Sustainable NHS transformation will depend on unlocking quality and efficiency gains through the cross-site reporting of diagnostic imaging.
It is 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 mean cross-site collaboration and reporting will be essential for the future of diagnostic imaging services at some facilities.
As NHS organisations struggle to recruit staff generally, radiologists and subspecialists are often not available or are remote from where images are acquired, leading trusts increasingly to use other healthcare professions to augment radiologist resources or outsource to the private sector, the latter at significant additional cost. This approach is not sustainable. One significant method to facilitate transformation is to enable cross-site reporting.
The cross-site reporting of diagnostic images, whereby organisations can share resources and maximise capacity, is contingent upon having the appropriate technology 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 local silos will not drive the much-needed service improvements. 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. The reality is very different: 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 gives clinicians access to all the diagnostic studies carried out in the country, independent of their location. Cross-site (and home) reporting, and indeed collaborative resourcing, is an inherent capability in the solution.
A second option, suitable for disparate PACS and RIS environments across a region, is to join those systems together with a technology such as XDS and use a ‘vendor neutral’ archive to house the data. This approach, which has proved particularly successful in Canada and to some extent in Europe, 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 apply some automated logic to the first two approaches, adding 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/escalation and resource optimisation.
The way forward
The best enterprise imaging solutions do not require trusts to replace their existing systems, but allow institutions to maximise the technology investments they have already made. The most effective are ‘standards-based’ and able to connect any PACS/RIS implemented across the NHS. This provides a basis for cross-site collaboration and reporting that can be enhanced with tools that support the intelligent management of workflow in radiology, including 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
In addition to productivity and efficiency gains, the enterprise approach is also 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 healthcare professionals.
There is little doubt that cross-site reporting can play a significant role in driving service optimisation and transforming patient care. Collaboration will be key, but to achieve it 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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