Is the NHS failing to leverage transformation from technology?

Adam Hill.2jpgThe NHS spends a great deal on IT but rarely embraces the service redesign opportunities this offers. Dr Adam Hill, Chief Medical Officer at Sectra, explores how this could change.

The NHS spends significant sums on its valuable IT infrastructure. But despite this investment, our health service often fails to embrace the service redesign opportunities this technology presents, with major deployments still often layered onto existing services.

Redesigning services can dramatically improve care and save substantial amounts of money. Yet missed opportunities mean that we have under-utilised assets, and all this in an era of more for less.

The real opportunity to reshape the delivery of clinical services hand in hand with the deployment of IT programmes can be seen by taking a glance at the recent history of diagnostic services within the NHS. Radiology and pathology are both service delivery specialities within modern day medicine. Consultants from neither speciality have their name above a patient’s bed, but both are mission critical diagnostic specialities, and the bedrock upon which modern day healthcare is based.

One of these specialities has already managed to embrace technology at a remarkable pace. The other has very effectively embarked on service redesign. Yet neither has achieved both—something that must happen in future in order to maximise benefits for patients, enabling a shift to a new era in which cost-effective health outcomes are commissioned.

Radiology and pathology: two sides of the diagnostic coin
Radiology has shifted to digital very rapidly in the NHS. The National Programme for IT (NPfIT) accelerated coverage of picture archiving and communication systems (PACS) to in excess of 95% within 18 months. Despite widely publicised criticism, NPfIT revolutionised the delivery of imaging diagnostic services in the UK. However, the potential to reduce inequality of care provision and improve cost-effective outcomes have been less successfully realised, ultimately impacting upon professional working conditions.

Not only does service redesign impact the health of our population at risk, but it can have any number of indirect benefits. As just one example, it could mean freeing up and consolidating vastly under-utilised real estate in the NHS. Clinicians providing a diagnostic service with a digital workflow can arguably report from an office, a hot-desk reporting hub, from home or whilst on the move with equal fidelity. But radiology is yet to really harness this opportunity.

Pathology, in contrast, has undergone a significant service redesign following the Carter Review in 2008, focused on reducing costs by 20%. However, this diagnostic service has failed to realise the impact upon equality of outcomes and cost reduction that come with implementing a digital workflow, despite the widely held anticipation that pathology will soon be the next big digitisation in healthcare.

IT infrastructure deployment can re-vision service delivery
Embracing IT infrastructure at the same time as the service redesign opportunities that new deployments offer can unlock the potential to transition clinical care provision from centralised environments, through to decentralised models and distributed networks of care.

In diagnostic services, this would mean the ability to balance workloads across a region. It would give hospitals anywhere in a region the ability to access clinicians with the right skillsets to prepare a specimen, perform an examination or report a finding.

Modern PACS systems are cross-enterprise document sharing, or XDS , enabled. They can allow federation of workflow across a region, something that has previously been balkanised by different PACS vendors. This workload balancing can allow hospitals to meet ever stringent service level agreements, whilst improving specialist job satisfaction.

Joining up tasks to join up care
Put simply the tasks of IT implementation and service redesign are currently decoupled. It is very infrequent that a hospital looks for IT to support a service transformation programme. It is equally rare that hospitals will use the deployment of an IT infrastructure project as an opportunity for service redesign to unlock efficiency savings.

We must now move away from a situation where IT is simply layered onto the existing healthcare service as a result of analysing current workflow to inform IT architecture.

The focus must now be on the use of IT to support hospitals and the people within them, whether that is the clinician, the radiology service manager, the CEO, the chief financial officer or the patient.

Innovators will embrace the opportunity to use IT to redesign healthcare, achieving affordable health outcomes today; the risk of being a late adopter is that cost efficiencies are not realised until much later, failing patients that can’t wait for our health system to meet their needs tomorrow.

*Radiology Information System/Picture Archiving and Communication System

About Dr Adam Hill

Adam is a dual-qualified Clinician and Mechanical Engineer, previously having co-founded and led a successful university-based research centre at the interface of both disciplines. Adam’s expertise is in the research, development and optimisation of medical technologies and healthcare services, with over 100 publications and 8 academic awards in the last 15 years.

Having learnt the fundamentals of his clinical trade in the NHS, Adam passed through the Royal Military Academy, Sandhurst, before serving as the doctor to the Household Cavalry Mounted Regiment. Upon retiring his commission, Adam held technical and commercial leadership positions within start-up companies spanning service delivery, skills development and, most recently, technology incubation, before working as a Management Consultant with international clients in the Lifescience and Healthcare industries. During the term of our most recent coalition Government, Adam has provided thought-leadership, advice and content to a handful of its initiatives and programmes.

Adam’s current interests include unlocking the value of networked services, believing that the whole is greater than the sum of its parts; the primacy of imaging in the realisation of personalised medicine; and powering efficiencies in care delivery through standardisation.

Sectra has a rapidly growing share of the RIS/PACS* market the UK, a powerful product portfolio, and a world-class research and development centre at the University of Linköping; these are our foundation, our building blocks and our brain trust with which we can design, develop and deploy solutions to the most complex of problems challenging our NHS customers today.

 

Skill mix in radiology: a personal tale

Chris Loughran BIR blogWhen Dr Chris Loughran published research into the benefits of trained radiographers reporting trauma radiology he was accused of committing professional suicide. But he was on a mission to spread the word.

 

 

Years ago I was appointed as Clinical Director of Radiology. I knew nothing about management and thought I had better go and learn something. I enrolled at Keele University for a diploma course in Management in Radiology. In the second year I had to write a dissertation. Scratching around for something I was inspired by Prof. Roger Dyson to consider what he termed “Clinical Radiography”, a concept that encouraged radiographers to move from the production of diagnostic images only to one where they also interpreted them.

Some research was essential and I was able to cajole three radiographers into contributing to the research effort. The aim was to determine if the diagnostic performance of the radiographers in trauma radiology could be enhanced with training, to such an extent that they could report such radiographs to a high standard. We showed that they could and the research findings were subsequently published in the BJR.1 We took the plunge even before the paper was published and with the backing of the East Cheshire NHS Trust those radiographers started to report directly to the accident department. I believe we were the first in the country to do this. The backing of the Trust Board was sought, and was essential, to ensure that in the event of error we were covered. It fulfilled my belief that radiographers could employ their talents to a greater extent—for the benefit of the department, the hospital in general and, of course, the patients.

I felt as though I was now on a mission—time to spread the word and encourage other departments to work in a similar fashion. To this end I decided to seek out further interest at a local regional radiologists meeting. Naively, I thought my proposals to expand our local in house training programme to a more established and regional exercise would be welcomed. Less time spent by radiologists on an element of the work that many were reluctant to undertake combined with better service delivery to patients seemed like an unbeatable combination. I should have known better! I had never been shouted down previously (nor since) but was that afternoon. “You’re committing professional suicide !” one colleague ferociously remarked, he’s probably forgotten, I never have. The idea clearly touched many raw nerves. So I slunk away, cowed, feeling battered and rejected. What I couldn’t really get my head round was the absolute rejection of the idea when I knew so many departments were struggling with their workloads and so many radiologists complained about it.

Despite this rejection the radiographers themselves picked up on the idea and I was asked by many organisations to speak about the research and the concept in general. I particularly remember one meeting in Nottingham where I spoke to a crowded lecture theatre. I was introduced by a radiologist, the talk went well and he very kindly remarked afterwards that I was so convincing he would buy a second hand car from me!

Later I was invited to help establish a course in radiographer reporting at Canterbury, Christ Church College. We agreed a schedule for the course and associated examination. I was privileged to be an external examiner and was mightily impressed by the very high standard that many candidates attained. Radiologists had (until then) never been examined in trauma plain film radiology to the extent these candidates were.

Of course, similar training soon followed elsewhere and it now is established practice in many departments. Indeed it has gone further with radiographers reporting other examinations including CT head scans, for example. Moreover, many adverts for radiologist positions now highlight this practice as an inducement for candidates to apply for their posts. Its moved a long way since that regional radiology meeting all those afternoons ago.

Its taught me that its not only the truth that matters but also the diligence with which it is pursued. If you believe in something keep going! As Edward Bulwer-Lytton put it, “Enthusiasm is the genius of sincerity and truth accomplishes no victories without it”.

  1. Loughran CF. Reporting of fracture radiographs by radiographers: the impact of a training programme. Br J Radiol 1994; 67: 945–50. doi: 1259/0007-1285-67-802-945

About Dr Chris Loughran

I qualified in Liverpool in 1976 and have been pursuing radiology since 1978. I trained in radiology in Liverpool. After a 2-year stint as Consultant at Broadgreen Hospital I went to the USA for a year where I was Assistant Professor in The Medical University of South Carolina, Charleston, USA. Returning to England I took up post in Macclesfield where I have been since 1986.

In my time I have been Clinical Director, Postgraduate Tutor, Associate Medical Director and Chairman of the Medical Staff Committee. I was Chairman of the Northern Branch of the BIR and BIR council member some years ago. Now I work as a clinical radiologist and am so lucky that I still enjoy the speciality as much as I did all those years ago.

 

A Radiologist in the Planning Room

DrSimcock_400x400

Dr Richard Simcock

Historically, physicians have been both radiologist and radiation oncologist, and diagnostic and therapeutic roles have sat comfortably with one physician.

Dr Richard Simcock argues that times have now changed and there is a strong case for a radiologist AND a radiation oncologist in the planning room.

Thor Stenbeck is a hero of Swedish physics. Soon after Röntgen’s first X-ray image Stenbeck could lay claim to the first documented therapeutic use (locating a bullet lodged in a skull). Later he successfully irradiated skin cancer with the first documented fractionated therapy. Stenbeck is our first example of a physician becoming both a radiologist and radiation oncologist.

Dr Thor Stenbeck

Thor Stenbeck at work

The model has been endlessly repeated. Throughout the 20th century the therapeutic and diagnostic possibilities of the magical rays were supervised by key pioneers. One of Britain’s greatest examples was Ralston Patterson. Patterson trained in radiology in Cambridge, South Africa, Aberdeen and the Mayo Clinic before leading Manchester’s Holt Institute and trailblazing for standardisation in the medical physics of therapy.

Patterson

Ralston Patterson

Patterson was an early President of the Faculty of Radiologists, later transformed into the Royal College of Radiologists (motto, “From Rays, Health”). The Royal College still accredits both radiologists and radiation (clinical) oncologists—but the world has moved on.

Today’s radiotherapy maximises therapeutic ratio by using the best of radiological imaging to accurately identify a malignant target and the organs at risk (OARs). It then uses image guidance to ensure that the bullseye of the target never drifts from the treatment beam. As technology develops so does the ability to identify and potentially spare new OARs. At the recent BIR Meeting on “Diagnostic Radiology for Advanced Head and Neck Planning” delegates heard data on “new” OARS such as cochleas and carotids as well as reviewing how to identify emerging OARs in the swallowing musculature on high-resolution CTs. The meeting buzzed with talk on MRI and PET fusion in the radiotherapy planning process as well as diffusion-weighted MRI and nuclear medicine in diagnosis.

These technologies are figuratively and literally decades apart from the images Patterson used to guide treatment and yet we cling to one relic from the age: the dual role of radiation oncologist as radiologist. This is a nonsense.

The interpretation of imaging should be performed by those most expert, and in almost every case that will be the experienced cancer radiologist. Despite this it is usually the radiation oncologist who defines the visible tumour target ( or gross tumour volume (GTV)) in radiation planning. One assumes therefore that the radiation oncologist is trained in radiology? Sadly not.

It is an embarrassing fact that the post-graduate training of the UK clinical oncologist (as specified by the RCR curriculum ) requires no training or examination in radiological anatomy nor radiology. There are examinations in statistics and cancer biology but no expectation that trainees should be formally taught how to use the imaging that they use as the eyesight of their weapon of choice. Clinical oncology trainees may however be examined in the design of a radiotherapy bunker—a fitting metaphor for this silo thinking.

Elsewhere in the world the situation is not much better. Neither the US nor Australian training schemes mandate any radiology training (although the Royal Australian and New Zealand College of Radiologists (RANZCR) are considering it). In Canada at least a 4-month radiology attachment is expected (a model followed by some UK centres e.g. Glasgow) but this is not long enough to learn a radiologist’s craft. A recent study identified 84 radiological competencies as a minimum for radiation oncologists. We need to change the model; not “Jacks of all trades” but Masters of one.

We must bring together radiological knowledge and harness it to an oncologist’s expertise. Radiologists remain essential in diagnosis, staging and response assessment. Radiation oncologists determine clinical target volumes and critically assess the final plan. The two come together to identify tumour targets and OARs; radiologist and radiation oncologist in the same room but not the same person.

The BIR meeting showed us how far we have come (and can go) in head and neck radiotherapy.

Delegates at the BIR Head and Neck event, November 2014

Delegates at the BIR Head and Neck event, November 2014

It illustrated that progress will reach its maximum potential if we collaborate as a multiprofessional team in the planning department.

Thor Stenbeck was a hero, but a century later we should not emulate him and his dual roles.

 

Find out more about BIR events

About Dr Richard Simcock MRCPI FRCR

Dr Richard Simcock has been a Consultant Clinical Oncologist at the Sussex Cancer Centre since 2004. Previously he had worked at the Sydney Cancer Centre, Australia and before that had completed five years of postgraduate specialist training in Oncology in London and the South East including Guys and St.Thomas’, Charing Cross and Mount Vernon Hospitals. He graduated from Guys and St.Thomas’ hospital in 1993.

Working closely with the surgical and nursing team Dr Simcock sees and treats patients diagnosed with early or advanced breast cancer. He advises on the role of radiation, chemotherapy, hormone, biological, and experimental treatments.
Dr Simcock prescribes and supervises courses of chemotherapy delivered by the team at the Montefiore or by home healthcare teams. In addition he prescribes, plans, and supervises radiotherapy treatment at the Royal Sussex County Hospital or at Spire Portsmouth (CPUK).

He is also involved in enrolling patients in trials of new therapies as well as trials of improved radiation therapies.

As a Head and Neck Oncologist Dr Simcock treats cancers of the larynx (voice box), tongue, tonsil and other rarer sites. He supervises, prescribes and plans curative treatments with radiotherapy and chemotherapy as well as giving post-operative radiotherapy treatments. Intensity Modulated radiotherapy is used as standard in these cases.

The advent of radiation protection through WWI radiology martyrs

Dr Adrian Thomas

As we commemorate the centenary of the outbreak of World War One and as we approach Armistice Day on 11 November, Dr Adrian Thomas, BIR Honorary Librarian, reflects on the huge impact that the WWI radiology martyrs had on the radiation protection standards we take for granted today.

 

Many things were to change in 1914 at the start of hostilities and were never quite the same afterwards. The old confidences were shaken.

One item that symbolizes this period for me is an old wrist watch given to me by Yvonne Beech. It was presented to Corporal Edward Wallwork RAMC (Royal Army Medical Corps). Wallwork was from Lancashire and had worked in the cotton industry; he came to London during the Great War, joined the RAMC and trained as a radiographer.

 

The wristwatch presented to radiographer, Corporal Walwork, by three London radiologists

The wristwatch presented to radiographer, Corporal Walwork, by three London radiologists

At the outbreak of hostilities the War Office requisitioned a newly completed five-storey warehouse, H.M. Stationery Office in Stamford Street, for a 1650-bed Red Cross military hospital. The hospital was close to Waterloo Station and was connected by a tunnel. The building today is part of King’s College London.

The silver Swiss wristwatch was presented to Wallwork by doctors Ironside Bruce (1879–1921), Stanley Melville (1867–1934) and George Harrison Orton (1873–1947).

2bThe three doctors had all served in the forces as radiologists. Before the war men wore pocket watches and only ladies wore wristwatches. It was said that a man would sooner wear a dress than a wristwatch! However, pocket watches were not practical in the trenches. The wristwatch is a typical good quality Swiss wristwatch from the end of the First World War period and the numerals and hands were designed to be filled with radium to create a luminous dial.

The presentation of the watch was as a token of appreciation for Wallwork’s work in the X-ray department of the King George Hospital from 1915 to 1919.

Patients rehabilitating at King George Hospital

Patients rehabilitating at King George Hospital

All of the three doctors were deeply involved in the BIR or its predecessor organisations and sadly all three suffered from radiation-induced disease.  Their names are recorded on the X-ray martyr’s memorial in the grounds of St George’s Hospital in Hamburg.

Ironside Bruce was on the staff of Charing Cross Hospital and the Hospital for Sick Children in Great Ormond Street. He was very talented and published widely and his well known book “A System of Radiology; with an Atlas of the Normal” came out in 1907.

The British radiological world was shocked when Bruce died of radiation-induced aplastic anaemia in 1921 at the young age of 42. The outcry resulting from his death resulted in the formation of a radiation protection committee.

George Harrison Orton was a pioneer of radiotherapy and was in charge of the X-ray department at St Mary’s Hospital in London. After his death it was said in his obituary that he was “perhaps the last martyr pioneer of radiology”. Stanley Melville worked at St George’s Hospital in London and was BIR president in 1934. Both Orton and Melville served periods as co-secretary with Sidney Russ (physicist at the Middlesex Hospital) of the newly formed British X-ray and Radium Protection Committee set up by the BIR, and radiation standards were set.

6

 

About Dr Adrian Thomas

Dr Adrian Thomas

Dr Thomas was a medical student at University College, London. He was taught medical history by Edwin Clarke, Bill Bynum and Jonathan Miller. In the mid-1980s he was a founding member of what is now the British Society for the History of Radiology. In 1995 he organised the radiology history exhibition for the Röntgen Centenary Congress and edited his first book on radiology history.

He has published extensively on radiology history and has actively promoted radiology history throughout his career. He is currently the Chairman of the International Society for the History of Radiology.

Dr Thomas believes it is important that radiology is represented in the wider medical history community and to that end lectures on radiology history in the Diploma of the History of Medicine of the Society Apothecaries (DHMSA). He is the immediate past-president of the British Society for the History of Medicine, and the UK national representative to the International Society for the History of Medicine.

BRITISH INSTITUTE OF RADIOLOGY www.bir.org.uk

BRITISH SOCIETY OF HISTORY OF RADIOLOGY http://www.bshr.org.uk

 

The journey to a single RIS-PACS environment

JJ Alberts2  Main logo and main strapline

Dr Johann Albert, Associate Director, Business Solutions at Alliance Medical, discusses the challenge of varying client requirements in a private diagnostic imaging setting.

Unlike most NHS Acute Trusts, who tend to have large static diagnostic imaging departments located around a single or a small group of hospitals, private diagnostic imaging providers tend to have numerous static locations, a central patient management centre and varying fleet sizes of mobile scanners that move around on a daily basis. Private diagnostic imaging providers also have to contend with varying requirements from their customers that include scan-only services, book-scan-and-report services, or even report-only services. Service levels vary from customer to customer and the actual process of managing a patient differs between NHS, self-pay, medical insurance and medico-legal customers.

RIS PACS Icon logoThis variability highlights the fact that any clinical system deployed within a private diagnostic imaging provider needs to be able to cope with different workflows within the same location. It also implies that the clinical systems need to manage the end-to-end patient pathway in a manner that is completely separated from a fixed geographical location, as different parts of the patient pathway can take place in different locations. An example of this is where a patient calls the patient management centre to make a booking, the scan takes place at one of the scanning locations and the clinical report is completed by a tele-radiology provider. The clinical systems should therefore understand the concept of a workflow and a distributed network of scanning locations, as well as have the ability to move information seamlessly among various locations in accordance with the desired pathway.

The customer base of a private diagnostic imaging provider also varies from a commercial perspective. There are significant differences in customer requirements for management information, payment calculations and billing processes. This is on top of more intricate billing requirements such as factoring, zero-rated VAT or VAT exempt treatments that apply to some, but not all customers.

The realities of a business built up over time
Some of the private diagnostic imaging providers in the market started out in the pre-digital era and in the early days most diagnostic images were captured, stored and reported based on film. Over time RIS and PACS clinical applications appeared and of course private diagnostic imaging providers adopted these as appropriate. Since these technologies were still in their early phases of development, the designs tended to reflect the limitations in technology at the time and it was focussed on serving the needs of specific contracts. Some of these providers also grew by acquiring other smaller companies with their own legacy systems in situ.

These contributing factors typically result in a variety of RIS and PACS applications installed in the same organisation, all of which serve different purposes, different contracts and manage different parts of the patient pathway. To any manager the obvious implications of this scenario are, amongst others, large management overheads, a high degree of complexity in the technology solutions, various manual processes and an inability to rapidly change to accommodate customer needs.

Procuring a single RIS-PACS

To move from a situation where there are multiple RIS and PACS applications in place to a single unified system carries some significant challenges. Engrained manual business processes, distributed staff locations, radiologist availability and varying customer expectations are all significant challenges to overcome and manage. This is not even talking about the technical and logistical issues that a project of this nature would face.

Understanding the customers’ needs must form the core of any such change process and this must be layered on top of the requirements from the relevant operational teams. One of the key decision points in the design and deployment of a unified RIS-PACS environment is the balance that needs to be struck between flexibility and standardisation.

The flexibility within the system to accommodate operational needs and customer requirements is very important for any commercial organisation. On the other hand it is no use accommodating different customer requirements if these cannot be delivered to a consistent level of quality and to a consistent service level. Although there is a degree of overlap, these two system properties tend to be opposing forces in terms of the demands they place on a clinical systems platform. A good balance can only be achieved through proper engagement with customers and the relevant operational teams.

The procurement of a RIS and PACS system, at least from a private diagnostic imaging provider’s perspective, needs to fulfil several criteria and these include:

• It must have an integrated billing engine that can cope with all the requirements from different customers.
• It must manage the entire end-to-end patient pathway in the absence of a hospital information system (HIS), which includes multiple inbound channels and multiple outbound channels.
• It must allow for different workflows to be accommodated within the same clinical application that is a specific property of the contract associated with the patient.
• It must understand and cope with a distributed network of scanning facilities, some of which are static and some of which are mobile.
• It must allow for electronic interfaces and for the integration of any new developments to take place in a consistent way that is easy to manage.
• It must allow the private diagnostic imaging provider to change and configure the system as an inhouse function and not one that requires vendor intervention to the degree it is prevalent today.
• It must accommodate different clinical workflows that include scan only, scan and report, report only, double reads, report audits and also remote reporting.

This list is not meant to be comprehensive, but it is intended to highlight the requirements that a private diagnostic imaging provider will view as essential, as opposed to most radiology departments within a hospital setup. This set of criteria does point out the fact that most of the incumbent RIS vendors, and to a lessor extend the PACS vendors, do not meet all the criteria. It is therefore inevitable that some degree of customisation and development will be required for any clinical systems platform to be successful.

The implementation process
Once the appropriate systems have been procured, attention needs to turn to the implementation process. It goes without saying that a formal project methodology must be followed to have any hope of a successful implementation. Instead of providing an account of all the formal elements that a project of this nature requires, we would rather want to share our experience of the top four learning points:

Change: with any new system, there will be an element of change. The obvious example is the fact that staff members will be using a different clinical system to manage their daily workloads. There is however several areas of change that often get overlooked in a project of this nature. These include items such as the mechanism for how radiographers can move an image from the scanner to a specific radiologist. This is a simple task, but one which is core to the operation of any diagnostic imaging unit. The overall system might work very well, but if the key tasks that staff members need to perform on a daily basis are overlooked then it is easy to undermine the success of the entire project.

Process standardisation: implementing a single unified RIS and PACS implies that the same business process will be followed at each location. To assume that each scanning unit operates in exactly the same way will be a mistake though. Local business processes will have evolved over time and are a function of location-specific factors, customer-driven preferences, individual staff influences and of course head office standard operating procedures (SOPs). There must be a high degree of focus on ensuring business processes are standardised at each location, in order to accommodate a single RIS and PACS application. Deploying a system that enforces a standardised business process on a business environment that operates in a variety of ways, has the potential to stall the entire project.

Communication: with a workforce scattered around the country and a large proportion of it serving a mobile fleet, it is no surprise that communication is one of those tenacious challenges that needs constant attention. No single communication method will suffice in this situation and it is up the project team to use any and all means available to ensure the relevant messages reach the correct target audience. These methods can include anything from formal letters, face-to-face meetings and even social media. Social media is of course playing an increasingly important role in most people’s daily lives and it is a very useful tool in the business environment as well. External stakeholders need to be included at the appropriate times.

Coordination: the nature of most private diagnostic imaging providers is such that different parts of the patient work flow can take place at different locations. The payer of the service is mostly the determining factor that dictates which element needs to take place where. This is however a moving feat for the simple reason that patients from multiple contracts can be scanned at any scanning unit. The respective units therefore need to cope with different contract workflows at different times throughout the day. The implications for implementing a RIS and PACS as a unified platform is therefore that it is easy to undermine the company’s ability to service a patient if the implementation of all the different supporting systems are not well coordinated.

Conclusion
The latest technologies around work flow management will allow most private diagnostic imaging providers to improve productivity as well as quality at the same time, but it is important to realise that any project of this nature and scale requires just as much energy to manage the business change process as it requires to change the technical system. Even though the journey to a single RIS-PACS platform might have its challenges, it is our firm opinion that the benefits far outweigh the costs and the risks.

About Dr Johann Alberts

JJ AlbertsDr Alberts is a qualified medical doctor and his main clinical experience is in emergency medicine, both in the UK and South Africa. his experience includes private, public and military healthcare systems. In 2007 he made a career choice that deviated away from clinical medicine towards healthcare management. His passion is to design and implement healthcare services to ensure that more patients can benefit from what is already a scarce resource.

After completing an MBA at Oxford University, Johann joined BMI Healthcare as a Programme Director, where he managed four divisions that included Physiotherapy, Health Screening, Speech and Language Therapy and Occupational Health.

Johann joined Alliance Medical in 2012, first working at group level designing a quality strategy, implementing benchmarking and assisting on various projects around the company. At present Johann is directing the RIS-PACS implementation project, which will be completed in early in 2015.

Spreading the word about radiation protection

Jeanette Snowden

Jeanette Snowden

Lead Radiographer Jeanette Snowden, from Derriford Hospital, talks about the impact of delivering a BIR accredited radiation protection course at Kitale Hospital, Kenya.

There are many charitable organisations quietly delivering fantastic projects around the world with little fanfare. EGHO (Exploring Global Health Opportunities) and MEAK (Medical and Educational Aid to Kenya) work together to improve health in Kenya, focussing on trauma and orthopaedics, patient safety, hospital staff education and training, and community health. The aim is to teach and leave a legacy of education.

In April 2013 I was approached by EGHO, who wanted an imaging service delivered to theatres in Kitale District Hospital, West Kenya, which was new to the project. The hospital required an image intensifier (II) and an educational package, and the trip was planned for November 2013. My imaging department donated a II, which was collected and whisked into a container for its lengthy sea-bound journey within a week. The educational package required a bit of thought; I have been teaching radiation protection (RP) for a number of years to many professions, and I know it’s not the sexiest of subjects to teach– it does not have the attributes of, for example, ED trauma education, which can be dressed up with graphic photos and adrenaline. However, RP is essential training.

Listening to the experiences of radiographers who had provided imaging back up on previous orthopaedic EGHO trips to other Kenyan hospitals, I realised there was little interest from the local radiographers to continue the theatre imaging service Kitale signonce the project had returned to the UK. The image intensifier remained dormant, restricting the scope of surgical procedures and directly affecting patient care. However, I discovered that accredited courses with a certificate are held in very high regard within the Kenyan working community. Engaging the local radiographers and the theatre staff in the safe use of the II and RP was essential to the delivery of the project, and I believed a certified course, accredited by the BIR, would be the key to its success. With the support of the Clinical and Radiation Physics department within my Trust, and Andy Rogers, Vice President (External Affairs) at BIR and Head of Medical Physics at Nottingham University Hospitals Trust, I wrote a RP course, to include a practical session for the radiographers, an exam, safety signage and the all-important certificates. Rather brilliantly, the BIR accredited it.

MEAK team with Kitale staff, handing over the IIThe journey from the UK to Kitale took a slightly-longer-than-expected 36 hours, but the reception we received from the staff couldn’t have been more welcoming. The UK team arrived with over 30 cases of donated kit, and the staff set about finding storage in the fairly limited facilities. Nothing was too much trouble. The donated II had spent four months languishing on the docks in Mombasa awaiting Kenyan authorisation to travel to West Kenya, and to our relief was given the stamp of approval just after we arrived in Kitale. I spent a day travelling to collect it with a truck and a driver, and our return caused quite a stir – I had not known that this intensifier was only the second one in the whole of West Kenya – no one had seen one before, let alone know what it was capable of! Much to my amazement, given the journey it had just undertaken and how ‘temperamental’ they can be, the II worked the moment I switched it on. We were all set to go.

I delivered the RP practical training over a few days, given the space restrictions of theatre, but the Powerpoint presentation was attentively received by 23 candidates (3 radiographers, 15 doctors and all of the theatre staff), all crammed into a tiny staff room at 8.30am. I tested their prior and post-course knowledge, and am happy to report that all candidates significantly improved their RP knowledge. Practical training occurred during operative sessions, where all staff complied with the signage, maintenance of Controlled (Restricted) Area, and wearing of PPE. And-the theatre Charge nurse adopted the responsibility of supervising the area after the team returned to the UK. I trained a senior radiographer, Mr Okumu, in the specific use of the image intensifier.

Franklin's injury

Franklin’s femur before surgery

I cannot over emphasise the delight with which the imaging equipment was received by the local staff, nor the impact that it has already had on patient care. Franklin was one of our patients who had been on the orthopaedic ward in Kitale for over three months with a fractured femur, sustained during a motorbike road traffic collision. He had stones tied to his leg to act as traction. He told me he thought he was going to die in that bed.

Franklin's femur post-surgery

Franklin’s femur post-surgery

Using the II for guidance, the UK team were able to teach the local general surgeons how to implant a sign nail into Franklin’s badly-fractured femur. On our final ward round, we saw Franklin putting weight through his leg; a massive grin on his face, singing and high-fiving everyone in the team. He said we had saved his life.

 

II arriving in KitalleKitale District Hospital now has an imaging service in theatre, delivered by local professionals who have completely engaged in education accredited by the BIR.

Through this experience I have learnt a great deal, not least to truly appreciate, and not take for granted, the undeniable volume of work that has resulted in the high level of safety and the high quality healthcare system that we have in the UK. Jeanette is due to return to Kenya in April 2014.

To support radiography departments in Kenya visit her fundraising page http://uk.virginmoneygiving.com/JeanettteSnowden  

About Jeanette Snowden, Lead Radiographer for Theatre and Mobile Imaging at Derriford Hospital.

I look after over 35 theatres and 40 wards, including 4 critical care wards, and I am RPS for the whole area. I teach radiation protection at both Plymouth and Exeter Universities, to the student radiographers and to all amenable staff at Derriford! I love my job, and believe that every quality improvement should have a direct impact on the care that we give to our patients.

Reflection, Surface and Material – What Lays ‘Beneath the Transparent’

HughTurvey_3_VLAs X-Pose Material and Surface Xogram exhibition opens in London, X-ray artist Hugh Turvey uses the exhibition themes to explore ways we can improve hospital environment through art.

Reflection
Four years ago I staged my first large public exhibition titled X-perimentalist. I rather fancied myself as a pioneer and wanted to reach out, to establish an audience who would appreciate the aesthetic of science and the emerging modality arts. I had come from a photographic background and wished to gain momentum for my work, as the earlier photographic pioneers had done before…a matter of classification, understanding and appreciation.

HughTurvey_Xograms_655_LONDON OXO EXHIBITION 2014__0019_Layer Comp 20
So how did it turn out? Overwhelming, humbling and surprising …most notably an amazing relationship with the oldest radiological society in the world and a series of healthcare projects were born…I metaphorically became a dad again with a series of new challenges of language, communication and expectation to innovate a new visual concept of ‘transparency’ between practitioner and public. Modality art is the perfect medium that visually embodies the science and when presented artistically can elevate, educate and orientate.

Surface
Radiotherapy_UCH_HughTurvey_HiddenGarden_0012_Layer Comp 13The concept of revealing truth is one of the simplest structures in storytelling. Everyone loves a good story and the discovery of character hidden in sometimes the most unlikely places. When you read ‘cover to cover’ you physically move through the book absorbing matter on your journey. This absorption is compelling and second nature to us. You lose yourself in it.
But I find medical/healthcare environments not easy to read. The covers are not enticing, the pages are not printed correctly or in a language I do not understand and I can’t focus on the story line. I have orientation problems and am most happy when I put the book down.

As Professor Gary Royle, from University College London says “We should consider whether there are any innovative developments we can propose around patient experience, in particular for the paediatric patients. The hypothesis is that some studies have indicated that this can potentially have a positive effect on the patient mood / experience and so could be beneficial to the patients / treatments / staff.

HughTurvey_Xograms_655_LONDON OXO EXHIBITION 2014__0029_Layer Comp 30

And here’s an idea of what could be done……

1. Explore the creative potential in the area between medical knowledge, understanding and use of modality art and the artists’ understanding of images and their power to communicate.
2. De-mystify the processes and technology used in diagnostic imaging to help engage patients, increase their understanding of the science and to help staff in communicating with them.
3. Produce artwork that is meaningful and engaging for patients, staff and visitors.
4. Develop a pilot/prototype educational tools which can help radiology staff in their work and benefit patients and the wider radiology community nationally.
5. Further artistic discourse and the debates surrounding art and science collaborations.
6. Aim to contribute to a re-engagement between the public and contemporary biomedical imaging techniques.
7. Implementation of new immersive way-finding, signage, feeds and curated digital art systems.

Transparent
Four years later, I know less having now seen the bigger picture.

Visit the exhibition at:
Xpose
gallery@oxo, Oxo Tower Wharf, Bargehouse Street, South Bank, London, SE1 9PH
Dates: 12 February – 23 February 2014
Opening Times: 11.00am – 6.00pm
Admission: Free

About Hugh Turvey’s Xogram work
High Turvey is an artist with an international reputation. His Xogram work is held in public and private collections throughout the world. Bridging the gap between art and science, graphic design and pure photography, it has been utilised in myriad applications, including, commercially, for marketing and advertising, in TV and film and by architects and interior designers.

Along with developing a body of work for the Science Photo Library, Hugh Turvey has collaborated on an ebook and iPad app called ‘X is for X-ray’ launched at the Radiological Society of North America (RSNA) in Chicago. His Xogram work has also been widely featured in newspaper articles and magazines around the world.

Among his commercial projects, he has made six award-winning TV adverts, using ground breaking Motion X-Ray. For the past three years he has been working with Waitrose UK on celebrity chef Heston Blumenthal’s ranges and has had images commissioned by L’Oreal, Paris.

Special thanks to: Senior Radiographer Sasha Moore YDH + Imaging Dept, Prof. Gary Royle UCL, Dr. Martin Fry UCL, Julia Solano + Radiotherapy Dept. UCLH, Niki Whitfield + Gloucestershire Oncology Centre Cheltenham and all the other hospital Trusts currently touring the Wellcome Trust inr-i project.