By Tony Collins
After fracturing my angle (slipping on a slope while mowing the lawn) I’ve been surprised how well parts of the NHS work – but not when it comes to the electronic transfer of records and PACS x-ray images from one trust area to another.
The minor injuries unit at one trust wasn’t able to send its PACS images to another trust’s orthopaedic department because it used a different PACS. [The NHS has spent more than £700m on PACS ]
“Can’t we email the images?” said a senior nurse at the minor injuries unit. In reply the clinician looking at my x-rays gave a look that suggested emailing x-rays was impossible, perhaps for security and cost reasons. [PACS images are sometimes tens of MBs.]
In the end the minor injuries unit (which within its own sections shared data electronically) had to download my x-rays onto CD for me to take the other trust’s orthopaedic department. The CD went into a carrier bag.
The next day, at a hospital with an orthopaedic department, after 4-5 hours of waiting in a very busy A&E, I gave a doctor the CD. “I don’t think we can read that,” he said. “We don’t have any computers which take CDs.”
After a long search around a large general hospital the tired doctor eventually found a PC with a CD player. Fortunately the minor injuries unit had downloaded onto the disc a self-executing program to load the x-rays. Success. He gave his view of the fracture.
Even then he didn’t have my notes from the minor injuries unit.
Comment
My care was superb. What was surprising was seeing how things work – or don’t – after the NHS has spent more than £20bn on IT over the past 20 years.
The media is bombarded with press releases about IT innovations in the NHS. From these it’s easy to believe the NHS has the most up-to-date IT in the world. Some trusts do have impressive IT – within that trust.
It’s when records and x-rays need to be transferred outside the trust’s area that the NHS comes unstuck.
As a nurse at my GP’s practice said, “Parts of the NHS are third-world.”
Since 2004 billions has been spent on systems to create shareable electronic patient records. But it’s not happening.
Within those billions spent on IT in the NHS, couldn’t a little bit of money be set aside for transferring x-rays and patient notes by secure email? That’s the real innovation the NHS needs, at least for the sake of patients.
In the meantime the safest way for x-rays and notes to be transferred from one trust to another is within the patient’s carrier bag.
Campaign4Change 
There are ways of transferring images. Most trusts belong to the Image Exchange Portal which does support electronic transfer of images. This is used every day by most Trusts for cancer care and for tertiary work. CDs are produced to give to patients and for legal work but there are other and better processes that are routinely used for the vast majority of transfers.
Hope you get better quickly
LikeLike
Thanks. I guess the message about the Image Exchange Portal hasn’t reached all the minor injuries unit/orthopaedic front lines yet.
LikeLike
I will repost to correct the typo: “how many could HAVE HAVE been given the care and treatment that humanity expects”.
LikeLike
This article highlights the very real need for change that this site promotes. The dichotomy of the £700m spent by taxpayers on PACS, and the comically low-tech method of accessing the data (CDs, carrier bags) is shocking, and should serve as a wake-up call to NHS trusts and the British public alike.
Despite the frittering away of £20bn on IT over the last 20 years, or perhaps because of it, the NHS seems to be no more skilled at patient diagnosis and care than it was in the pen-and-ink days. It’s actually worse. So much for computers.
One wonders how many people could have been cured; how many could have been given the care and treatment that humanity expects; how many would still be here today, had £20bn not been wasted in such a way?
The now discredited and banned Liverpool Care Pathway (LCP) – by all accounts a money-saving scheme to kill-off the elderly, free-up beds and to receive financial incentives for doing so – can now be re-evaluated as a way of offsetting the financial profligacy of misguided NHS IT projects. I think, anyway.
I hope your ankle recovers.
LikeLike
I remember Fujitsu saying (at HC in Harrogate) “interoperability wasn’t in the specifications”..
LikeLike
Thanks Mary. All the more reason perhaps for the NHS to use secure email to transfer images between trusts. It won’t be cheap to transfer large files but probably much cheaper than trying to make PACS compatible
LikeLike
If images were to be transferred between Trusts by secure email – which I suppose means NHSMail? -what are the implications for bandwidth, the N3 reprocurement and the rest of traffic using NHSMail?
Goodness knows it was slow for GPs (“GP enterprise systems are not part of Spine services”) before I retired – and now most GP systems are remotely hosted…
LikeLike
It’s a good point but the demand for x-ray images to be transferred outside a trust’s PACS region is limited. Large sums are still allocated to NHS IT – some trusts seem to take it in their stride when they spend more than expected (sometimes millions more than expected) on a new PAS – so would it be such a financial burden if the email system and spine were enhanced to allow the transfer of large files?
LikeLike
Two things:-
With increasingly specialised tertiary Trusts and referral networks, *would* the volume of traffic be limited – and not ever increasing?
And whose budget would suffer to allow expansion of N3 & NHSMail (which are centrally funded) to handle the very large files involved?
(GP2GP record transfers often cannot manage all their attachments because of planned bandwidth restrictions)
LikeLike
An expansion of N3 and NHSMail should be centrally funded. There is no reason trusts should be financially worse off for transferring large files out of their PACS area for the benefit of patients. The Dept of Health can find the money when it wants – it found about £9bn for the NHS IT programme including large sums on consultancy, foreign trips, hotels, self-promoting marketing DVDs etc.
LikeLike
Thanks Dave – well spotted. Little has changed on sharing PACS images since 2009.
LikeLike
Tony – Good luck with the healing and best wishes for a full recovery.
You have already covered this very same topic back in 2009 (via Computer Weekly):
http://www.computerweekly.com/blogs/public-sector/2009/09/pacs—the-saviour-of-the-127b.html
LikeLike