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Multi-site Issues – an Overview

This overview explores the challenges and dilemmas posed by mergers in multi-site healthcare systems, specifically focusing on RIS/PACS systems and cancer networks. It also discusses the need for standardizing codes and the role of national agreements in streamlining workflows.

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Multi-site Issues – an Overview

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  1. Multi-site Issues – an Overview Mergers Cancer Networks National Issues Dr Keith Foord Consultant Radiologist East Sussex Hospitals NHS Trust

  2. The issues (mergers) • To date most of us have thought about single hospital RIS/PACS • Mergers bring dilemmas • Different philosophies • Changing perspectives • Long term planning change • Multiple IT systems • Commercial issues

  3. RIS2 PACS1 RIS1 Archive1 = PACS1=PACS X? RIS1+ RIS2 =RIS Y? Archive1+Archive2 = Shared archives MERGERS One Hospital has PACS

  4. PACS2 RIS2 PACS1 RIS1 Archive2 Archive1 = PACS1+ PACS2 =PACS X? RIS1+ RIS2 =RIS Y? Archive1+Archive2 = Shared archives ? MERGERS Both hospitals have PACS

  5. RAIDS Archive workflow MOD Manager SAN Eastbourne Hospital installations agreed 2002 Nec Med Siemens Angio DSI Ultrasound Siemens MR Siemens CT AGFA CR PAXport W/S PAXport PAXport Lumisys 75 with QA Station PACS Broker Linked to RIS RIS Server MOD Archive Dry Laser DICOM Printing DICOM Print server Workflow manager Hastings Dtabase manager Balanced PACS Web Server Balanced PACS Web Server Radiologists Workstations Trust Intranet 1000 plus Intranet / CIS users

  6. RIS Server RAIDS Archive workflow Web Server RAID Image Web Server SAN Bexhill Hospital CR & Conquest Hospital, Digital Image and Web installations 2002 New DICOM Nec Med Philips V3000 Philips new DSI Ultrasound Picker Polaris MR Siemens AR/T CT Philips DSI DICOM link Philips PCR Picker W/S Philips EV Philips Compano CR CIS Server NM viewer PAS Server DICOM Print server DICOM Print server Dry Laser DICOM Printing Bexhill Hospital Dry Laser DICOM Printing Radiology users Trust Intranet Eastbourne Web users

  7. The issues (clinical networks) • Cancer networks cover three or more Trusts • Need to move images • How? • Security and encryption issues • Point to point • WAN - ?role of StHA • Web based systems • Based on one PACS • Or de-novo setup

  8. Public networks (seems to include NHSnet) F i r e w a l l F i r e w a l l Archive Gateway Gateway Archive Secure DICOM (DICOM security Enhancement 1) Encryption /de-encryption Encryption /de-encryption F i r e w a l l F i r e w a l l PACS Web Client PACS Web Server PACS Web Server PACS Web Client Archive Archive CLINICAL NETWORKS Encrypted SMPT

  9. Maidstone sneakernet e DICOM host to webserver transfer HTTP transfer, SSL encrypted End user browsing Firewalls HH Hastings e e e Worthing e e Brighton Eastbourne Brighton & Sussex University Hospitals East Sussex Hospitals

  10. Better than nhsnet? PACS Web Server PACS Web Server Network Web Server PACS Web Server PACS Web Server PACS Web Server VPN (private) – SW London project VPN (DSL with encryption) Dedicated WAN - Glasgow BT Metro VPN – Wales ‘DAWN2’ (or over short distances BT LES - LAN Emulation Circuit) Network Web Server

  11. UK, SE and Yorks/Humberside ADSL coverage Oct 2002 Position of Conquest Hospital and radiologists homes compared with local ADSL coverage

  12. CLINICAL NETWORKS Videoconferencing and data exchange to support Improving Outcomes Guidance implementation

  13. Example -Upper GI IOG • Initial diagnosis and staging at Cancer Unit (Hastings / Eastbourne / Worthing / Haywards Heath) • Discuss with UGI surgeons at UGI Cancer Centre (Brighton) • Yes ? Sx :Transfer patient for assessment No Sx : Keep patient at Unit • Discuss with Centre assessment and treatment plan • Unit for chemotherapy / palliation

  14. Information gathered at initial presentation and diagnosis plus local staging History Clinical examination Endoscopy Histopathology CT/CXR/Ultrasound Abdo ECG/Spirometry Text General Condition of Patient Images Tumour Type TNM Text

  15. Information held in Unit : PAS (CIS) RIS Path IS Endoscopy IS Cardiology IS Chest Medicine IS PACS Information added at Centre More history Endoscopic US PET In: PAS (CIS) PACS RIS Endoscopy IS Chemotherapy Palliative stage

  16. Data/images being displayed - from demonstrating unit Our heads Their heads Digital microscope Group TV camera Control PC Interactive White Board Close up TV camera Dig. film/ document viewer ComPC ISDN

  17. The issues (national) • Many different RIS • Standardising short codes • IHE • SNOMED codes • Role for RCR group ? • If we need to move images around the country we really should be considering single descriptors

  18. The issues (national) • Many different RIS • Not much can do about this • New PSPs may start to rationalise • But ? Engulfment in whole EPR • Part of new PACS?

  19. The issues (national) • Standardising codes • National agreement on codes via RCR – unlikely? • SNOMED codes – how far away are they? Are they relevant to workflow control or just diagnostic codes • IHE – DICOM/HL7 transactions • 3 types of code • Order Code (ie what requesting clinicians recognise as a RIS code e.g. for Barium Enema • Requested procedure codes (ie for the resource requirement e.g. for a Barium Enema) • Which may contain one or more Protocol codes (defined to organise the radiographers work – in the case of a Barium Enema the fluoroscopic and CR/DDR elements

  20. The issues (national) • Role for RCR group ? • If we need to move images around the country we really should be considering precise descriptors • Go with IHE and let BIR lead in UK, but have RCR PACSgroup input ?

  21. The issues (national) • Another role for RCR group ? • National Radiology messaging project • NHSIA initiative, for implementation end 2003 • Specification and delivery of a list of agreed codes for use in electronic reports to GPs

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