Picture Perfect

Sustainable NHS transformation will depend on unlocking quality and efficiency gains through the cross-site reporting of diagnostic imaging, says David Howard, Change Healthcare.

It’s widely accepted that collaboration is fundamental to the sustainability and transformation of NHS services. This is particularly the case in radiology, where a paucity of radiologists and divergent geographical challenges means that cross-site collaboration and reporting has become essential. The drivers are well understood. As NHS organisations struggle to recruit radiologists and subspecialists are often remote from where imaging is taking place, trusts are increasingly using other professions to augment their radiology resources or outsourcing to the private sector at significant additional cost. The approach is not sustainable. The only way to unlock transformation is to enable cross-site reporting. The question is how.

The cross-site reporting of diagnostic images, through which organisations can share resources and maximise capacity, is contingent upon developing the right technological infrastructure to support collaboration. Certainly, as care pathways move patients through a variety of provider settings, maintaining the old approach of storing diagnostic images in silos at the institution level will not drive the service improvements the NHS desperately needs. However, despite common consensus on the need for change, progress has been slow, stifled by a common misconception that organisations need to rip out existing PACS and RIS and replace them with expensive new solutions. The reality is very different. Believe it or not, NHS trusts have tangible, realistic and affordable options that can move them towards more collaborative models of working.

Pathways to progress

There are various routes that trusts can consider to facilitate cross-enterprise collaboration, with choice ultimately dependent on an organisation’s digital maturity. One option is for everyone to be on the same system. A good example of this is NIMIS in Ireland, where the country’s much-acclaimed Radiology QI programme is underpinned by an enterprise imaging solution that gifts clinicians – anywhere – access to all the diagnostic studies carried out in a region. Cross-site reporting, and indeed collaborative resourcing, is an inherent capability in the solution.

A second option, suitable for disparate digital infrastructures where there are multiple PACS and RIS vendors in place across a region, is to join those systems together with a technology such as XTS and use a ‘vendor neutral’ archive to house the data. This approach, which has proved particularly successful in Canada, provides full access to images wherever you are and can therefore sustain cross-site reporting.

Finally, a third option – best-suited to more mature digital environments – is to embed some logic into the first two approaches with the addition of an intelligent workflow layer that uses information gleaned from imaging data to drive work to the most appropriate radiologists. This approach – a truly holistic enterprise imaging solution – enables cross-site reporting, task prioritisation/assignment and resource optimisation.

Alternative view

An alternative approach was proposed by the Royal College of Radiologists (RCR) in 2016, which argues that the NHS Network Teleradiology Platform (NTP) could lay the foundation for more collaborative working across clinical networks. The RCR recommendation advocates the introduction of a cloud-based teleradiology solution that mimics local PACS and provides reporting radiologists with another platform for reporting. Whilst the NTP would certainly enable greater sharing of expertise across specialities and could help facilitate efficient out-of-hours reporting using shared resources, the approach could prove challenging and costly to deploy. 

Fundamentally, the RCR model invites trusts to buy a second system – a National PACS that sits on top of their existing, local PACS/RIS. In the process, it introduces an additional platform that takes reporting radiologists outside of their familiar environment. The approach requires radiologists to use two systems, meaning two different user interfaces, multiple logins and separate IT environments. This, in turn, leads to additional training requirements, additional information governance and, naturally, additional cost. These factors will increase, rather than remove, barriers to use and will undoubtedly prove counter-productive in the quest for collaboration. Moreover, the approach is unlikely to facilitate MDTs or unlock the service transformation gains that effective cross-site reporting can deliver.

With regional NTPs able to connect with trusts’ existing IT systems, the RCR-backed approach means organisations would not need to replace their PACS/RIS solutions. However, the solution undermines institutions that have already developed enterprise imaging capabilities – resembling an unnecessary plaster to stick on top of existing solutions. Moreover, the approach is highly radiology-centred. True enterprise imaging strategies cover the gamut beyond radiology, enabling all the investment in technology and infrastructure to be leveraged by other departments across an enterprise, rather than just the radiologist.

The way forward

The best enterprise imaging solutions do not require trusts to ditch their existing systems – but they do allow institutions to maximise the technology investments they have already made. The most effective are ‘standards-based’ and able to connect any PACS/RIS available with the NHS. Standards-based connectivity provides a basis for cross-site collaboration and reporting that, with the right technology, can be enhanced with tools that support the intelligent management of workflow in radiology. The smartest tools include flexible workflow rules engines that integrate with heterogeneous system environments to consolidate interpretation and quality tasks. Moreover, they replace silos of information with enterprise visibility that enables organisations to collaborate, optimise resources and maximise IT investment. 

However, the enterprise approach is not just about productivity and efficiency gains – it’s a recognised means of driving quality. Holistic enterprise imaging systems not only promote peer review, their resource optimisation and prioritisation tools free up specialty radiologists to focus on their specialisms – improving quality and, in some cases, re-motivating disenchanted HCPs.

Picture perfect

There’s little doubt that cross-site reporting can play a significant role in driving service optimisation and transforming patient care. Evidence shows that where organisations have a greater visibility and consolidation of information – and the infrastructure to enable collaboration – meaningful gains in quality, efficiency and patient outcomes can be realised. Certainly, if STPs are to meet their goals in an under-resourced NHS, the health of providers’ radiology services will be a critical factor.

Collaboration will be key. To achieve it – and to improve workflow and align demand with capacity – an enterprise imaging strategy is essential. The most progressive organisations will be those that recognise the need and the opportunity – and engage a trusted transformation partner to deliver an imaging strategy that enables a shared vision. 

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