HMS - PACS installations in a networked environment
Combining multiple hospitals
Dr Nicola H Strickland BM BCh, MA Hons (Oxon) FRCP, FRCR, Consultant Radiologist and Honorary Senior Lecturer at Imperial College Healthcare NHS Trust, Department of Imaging, Hammersmith Hospital, London, trained in natural science and medicine at the University of Oxford, and in radiology at Hammersmith Hospital, London. Now a staff member at Imperial College Healthcare NHS Trust, she has been in charge of the clinical aspects of imaging information technology (including one of the world's first filmless PACS installations) for the last 16 years.
Last year, she became Registrar of the Royal College of Radiologists. She is also Chairman of MIR (Management in Radiology/Making Imaging Relevant) a subcommittee of the ESR, and past president of EuroPACS, the radiological section of the UK’s Royal Society of Medicine, and of the Anglo-French Medical Society. She has lectured and published widely on issues relating to imaging IT and PACS.
‘The key to implementing PACS installations networked to multiple hospitals is fully to establish in advance exactly what clinical scenario needs to be satisfied. There are several possibilities, and the requirement and challenges of each will be considered.
‘At one end of the spectrum the multiple hospitals need all to function as a single seamless "virtual hospital" unit. In this scenario the only truly satisfactory solution is to have identical IT in each hospital: i.e. the same PACS, the same radiological information system (RIS), the same remote electronic requesting system (ERS) or "order comms" as it is sometimes known, the same electronic feedback of results system - usually via the electronic patient record (EPR) or its equivalent. Only with exactly the same IT networked together is it possible for the imaging departments in the various hospitals to become truly location independent, with communal reporting work lists, communal multidisciplinary team meeting (MDTM) folders, and the most efficient and economic use of sub-specialist reporting radiologists.
‘At the other end of the spectrum the multiple hospitals function more-or-less independently in their daily workflows, but require the ability to easily interchange imaging studies and their associated reports, for expert referrals, patient transfers, or discussion at MDTMs. Under these circumstances, data sharing by XDSi (cross platform document sharing for imaging, as defined by IHE (Integrating the Healthcare Enterprise) solutions should be adopted, or else other extremely unsatisfactory solutions are employed by default - for example: data transfer by CDs or other removable media (often with a variety of encryption protocols), DICOM push of images only without their reports on a point-to-point basis etc. MDTMs require high performance networking links for audio, imaging and textural data with equipment which is robust and simple to operate.
‘Many of these issues are currently inadequately addressed resulting in radiologists and other clinicians in Europe and North America working in environments equivalent to "digital islands" isolated by their own IT which functions well in a stand-alone mode, but which integrates poorly, if at all, in a networked setting.’