EHI Awards 2010: x-ray vision

The Image Exchange Portal won ‘innovation in healthcare interoperability’

The introduction of picture archiving and communications systems across the NHS has undoubtedly brought benefits; both in terms of patient care and increased efficiency.

Trusts have been able to reduce their reliance on the use of analogue imaging, such as photography and x-ray film, cut down on expensive chemicals and storage, and improve the speed of the service they offer to patients.

But PACS can be expensive to implement. And unless clinicians can share and exchange images readily – not just within a hospital but across a trust or even, potentially, between trusts -- some of those benefits are lost.

PACS: great so far as it goes

Since PACS was rolled out nationally, a persistent criticism has been that it is not as easy as it could be to share images.

Indeed, in some ways, sharing electronic imaging outside a PACS system has become harder than it was with x-rays and prints, since technicians have to burn images to CD or DVD - sometimes from different imaging systems - before they can be sent by courier or post to another hospital.

Internal NHS estimates suggest that the administrative cost of sending a CD or DVD of medical images is £12.50 – a cost that adds up to a significant annual sum in a busy hospital or clinic. Transferring a disk long distance by taxi can cost hundreds of pounds.

Nor are costs the only issue. There are inevitably delays with the use of physical media, and data loss risks, too.

Even when a disk arrives, the information has to be transferred to the clinician's workstation, either directly or via the hospital’s network, to be viewed. If several clinicians in different locations need to hold a case conference, each will need a CD.

Opening up the exchange of images

The NHS' Image Exchange Portal set out to remove the problems caused by physical media, replacing disks with a web-based system for loading and sharing images. It was developed by Burnbank Systems and teams from the Department of Health and NHS Connecting for Health.

By using the IEP alongside PACS, trusts can reduce the risk of data loss, speed up the transfer of images between departments or hospitals, and support better collaboration between clinical teams. With the right computer hardware, doctors and surgeons can also view medical images from home.

According to Andrew Meyer, PACS programme head at CfH, IEP is designed to have a "zero footprint" when connected to trust systems, with the data transferred across existing systems, in particular, the N3 network.

As a result, the set-up costs are "in the low thousands", including connections and software licences. "IEP pays for itself many times over," says Meyer. The system can also be implemented quickly, another factor that has been critical in gaining support from trusts.

Some 177 sites are now connected to IEP, with the system handling in the region of 1,400 records daily. Around a third of those are emergency image transfers, for example for patients about to undergo urgent surgery.

A full study, according to Meyer, takes 10-15 minutes to transfer using IEP, against hours by courier or possibly days by post.

Addressing workflows

The real benefit, however, has been in the way the IEP integrates with existing clinical workflows, according to Meyer and Philip Webster, the DH’s imaging technical lead.

A large amount of the team's effort, Meyer says, has been spent on understanding how clinicians in different specialisms work. This has included visits to clinics and hospitals as well as meeting with trust PACS leads and data owners.

In turn, this has helped with implementing IEP, and ensured that it is both used, and useful, to clinical staff. The technical differences, Webster suggests, are relatively minor, but workflows can and do vary significantly.

"As we develop the system further we are have meetings with specialisms such as cardiology. That means finding out the requirements around the data that needs to be exchanged around the cardiology network.

“We are also working with trauma, cancer and paediatric networks and entering into a dialogue with them too," he explains.

In some specialisms, the focus is on access to images for theatre, in others it is for pre-consultations in clinics, and for others, for conferences between specialists.

Some clinicians are also starting to use IEP to show images to patients, for example to offer reassurance before a hip replacement operation.

"It is down to local clinical practice and working in the best way," Webster explains, "but it means we need to be on the road quite a lot." Understanding the differing requirements of clinical teams, though, has helped to ensure the take up of IEP.

Further developments

The next phase of development will include support for further clinical workflows for new specialisms, as well as extending the interchange system to support other data types, as well as images.

The team is looking at adding clinical reports and technical data to the system, a development that is made easier by the fact that IEP supports the DICOM standard for electronic data interchange.

A further development will be to extend the use of the IEP into primary care, allowing doctors to review images before referring patients on to a hospital, as well as for following up treatment. The IEP team is already working on pilots for primary care diagnosis.

The hope is that, as it develops, IEP will fill some of the gaps in PACS, especially where doctors, surgeons and other clinicians need to collaborate for a patient's care, or where a patient has to receive treatment away from where their original scans or x-rays took place.

"The technology mustn't be an impediment to transferring data," says Webster. "If it's in a digital format the image exchange system can handle it.

“So there's the option not only to do more radiology, but retinal photography and other digital images. And we are open to adding further clinical information that might be pertinent."

The closing date for this year’s awards is 3 June. Enter now if you want to be in with a chance of seeing your work recognised at the EHI Awards 2011 in association with BT; and joining us for the glittering black-tie awards dinner in London in October.

The EHI Awards 2011 in association with BT seek out and reward outstanding work within the UK healthcare IT sector. Entries are open now on the dedicated awards website, and will close on 3 June at 4pm.

This year’s awards will be presented on Thursday, 6 October at the Grand Connaught Rooms in Covent Garden, London. For more information or to reserve a table, please visit the awards website.

To find out more about previous winners of the awards, visit our case studies showcase.

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