Guy’s and St Thomas’ NHS Foundation Trust

The first NHS PACS in the cloud – faster, safer reporting at Guy’s and St Thomas’

Guy’s and St Thomas’ NHS Foundation Trust became the first trust in England to use a picture archiving and communication system (PACS) in the cloud in 2017. The Sectra PACS is taking pressure away from the trust’s IT resource, with infrastructure managed entirely by the vendor. The secure system is helping professionals across the hospital. It is transforming how staff communicate on images, and has placed the trust in a strong position to manage new ways of working across the enterprise and regionally. With many benefits delivered, the success of the project offers a beacon for other trusts.

The single biggest thing from a radiologist’s point of view is that the system is now much faster. It delivers images quickly. The configurability of the system allows us to send imaging to the specific group of sub-specialists who report it. That is a complicated thing to do, but the system is sufficiently configurable that we can do that.

Dr Jim Carmichael, paediatric radiologist and clinical lead for PACS at Guy’s and St Thomas’

A PACS without the hardware headache

When Guy’s and St Thomas’s NHS Foundation Trust needed to replace an ageing PACS system, it made a decision that no other trust in the country had made before.

“We didn’t have the space in our datacentre,” says PACS manager Roy Burnett. “We investigated a cloud architecture and the consensus amongst our IT management was that cloud would be the best solution.”

The immediate advantage to the trust’s IT team was that they didn’t need to manage the infrastructure. “If more memory is needed, or new servers, Sectra will add them,” says Mr Burnett. “We don’t need to go through the process of evaluations and onsite studies. If there is a problem, Sectra comes up with the solution.”

Moving to the cloud has placed the trust in a strong position to remain up-to-date with the latest patches, virus software and Windows updates, which are all managed by Sectra. During the 2017 WannaCry attack that affected trusts across the country, Guy’s and St Thomas’ was able to keep its PACS system up and running, as the latest patches were up to date.

“A whole layer of additional management and complication removed, that doesn’t need to involve our busy IT team, which doesn’t specialise in PACS,” says Mr Burnett.

Integrating other ‘ologies’ into the PACS

The PACS is already being used for far more than radiology images. Thousands of users across the trust are using the PACS to deal with dental, cardiology, research and other imaging.

Used in conjunction with a Sectra vendor neutral archive, also in the cloud, the system is able to have a hospital wide impact.

“The hospital now has a single imaging archive,” says Mr Burnett. “Integrating other specialities into that workflow is a complex piece of work. But in a cloud solution, hardware and software requirements are managed by Sectra.”

As other disciplines digitise – such as pathology – being able to bring additional department’s imaging into the PACS is expected to be an easier, if still challenging task.

Dr Jim Carmichael, paediatric radiologist and clinical lead for PACS, explains that the benefits of PACS are already clear to those working in radiology, something he expects will “percolate through the organisation”.

“Integrating other ‘ologies’ doesn’t need us to place pressure on the IT team,” he says. “It is still complicated, but we don’t have to worry about needing extra terabytes of storage.

“Expanding the use of PACS is a difficult piece of work that requires a lot of clinical and user governance input. But we are working well with Sectra and we find them responsive.”

... there is literally one or two clicks to get to the reporting interface, whereas previously we were looking at 30 seconds to a minute of clicking per exam.

Dr Jim Carmichael, paediatric radiologist and clinical lead for PACS at Guy’s and St Thomas’

Improving reporters’ performance

The responsiveness of the system is having a big impact on the efficiency and efficacy of reporting. “People are able to report much more quickly, and much more reliably than before,” says Dr Carmichael.

“The single biggest thing from a radiologist’s point of view is that the system is now much faster. It delivers images quickly. The configurability of the system allows us to send imaging to the specific group of sub-specialists who report it. That is a complicated thing to do, but the system is sufficiently configurable that we can do that.”

The entire reporting process has been significantly streamlined through the new PACS. Staff no longer need to open a separate radiology information system, or RIS, which was previously relied on for reporting, and presented staff with a “very un-streamlined interface”, that made work around admin, database management and appointments complex, says Dr Carmichael.

“My users now launch PACS immediately in the patient context, with a filtered speciality worklist,” he says. “They can report directly into the PACS system with voice recognition – there is literally one or two clicks to get to the reporting interface, whereas previously we were looking at 30 seconds to a minute of clicking per exam.”

“The new PACS is highly integrated, saves a great deal of time and prevents a lot of distractions,” he adds. “We can view imaging from 2005 onwards within a few seconds, something we have never had before. That is fabulous for our users. The expectation for older imaging in other trusts is that it takes several minutes to recall and bring things back from the archive. We have a very fast and responsive system.”

For professionals with a busy worklist for the day “your performance is significantly increased”, says Dr Carmichael.

“The delay to get into the report seems trivial – say ten seconds. But if you multiply that by 50 exams in an hour – ten seconds added to each exam easily adds up to a 10% impact on your performance.”

Right reporter at the right time and second opinions

The system has also helped departmental efficiency. “We filter 95% of our radiology data to get it to the right reporter at the right time. That has been extremely useful,” says Dr Carmichael.

Individually tailored worklists for staff means that clinical sub-specialties can focus on the most pertinent work that needs their attention.

Input from different colleagues can also be much more easily gained. “Within the trust, sending scans for second opinions and to other staff has now been solved,” says Dr Carmichael. “This was an enormous difficulty for a long while, but the PACS software has dealt with that. It is now easy to pass scans between worklists, and to contact another radiologist for a second opinion.”

Patient safety – new guarantees

This is about more than efficiency. Dr Carmichael explains there are “big benefits for patient safety”.

“Configurability of Sectra software means as a PACS team we can guarantee to the organisation that a scan, say a CT chest, will not come off the reporting list until it is dealt with. That sounds like a basic thing, but it didn’t exist in previous generations of PACS. People worked off day lists which showed you CTs done that day. Ones not reported that day may or may not appear on a catch up or to-be-reported list.” 

Use by wider clinical staff

Outside of the ologies, clinical staff have different options to access imaging directly. This includes a thin client, that allows images to be accessed at speed by the clinician at the point of care. And authorised healthcare professionals across the hospital can also access the full PACS client to interrogate imaging in greater detail.

Dr Carmichael says: “Currently a lot of clinicians use the full PACS client. All the feedback we have had is that it is great. This is significantly faster than the previous PACS, imaging is much more adaptable, they can see it in different ways. They can do 3D reconstructions, and basic image manipulation.

“It is pushing a lot of capabilities out to clinicians that used to only be available on very high powered PACS computers in the radiology department.” 

We don’t use WhatsApp

Other capabilities of the PACS have allowed the radiology department to develop a much more robust approach to clinician enquiries. “Previously we had little ability to communicate,” says Dr Carmichael. “We would have a tonne of radiology enquiries coming in. Calls came in from secretaries, and it meant there was a registrar who was answering endless phone calls about whether something was reported. It was extremely inefficient.”

An instant messaging style chat function in the Sectra PACS has changed this, allowing any user to see the location of colleagues and to real-time chat with them. “These functions have helped us to really modernise,” he says. “If a clinician wants to speak to a radiologist about Mr Smith’s brain MRI, that used to require a secretary to wander around the department to find the radiologist, or to email them. Now they can directly contact that radiologist and chat to them.”

With a reliance on consumer instant messaging in the NHS highlighted in the media, Dr Carmichael insists his staff have a “very popular, and completely secure alternative”. “Our radiologists don’t use WhatsApp – it’s not necessary.”

We are getting closer and closer in how we work across organisational boundaries. Access to other trust’s imaging means that we can see patients and reduce the risk of re-imaging them unnecessarily.

Dr Jim Carmichael, paediatric radiologist and clinical lead for PACS at Guy’s and St Thomas’

Regional working – tech is no longer the inhibiting factor

Within the new PACS staff are already able to see images from outside of the trust, including those captured by nearby King’s College Hospital. “We are getting closer and closer in how we work across organisational boundaries,” says Dr Carmichael. “Access to other trust’s imaging means that we can see patients and reduce the risk of re-imaging them unnecessarily.”

He also believes this places the trust in a strong position for regional ways of working. “This is a big piece of work, but we have the infrastructure that allows us to make those connections. The challenge is NHS management and clinical governance. It is great to be in position where PACS IT is no longer the limiting factor.”

An NHS first, an NHS success

As the first PACS in the cloud for the NHS, the project has seen a remarkable range of benefits for the enterprise, and for various professionals. IT teams are not burdened with infrastructure demands, radiologists are reporting far more efficiently and effectively, clinicians are able to do more with imaging at the point of care, and the trust is better prepared for regional and cross-enterprise ways of working now required. The accomplishments at Guy’s and St Thomas’ NHS Foundation Trust offer the evidence for other trusts to replicate success.

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