Two NHS trusts in the North West of England have taken the lead in breaking down barriers between diagnostic departments and frontline clinical staff, in a move that healthcare professionals say is changing how they can view and diagnose patients, and that is improving collaboration between hospitals across the region.
University Hospitals of Morecambe Bay NHS Foundation Trust has become the first amongst neighbouring trusts in Cumbria and Lancashire to move away from its local service provider contract under the former NHS National Programme for IT, and is now making crucial patient imaging and reports instantly available to staff both across its own hospitals and in virtually held regional multidisciplinary team meetings (MDTs).
The move is already having a significant impact on patient care, following the go-live of what staff have described as a “state of the art” picture archiving and communication system (PACS) and a vendor neutral archive (VNA) from Swedish healthcare company Sectra.
At the point of care, frontline clinicians no longer need to manually request x-rays, CT scans or MRIs and can instantly view a full range of crucial imaging and reports from anywhere in the hospital, directly through the trust’s Lorenzo Electronic Patient Record system. For the first time they can also choose to interrogate and manipulate imaging themselves by logging directly into the new enterprise wide PACS, which has historically been used only by staff in the radiology department.
In preoperative planning, surgeons can now virtually reconstruct a patient’s joint in 3D before going into theatre, and a much more detailed view of patient imaging is changing the way a full range of healthcare professionals can understand their specific patient’s condition.
“This has changed the way we look at patients and is better connecting radiology to clinical delivery,” said Dr Sameer Shamshuddin, consultant musculo-skeletal radiologist and PACS lead, at University Hospitals of Morecambe Bay NHS Foundation Trust.
“Examining a patient’s imaging is now like reading a book. Previously we could only look at reconstructions created by radiographers, we couldn’t change things ourselves whilst reporting. Now we can carry out very detailed interrogation of patient imaging, simultaneously viewing and manipulating multiple layers from skin to bone in very high end 3D.
“On a single monitor we can look at as many as 40 different images, and simply flip from one page to another, rather than moving between multiple monitors and systems. This makes life very easy when comparing historical imaging to understand whether a patient has improved, and is particularly powerful in complex cases.”
Dr Marwan Bukhari, consultant rheumatologist and clinical lead for rheumatology at the University Hospitals of Morecambe Bay NHS Foundation Trust, added that the new PACS is proving particularly important for teaching.
“We can now get results and x-rays at the bedside. We can better understand progress with the patient journey, and see if they are getting better. But this is also really helping us to quickly build a teaching portfolio. At the press of a button we can add anonymised images with linked text, for example ‘lung cancer’, to a teaching folder, providing a valuable resource to educate junior staff.”
Multi-disciplinary team meetings held virtually with several neighbouring trusts are now also being significantly enhanced, with authorised professionals in other hospitals able to log directly into the PACS at Morecambe Bay to view patient imaging and reports, simply by clicking a link, instead of spending lengthy amounts of time manually transferring images.
“This is a giant leap forward for workflow,” said Dr Shamshuddin. “Within the hospital, chat functionality is allowing me to seek instant peer review from my colleagues without spending time searching through corridors. And across the region, our MDTs are now better connected. Previously, when head and neck cancer MDTs were held in Preston, for example, we had to transfer the images over the image exchange portal for radiologists to load the image into their PACS, process it and prepare for the meeting. Now our colleagues in neighbouring trusts can securely log into our PACS by simply clicking a link. The meeting is video-conferenced and everyone is working from the same imaging, allowing us to share scarce expertise seamlessly.”
Far more than radiology images will be made available through the new technology, with as many as a dozen diagnostic departments at the Morecambe Bay trust set to make their imaging available trust-wide over the next two years, by storing it in the VNA.
Emma Jackson, PACS and radiology IT manager at University Hospitals of Morecambe Bay NHS Foundation Trust, said: “We are breaking down departmental silos without the need to get rid of established departments and disciplines. Across the hospital this is providing clinicians with much better access than they have ever had before. If they log into the PACS they already have as good a view as the radiologists do, and this will advance further as more and more ‘ologies’ use our new VNA to store patient imaging. This means the trust will have much better resilience and we are moving the confines of departments to an enterprise wide imaging system.”
Andy Wicks, chief information officer at University Hospitals of Morecambe Bay NHS Foundation Trust, added: “The Sectra deployment is an important component of our Electronic Patient Record strategy. When our clinicians view PACS images at the bed side, they can do that in context of the wider patient record which now includes electronic results, doctors and nurses notes, assessments, care plans and a wealth of valuable information on which to base crucial clinical decisions.”
Lancashire Teaching Hospitals NHS Foundation Trust, which has also now signed a contract, is expected to achieve similar enterprise wide and regional gains for Royal Preston Hospital and Chorley and South Ribble Hospital, when the trust goes live with the Sectra technology later in 2017.
Dr Chooi Oh, clinical director for radiology and consultant radiologist at Lancashire Teaching Hospitals NHS Foundation Trust, said: “This is a big jump, not a minor transition. We will be moving to a state of the art PACS driven workflow, with a system that will also allow us to audit our colleagues’ findings quickly and easily.
“Urgent findings about a patient’s condition can also be more easily flagged up to clinicians at the click of a button or voice command. This will facilitate and streamline the governance of such notifications more efficiently.
Jane Rendall, managing director UK & Ireland for Sectra, said: “Work in Morecambe Bay and Lancashire represents a real hunger in the NHS to integrate diagnostics with the rest of medicine and to make crucial imaging available in a timely manner to the people tasked with saving lives. Information can no longer be confined in radiology, pathology or any of the ‘ologies’. We need to make it accessible enterprise wide, and we need to ensure that vital intelligence from diagnostics can follow patients across organisational boundaries, so that healthcare professionals can make the best diagnoses and decisions for safer and better patient care.”
