PACS will democratize digital imaging

Interview with Dr. Tony Newman-Sanders, National Clinical Advisor to UK NHS CFH PACS Programme

In the UK, a national initiative designated NHS Connecting for Health (CFH) came into operation in 2005. The purpose was to support the UK National Health Service (NHS) in delivering better, safer care to patients, by using new computer systems and services to link general practitioners and community services to hospitals. PACS has been one of the successes of this program, with the system now introduced in trusts across the UK.

Sectra met with Dr. Tony Newman-Sanders, National Clinical Advisor to UK NHS CFH PACS Programme, to discuss how radiology IT can fundamentally change the way healthcare is delivered. Dr. Newman-Sanders believes that PACS has the possibility to create a boundary-less radiology; moving healthcare professionals from a report-centered mindset to a democratized, image-focused workflow.

Now that PACS is installed throughout the UK, what are the next steps and goals of Connecting for Health in terms of digital imaging?

With PACS installed, we now need to look at how we can enable a broad sharing of images and reports throughout the different departments of hospitals as well between the hospital and outlying healthcare settings. We need to take the next steps towards a networked healthcare between professionals across different organizations.

PACS has also given us a much more intuitive way to look at radiology images. Even large CT and MRI image datasets are now easily visualized by just scrolling through the stack from your workstation. This means that PACS has an enormous power to democratize the world of imaging. I believe that with PACS making image reading this intuitive, it should be made more widely available. There is no intrinsic reason why images should be available to radiologists only. In an ideal patient-centered world, front line clinicians, would have access to and be able to take confident informed decisions based on the images, not just reports.

You mentioned sharing images and reports between different hospitals. What are the advantages of a connected healthcare?

A regionally, and even nationally, connected healthcare is definitely one of the major goals of NHS Connecting for Health. We work towards a vision in which clinics and hospitals seamlessly can share images and reports—a boundary-less radiology. This would increase the level of patient care we can provide and improve efficiency. Each patient’s full history would always be available at your fingertips. Images would not necessarily have to be read at the same place they are produced, clinicians can discuss cases with other clinicians and so forth. Radiologists, clinicians and others sharing experiences and second opinions across the trusts would also feed an exponential learning curve improving the level of care in the long term.

Multidisciplinary meetings would also really benefit from being able to share images. Having access to images taken at different clinics would provide efficient and complete diagnosis.

What are the patient benefits from regionalizing healthcare?

In the London area, just as in many other places in particular, a connected healthcare is extremely important from a patient point of view. People don’t only go to one hospital, but visit clinics and hospitals throughout the region. And for multidisciplinary cases, people regularly visit more than one clinic during diagnosis and treatment. Sharing images and reports would definitely benefit patients in terms of shorter waiting times and a better level of care with each doctor having a complete case history.

The same is true on a national level. A doctor having access to a summary care record would be better off providing care for a patient coming in during vacation in a different part of the country for example.

Going back to making images available outside the radiology department, would you give some examples of how healthcare would benefit from that?

The pressure on healthcare and radiology departments is constantly increasing and will continue to do so due to increasing dependence on imaging and an increasingly aging population. In order to continue to deliver care in a reasonable time frame, one of two things need to happen. Either we need to vastly expand the number of radiologists so that reporting can be done as close to real time as possible. Alternatively we can plan to use the possibilities in IT to empower front line clinical personnel to read and act on images themselves as is widely done with chest X-rays, and orthopaedic radiographs today. In an increasingly constrained financial environment it seems to me, that the latter model is more cost effective.

There is clearly the huge challenge of maintaining the quality and safety which a dedicated radiology corps currently provides but there is no intrinsic reason why this could not be addressed over time through making training and accreditation in diagnostic imaging a central part of all clinician accreditation.

Making images widely available throughout the hospital gives clinicians the potential to make a more complete patient diagnosis. They could use radiology images such as a CT scan, as part of the input in their overall patient assessment rather than only looking at the radiologist’s report. Nothing beats looking at the images with the patient actually in front of you. Radiologists infrequently have that possibility, whereas clinicians nearly always do.

What is the patient benefit in this scenario?

Patients would no doubt receive a quicker and more clinically focused diagnosis. No matter how much information you put into the request, no report is perfect. Nothing beats sitting in front of the patient with the image as well as the information the clinician has from history, examination lab tests, etc.

Another aspect is patient safety. Reports are routinely updated and altered due to several different reasons. Today, there’s no good way to ensure than everyone is reading the latest version of the report. But, in an image-focused world you don’t have this problem. A radiologist might occasionally add an annotation to an image or such, but overall the image data set stays the same. Many are saying that connected healthcare can also help in solving the issue of a shortage of radiologists and expertise. What is your view on that?

There are certainly advantages with that as well. For example, there are types of cases that I read very seldom. For optimal reporting and efficiency, these could be passed on to experts who specialize in reading only those types of cases instead of me continuing to read those on rare occasions. Also, in certain areas, there might be a need for radiology departments to share workload, let radiologists work remotely and so forth. Moreover, a regionally connected PACS will allow radiologists to read images with a full image history at their fingertips. However, it could be argued that radiology-to-radiology networks enhance a report-centered, workflow and may divert from a fundamental shift in the way we think of digital imaging.

How would this change the radiologists’ role?

First of all I would stress that we as radiologists need a non-threatened attitude. There is no need at all for radiologists to worry about becoming redundant. Radiologists are needed to provide quality control, lead on standards, governance and training; to report on specialist and difficult cases, among many other things. Radiologists have a different training to clinicians that will enable them to see things even a trained clinician might miss. A review report, supplementing an initial clinically focused interpretation would be a huge contribution to patient safety, picking up significant additional, peripheral or incidental findings and suggesting further image based management. Much of this would occur in a multidisciplinary setting.

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