
Lumisys 75with QA Station
Dry LaserDICOM Printing
MOD Archive
DICOMPrint server
1000 plus Intranet / CIS users
RISServer
Balanced PACSWeb ServerHastings
WorkflowmanagerDtabase
manager
PAXport PAXport
Archive workflow MOD Manager
RAIDS
SAN
Bexhill Hospital CR & Conquest Hospital, Digital Bexhill Hospital CR & Conquest Hospital, Digital
Image and Web installations Image and Web installations 20032003
Bexhill Hospital
Picker Polaris MRSiemens AR/T CT
Philips EV
Philips PCR
New DICOMNec Med
Philips new DSI
Philips V3000
Trust Intranet
Picker W/S
Dry LaserDICOM Printing
DICOMPrint server
Philips DSI
Web users
RISServer CIS
Server
DICOMPrint server
Dry LaserDICOM Printing
Radiology users
Philips Compano
CR
PASServer
NMviewer
Eastbourne
Ultrasound
DICOM link
ImageWeb Server
Web ServerRAID
Archive workflow
RAIDS
SAN