The Scottish Government

1. Portfolio/Number/Name:H/T 9 Digital X-rays / Picture Archive Computer System ( PACS)

2. Programme/Activity:

PACS is a computer system that captures, stores, distributes and displays digitised images. Images can be relayed to any destination capable of receiving them, and can be reviewed in different destinations simultaneously. Improving the imaging of patients in healthcare will inevitably increase the efficiency of the healthcare system as a whole.

The introduction of PACS in NHSScotland opens up potential to deliver a range of benefits to patients. Clinicians will be able to access images taken at stages along pathways and readily access relevant patient records. This will streamline care and speed up diagnosis and treatment.

PACS offers the opportunity for radiology reporting to be done remotely, utilising telemedicine and potentially facilitating much more flexible working of radiologists who will be able to access images on a 24-hour, seven day a week basis. It challenges traditional radiology reporting structures and encourages organisational review and reconfiguration of imaging services across health communities for maximum efficiency.

As part of the national eHealth Strategy, SEHD has identified national funds to implement PACS throughout NHSScotland over the period of this Efficient Government Programme. A procurement exercise for a PACS system and supplier has recently been completed..

In addition to time saving, positive impact on quality can be anticipated due to a number of benefits. These can be grouped under two main headings:

Improving the quality of overall patient care and reducing clinical risk

Increased numbers of reported images and so reduced clinical risk and better service to GPs

Quicker diagnosis and more timely clinical decisions - including for GPs

Fewer clinical procedures repeated (including, but not restricted to, radiology) because of lost/mislaid images

Fewer rejects, resulting in fewer retakes and so reduced radiation exposure for the patient

Less unauthorised access to images through security functions within PACS

Fewer instances of suboptimal clinical decisions being made in absence of access to image (inc previous images)

Reduced risk of clinical errors resulting from use of hard copy where patient not identified clearly on image

Avoid losing old images through destroying hard copy for reasons of lack of space

Improving the working environment and facilities for staff

Contribute to reduced staff turnover and improved morale through the introduction of modern PACS technology

Reduced health & safety risks associated with the manual handling of hard copy images

Better working practices for clinicians beyond Radiology (inc easier image manipulation and ability to prepare behind the scenes)

Patients no longer have to carry their films around with them

Enhanced teaching and research through ready access to PACS images

3. Savings

3.1 Current target; £m

2005-06

2006-07

2007-08

Cash

0

0

0

Time

3.25

13.4

23.5

3.2 Efficiencies delivered; £m

2005-06

2006-07

2007-08

Cash

0

-

-

Time

0

-

-

4. Accountable Officer for delivery

Kevin Woods, SEHD Chief Executive

5. Project Manager

Charlie Knox, SEHD Head of Computing & IT Strategy Division

6. EGDD Portfolio Manager

Rowena Simpson

7. Description of efficiency and actions to be taken

7.1 What is the efficiency improvement? How will the efficiencies be made?

There are various ways in which staff time will be released, thereby improving operational effectiveness and the patient experience:

Less staff time spent handling hard copy images, inc routine handling plus finding lost/missing images

Less wasted staff time associated with clinic appointments aborted due to not having images to hand

Fewer rejects, resulting in fewer retakes and so less wasted staff time

Fewer unnecessary admissions and patient events on the patient journey caused through not having access to all the images

Reduce overall patient waiting on the ward, in A&E etc. by obtaining faster radiological reporting

Eliminate patients being asked their name, address etc. multiple times by staff within Radiology

Freeing up of clinician time (e.g. for consultation with GPs) through remote access to images enabling remote reporting and 'virtual' multidisciplinary team meetings

Reduced length of stay duration resulting from cumulative effect of above benefits

The method of deriving the efficiency figures is as follows:-

Extensive before-and-after timings have been conducted on traditional versus digital X-ray services in a typical hospital. The time savings vary across a range of staff, from filing clerks to consultant radiologists. Savings for each staff category have been quantified and converted into w.t.e. The cash equivalent has been derived by applying appropriate salary rates.

Hence in the hospital studied there are 238,000 X-Ray investigations per annum and calculated time releasing efficiencies of £2,364,000 p.a.

It is therefore not proposed to devote the significant effort to undertake this level of study in each hospital. Instead, a formula has been devised to give a cash saving figure per X-ray investigation: £9.93. The number of investigations carried out in each NHS Board without a PACS has been baselined, hence when PACS is fully implemented in the particular NHS Board the time efficiencies can be calculated using this formula.

The number of X-Ray investigations undertaken per annum in NHSScotland which are currently not digital, ie. traditional rather than PACS, is 2,374,050. This number and the significant associated time efficiencies explain the significant planned efficiencies.

7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement?

A national procurement exercise of a PACS supplier and service has recently been completed.

There will now be a managed roll-out programme over the course of this Efficient Government Programme. Supported by national funds and including local facilitation, the programme has been commissioned by SEHD to NHS National Services Scotland ( NHSNSS). Key action manager within NHSNSS is Ron Anderson, Head of National IT Programmes.

Roll-out project and resource plans will be agreed and monitored with each NHS Board. The project will be directed by a Project Board chaired by Charlie Knox (Action Officer mentioned above) and supported by a reference group of radiologists.

The partnership working extends to NHSScotland's commercial IT Services supplier, Atos Origin, who will work with the PACS supplier to deliver a managed central service for the system.

8. Associated costs

8.1 Are there any development or redundancy costs associated with the delivery of this efficiency?

This project was embarked upon to secure better access to patient information and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving.

9. Measurement

9.1 What are the inputs that will be measured?

The key data required is number of X-Ray investigations held within the PACS system, which can then be compared with the known total X-Rays taken. The PACS system is readily able to run off extract reports and analyses.

9.2 What are the outputs that will be measured?

Statistics will be taken as analysis extracts direct from the PACS systems on number of images captured/ stored, and these will be compared to total expected numbers. Since the PACS system is readily able to run off extract reports and analyses, the information is not subject to error.

9.3 What is the baseline for inputs and outputs?

In 2004-5 some 22% of X-Rays in NHSScotland were digital/ PACS

10. Quality cross-check

10.1 What quality indicators are being used to ensure that quality of service is maintained or improved?

Due to the nature of the service improvement it is not considered that quality checks over time are required. Hence once the software has been designed and tested the data continues to flow into the patient record.

What will be monitored however is the 'live time' of the service, as part of routinely collected statistics for contract performance.

11. Monitoring

11.1 What are the arrangements for monitoring the delivery of efficiencies?

Measurement of progress toward full implementation will be built in to project reporting to the national PACS Project Board. In addition to monthly highlight reports there will be 6 monthly updates on progress toward the targets.

12. Reporting

12.1 What are the arrangements for reporting the delivery of efficiencies?

Measurement of progress toward full implementation will be built in to project reporting to the national PACS Project Board. In addition to monthly highlight reports there will be 6 monthly updates on progress toward the targets.

13. Dependencies

13.1 Explain if your efficiencies are dependant on legislation or other structural changes being achieved.

No legislation or structural changes required.

14. Use of efficiencies

14.1 How are the efficiencies released from improvement activity being used to improve front-line services?

Funding allocations from SEHD to NHS Boards for primary care did not assume time efficiencies. Due to the nature of the project there is no time released, but time is more productively applied.