Optimising workflows and improving radiology reporting with IMPAX at United Lincolnshire Hospitals NHS Trust

Delayed reporting, incomplete patient records and heavy workloads. Like other radiology departments worldwide, these were just some of the headaches that the radiology departments of United Lincolnshire Hospitals NHS (National Health Service) Trust would have to contend with daily. In 2006 the Trust took definitive action to overcome these difficulties, installing Agfa’s IMPAX, a robust picture archiving and communication system (PACS) for imaging-based planning, interpretation and results distribution.

Agfa Healthcare had been selected by CfH, (Connecting for Health),as part of the National Programme for Information Technology (NPfIT) to provide digital imaging management solutions to the Trust. The CfH is the delivery arm of the UK's long-term programme, NPfIT, to deliver improved integrated record services across the nation and considered to be the world's largest government sponsored roll-out of healthcare IT solutions. Yet, even before the agreement had been made to use Agfa systems, the radiologists of ULH had turned their eyes to IMPAX as their favoured option for information and image management.

As Merrill Hayes, PACS and Radiology Information Service (RIS) Programme Manager at the Lincolnshire Trust who managed the installation of the IMPAX system with Agfa explains, "Prior to the CfH agreement, our staff had been looking at a number of alternative PACS systems, of which IMPAX was one. They were looking for a system capable of providing tangible and measurable benefits that could allow them to deal with local hospital and pan-Trust work lists. When CfH awarded the regional contract to Agfa, our radiologists were quite relieved as IMPAX was the specific programme they had marked out as being their preferred solution. The system was subsequently installed to all our radiology departments and we went live on an enterprise-wide basis in September of this year."

Streamlining workflows

Combining RIS and reporting solutions into a single integrated system, IMPAX has been designed around the daily workflows of radiologists and imaging specialists to deliver a rich user experience that can truly optimise and expedite work lists. "Before the installation of the IMPAX system, our imaging specialists operated in a strictly film and paper based environment. With this, our staff experienced many of the common pitfalls and delays that every hospital in a similar situation would. These issues were primarily related to difficulties in finding and transporting film between sites and different hospital wards. When we installed IMPAX, our radiologists had to re-examine their routines and identify all those places where inefficiencies were created and money lost because of having to rely on film and hard copy images. The ramp-up for this did not take long as our teams were very keen on deriving maximum value out of the system so that they could optimise the use of their time and expedite case loads."

Once installed, the advantages of running an integrated RIS and PACS system were quickly realised, both from a time management and a diagnostic perspective. IMPAX's easy-to-use review, reporting and results distribution system empowers users to act, plan, analyze and explore clinical data - not just read it, resulting in improved organizational efficiency and communications between all those involved involved in the diagnostic imaging chain.

As Mrs. Hayes continues, "The benefits to daily workflows with IMPAX were almost immediately evident. Previously, radiologists would have to wait for film packets before they could begin reporting. There would then be a second delay as the films would have to be transported back to ward and clinics by porter or courier. With IMPAX, however, radiologists can begin reporting as soon as they receive requests and the images are taken. Their reports are then made instantly available to all authorised parties across the Trust and community hospitals. By eliminating these lag times our radiologists have been able to get through cases at a much faster rate. From an organisational standpoint, we've also found that cross-site communications have improved - this is particularly important to us as we are such a large and geographically dispersed Trust that also provides an imaging service to a number of Primary Care Trust (PCT) hospitals. Radiologists reporting at our Boston site, for example, no longer have to wait for images to arrive by courier from Skegness and can continue to refer patients to specialist centres (e.g. Nottingham or Sheffield) but now using a digital image rather than film."

An enterprise-wide solution

The efficiencies brought by IMPAX have not been limited to the radiology departments of the Lincolnshire Trust alone. Through a digital connection to departmental and hospital information systems, users within the healthcare enterprise can gain an integrated view of patient data, presenting information from virtually any imaging modality. As explained by Mrs Hayes, "Staff from the nuclear medicine departments have also been among the early adopters of the IMPAX system at Lincolnshire. In a similar manner to our radiologists, they are now able to enter patient information and images from gamma cameras directly into a centralised system, which instantly links to patient records. Consultants viewing Nuclear Medicine images have been very enthusiastic about the quality of the coloured images they are now viewing compared to the poorer quality paper format images they used to work with. Similarly, the images generated with the IMPAX system have benefited our orthopaedic departments and enabled some degree of improved analysis and diagnosis. In turn, this leads back to additional time savings for the radiologists as they have been receiving fewer queries about images. Those they do receive also now tend to be more specific case-related questions, while admin-related queries have completely dropped off."

Beyond these intuitive time saving and diagnosis related benefits, moving to IMPAX for a digital imaging environment has enabled a number of economical benefits across the Lincolnshire hospital sites. "From a budgetary point of view, IMPAX has had enabled multiple, Trust-wide savings that are accumulating into a significant amount. There is first the obvious elimination of film costs, both in terms of procurement and development. We've also been able to significantly reduce the need for portering and courier services. Whereas before we'd have to send images by courier, taxi or even with the patients themselves, we're now sending and receiving digital images securely and instantly throughout the Health Community Wide Area Network."

Improvement to the entry, security and storage of data also reduces the administrative burden to doctors, nurses and support staff who manage or make use of diagnostic images and patient records. All data is entered once and flows through in real-time across all systems, saving users from having to update patient data (such as demographics) on multiple systems. Through the use of automatic reconciliation of orders and studies, the likelihood of mismatching a patient to a study is also minimized and manual reconciliation processes by technologists are reduced. Scheduled worklists also fit into the workflow of image review and reporting to support the clinical assessment of cases.

"One comment I've heard time and time again from staff across all sites is that since the IMPAX system has been installed, their work environments have become much calmer. The mountains of film, case files and patient records that used to climb higher and higher have all been significantly reduced as most materials are now managed on-line. Doctors and nurses are also no longer wasting time looking for film as images can be readily accessed from local computers and are usually available before the patient returns to the clinic or ward. This has also allowed our staff to put their time back into their core duties of treating patients." commented Mrs Hayes

Easing pressure

The final barometer for any new piece of medical equipment or software is whether or not it enables healthcare providers to offer improved treatment to their patients. At United Lincolnshire Hospitals Trust, the advantages brought by moving to a digital imaging system with IMPAX have brought both overt and subtle benefits that have enhanced the quality of service the Trust offers.

As Mrs Hayes concludes, "Patients won't necessarily be aware of the benefits a system like IMPAX brings to their treatments. The one obvious thing that our patients have noticed is that their images will have arrived from radiology to their doctors before they themselves get back to the ward or clinic. This is particularly true among outpatients and those with conditions that necessitate multiple imaging sessions. The real benefits brought by IMPAX have occurred at the back end, chiefly being a reduction in report turnaround time, a substantial reduction in film and hard copy images, a decrease in operational costs and, most importantly, it has enabled an improvement in service from the radiology department and all those involved with diagnostic imaging."

About the United Lincolnshire Hospitals NHS Trust

Formed in April 2000 by the merger of the three former hospital trusts in Lincolnshire, the United Lincolnshire Hospitals NHS Trust provides acute services to the people of Lincolnshire from District General Hospitals at Lincoln (County Hospital) and Boston (Pilgrim Hospital), Grantham and District Hospital, County Hospital Louth and from Primary Care Trust managed hospitals in, Skegness, Gainsborough and Spalding covering a rural area of approx 2,400 square miles. The Trust employs approximately 7,000 staff and treats more than 175,000 accident and emergency cases, nearly half a million outpatients and almost 100,000 inpatients annually.