/ Vision for future development
Programme / NPfIT / DOCUMENT NUMBER
Sub-Prog/Project / PACS / National Prog / Org / Prog
/Proj / Doc
Type / Seq
Group Prog. Director
Nat Impl Director / CKM
KM / NPFIT / PACS / PMG
PACS Prog. Director / MJ
Author / KM/DJ/ED / Version No / 3.2
NPO/PSO Contact / Status / Final Draft
Picture Archiving and Communications System (PACS)
Vision for future development of PACS and RIS
National Clinical Reference Panel
Page 3 of 28/ Vision for future development
Programme / NPfIT / DOCUMENT NUMBER
Sub-Prog/Project / PACS / National Prog / Org / Prog
/Proj / Doc
Type / Seq
Group Prog. Director
Nat Impl Director / CKM
KM / NPFIT / PACS / PMG
PACS Prog. Director / MJ
Author / KM/DJ/ED / Version No / 3.2
NPO/PSO Contact / Status / Final Draft
Version / Date / Amendment History
V 1.2 / 26/09/05 / First draft for comment by PACS Team
V 1.3 / 14/10/05 / Draft revisions KM/ED
V 1.4 - 5 / 24 & 25/10/05 / Draft revisions by KM/DJ
V 1.6 - 8 / 15, 18 & 25/11/05 / Draft revisions and additions by KM
V 1.9 / 28/11/05 / Additions by DJ
V 2.0 / 30/12/05 / Major redraft by KM, taking account of stakeholder comments
V 2.1 / 09/01/06 / Further content added
V2.2 / 10/01/06 / Section 2.2 revised
V2.3 / 12/01/06 / Content added
V2.4 / 16/01/06 / Initial QA comments included. Content added. Issued as first draft for DH review
V2.5 / 20/01/06 / Revisions by KM on behalf ED
Technology assessment moved to Appendix B
V2.6 / 28/03/06 / Revisions by KM following feedback from stakeholders including Physiological Measurement Group
V3.0 / 29/03/06 / Revised following review with PACS technical team and further input from Diagnostics Branch
V3.1 / 31/03/06 / Minor revisions following review by ED and NCRP 30/3/06
V3.2 Final Draft / 25/04/06 / Final additions of CRP list and K&M diagram
Approvals
This document to be approved by:
Name / Signature / Title / Date of Issue / VersionErika Denton / National Clinical Lead for Imaging; Joint Chair PACS NCRP
Michael Thick / Joint Chair PACS NCRP
Kathy Mason / National Implementation Director
Max Jones / PACS Programme Director
This is a controlled document.
To be reviewed by:
The PACS National Clinical Reference Panel
PACS Connecting for Health Technical Team
Table of Contents
1. Introduction 4
1.1 Purpose of this Document 4
1.2 Background 4
1.3 Summary of Review Approach 4
2. Overview of Development Strategy for Diagnostic Imaging 6
2.1 Policy Drivers 6
2.1.1. System reform 6
2.1.2. Patient Led NHS 6
2.1.3. Patient choice 7
2.1.4. Workforce reform and service redesign 7
2.1.5. Organisational change, commissioning a patient-led NHS 8
2.1.6. Integrated Service Improvement Programme (ISIP) 8
2.1.7. Financial reform, Payment by Results 8
2.2 Vision for Diagnostic Imaging Services 8
2.2.1. Information Vision for Diagnostic Services 12
3. Meeting the vision 13
3.1 Vision enablers 13
3.1.1. Imaging workforce modernisation 14
3.1.2. Independent sector capacity 14
3.1.3. Technology solutions 14
3.1.3.1. PACS solutions 14
3.1.3.2. Clinical Information Systems 15
3.1.3.3. Medical Devices (Modalities) 16
3.1.4. Service Transformation 16
4. Conclusions 18
4.1 Proliferation of medical devices 19
4.2 Image volumes 20
4.3 Image traffic 22
4.4 Information Governance Issues 22
4.5 Standard National Coding and Reporting Requirements 22
4.6 Service transformation impacts 23
4.7 Integration with other NPfIT applications 23
4.8 Independent sector interdependencies 24
4.9 Non-NHS CfH PACS solutions 24
4.10 Non radiological imaging information systems 25
4.11 Broadening PACS Access 25
APPENDIX A: NATIONAL PACS CLINICAL REFERENCE PANEL MEMBERSHIP 26
APPENDIX B: Initial assessment of technology solutions by service
Page 3 of 28PACS Programme: NCRP Vision for future development
1. Introduction
1.1 Purpose of this Document
This document aims to set out the vision and next steps in the ongoing development of PACS to support the wider strategy for diagnostic imaging across the NHS.
1.2 Background
As part of the process that underpinned the decision to proceed with the procurement of PACS systems as part of the implementation of the National Programme for IT (NPfIT), a PACS Programme Strategy was developed in December 2003. This was later reflected in the Programme Initiation Document, finalised in January 2005[1]. The PACS Programme, in the light of emerging policy and strategy for the development of diagnostic imaging services in the NHS and the progress with implementation to date, has identified the need to review these original strategic plans for the procurement and ongoing development of PACS for the NHS.
1.3 Summary of Review Approach
To commence this review, a facilitated workshop was held with members of the PACS National Clinical Reference Panel (NCRP) on 31 August 2005. A list of members of the NCRP is included at Appendix A. This identified the key clinical and service issues that PACS needs to support in the future.
This document forms the second element of the review; taking the development strategy for diagnostic imaging and assessing any potential gaps in the current provision and plans for PACS (and where relevant other national enabling initiatives).
The third element, planned to occur following release of this document, is further analysis by technical and commercial members of the NHS Connecting for Health (NHS CfH) PACS central team to provide an action plan for which issues will be resolved through the NHS CfH contracts and to identify any issues which are beyond the scope of NHS CfH to resolve.
Following this, an assessment will be made by the PACS NCRP and the National Diagnostic Imaging Board to recommend any further work to enable delivery of the diagnostic imaging strategy for the NHS. The three other DH Diagnostics Steering Groups, Endoscopy; Pathology and Physiological Measurement, will also be consulted, along with the 18 weeks programme.
The timeline for this Strategy Review process is:
1) NCRP Strategy Review Launch Workshop – August 2005
2) Review and discussion with key stakeholders – Sept 05 – March 06
(Including the National Imaging Forum in April 2006)
3) Vision Document approved by NCRP – April 2006
4) NHS CfH PACS Development Roadmap – April – June 2006
2. Overview of Development Strategy for Diagnostic Imaging
Diagnostic imaging is an essential part of the care pathway for a large proportion of patient care.
It is provided in diverse locations and has to be ‘on-demand’, since further care is often very dependent on the findings of the diagnostics undertaken. The demand for diagnostic images, in terms of volume and image diversity, is increasing year on year and is expected to continue as such.
Many stakeholders rely on diagnostic images, often needing information remote from the image source and over different time periods.
Technology advances in image acquisition, storage and analysis have changed the way in which this service operates and is used over the last two decades. The technology advance is expected to continue over the next decade, thereby further improving efficiency, value and quality.
2.1 Policy Drivers
There are a number of policy drivers directly relevant to diagnostic imaging and others where diagnostic imaging plays an important role in their wider achievement. Relevant policy drivers are summarised here:
2.1.1. System reform
System reform represents a group of interconnected policies that aim to support the transformation of the NHS to a system that is truly patient-led. They will give patients more choice, more personalised care and real control to improve their own health. Most recently the Primary Care White Paper: Our Health, Our Care, Our Say.[2]
2.1.2. Patient Led NHS
In March 2005 the Department of Health’s ‘Creating a Patient-led NHS – Delivering the NHS Improvement Plan’[3], set out the next steps in delivery of the NHS Improvement Plan focusing on the system reform required to put patients at the centre of care delivery.
Service models will be developed to give patients more choice, control and improved access. Integrated patient pathways will follow the patient’s journey; ensuring services are designed and delivered around the patient. Diagnostic imaging is a key component in a very high proportion of such patient pathways and work is in hand to develop much more flexible and accessible services across the country. There is also an increasing move towards use of diagnostics in screening services and early diagnosis in priority pathways such as cancer and CHD, contributing to better health promotion, protection and improvement.
Diagnostics is identified as one of the five key targets set for the NHS to enable delivery of the overall system reform. The other four key target areas are:
· 18 week waiting targets[4]
· Health improvement
· Long term conditions
· Unscheduled care
Clearly, improved diagnostic services will also impact on the other target areas
2.1.3. Patient choice
Patient choice is at the core of the governments’ current policy, this is reflected in the current targets that are being implemented to give patients a choice. Of particular relevance to this review is the ‘choice of scan’ target.[5]
2.1.4. Workforce reform and service redesign
Effective implementation of Agenda for Change[6], the new consultants’ contract[7] and realising the benefits in terms of a workforce appropriately skilled and available to deliver the health service of the future is a key factor in achieving these changes.
The appropriate and effective use of extended roles is another aspect of workforce reform that has been identified as one of the Modernisation Agency’s Ten High Impact Changes[8].
2.1.5. Organisational change, commissioning a patient-led NHS
The planned organisational changes for Strategic Health Authorities, Primary Care Trusts and the inclusion of private healthcare providers in the ongoing provision of NHS services to patients must not constrain patient choice or access to services. It is also essential that future service transformation in the NHS is coordinated across providers to provide seamless and cost effective services.
2.1.6. Integrated Service Improvement Programme (ISIP)
The Integrated Service Improvement Programme (ISIP)[9] is a national initiative enabling health economy-wide service transformation with consistent, transparent and comparable measures across the whole of the NHS. For diagnostic imaging services spread over a large number of organisations, this planning regime will be essential to focus scare resources and make best use of capital investment.
2.1.7. Financial reform, Payment by Results
In future, all services, including diagnostic imaging will need to be able to be identified and accurately costed in line with standard national tariffs in order to support the new financial regime, where services will be invoiced to commissioners on the basis of activity.
This approach is being supported by the development of standard national coding for all diagnostic imaging interventions and activities to enable compilation of invoices based on activity.
2.2 Vision for Diagnostic Imaging Services
The delivery of diagnostic imaging services across the NHS is a wide ranging and complex challenge. The vision is described below, grouped within a number of change areas.
Access
· It is planned that, patients will not wait longer than six weeks for any imaging and in many cases this will be available on demand in order to deliver this target of maximum waiting times for treatment overall of 18 weeks, from GP referral to hospital treatment. This is a psa target to achievable by December 2008[10].
· To achieve this target will require redesign of the referral pathways and protocols, including increased and earlier use of diagnostics imaging. It is also likely to include direct access to imaging services from primary care.
Availability
· Different delivery models, where services are provided in different environments such as one stop diagnostic and treatment centres and walk in centres, tailored to local health community needs.
· Further development of specialist clinical networks, such as those currently in place for cancer, CHD and emergency care.
· More centralised diagnostic imaging reporting services, able to provide services to a wide health community 24 hours a day 7 days a week. Such models will maximise the benefits from capital equipment and enable greater flexibility of the imaging workforce.
· There will be plurality and contestability of the provision of imaging services, which will be delivered through a combination of NHS and independent sector provision.
Choice
· Patients will be offered a choice of time and place for their diagnostic imaging.
Scope of diagnostic services
· The following have been identified by the PACS National Clinical Reference Panel for inclusion within the vision scope:
o Diagnostic Imaging
§ Angiography inc cardiology
§ Breast screening
§ CT
§ Dental imaging
§ DEXA
§ Fluoroscopy
§ MRI
§ Nuclear medicine
§ PET
§ Plain film radiography
§ Radiotherapy
§ Symptomatic mammography
§ Thermography
§ Ultrasound
o Pathology
§ Cytology
§ Haematology
§ Histology
§ Microbiology
§ Pathology
§ Virology
o Endoscopy (including gastro and intestinal)
o Physiological measurement
§ Dermatology
§ ECG waveforms
§ Echo cardiography
§ Electrophysiological measurement
§ Endoscopy (other, eg. Laproscopy)
§ Medical photography
§ Ophthalmology
Clinical Standards
· All services commissioned by the NHS will be delivered to the same comprehensive framework of national standards that encompasses all providers, both public and independent sector.
· Professional training will be carried out in line with DH policy and recommendations made by the Royal Colleges and other appropriate bodies.
· Diagnostic imaging services will be delivered in line with best practice as advised by the Royal Colleges and other appropriate bodies. This will include policy on National retention of appropriate images.