Affiliated Teaching Hospital
BOARD OF DIRECTORS:
25th NOVEMBER 2016
AGENDA ITEM:
9.5
SUBJECT:
EMRAD IMPLEMENTATION AND RADIOLOGY
BACKLOG
RESPONSIBLE DIRECTOR:
Clare Culpin, Director of Strategic Development and
Corporate Governance & Deputy Chief Executive
AUTHOR:
Vicki Arnold, Director of IT and Tracy Reid, General
Manager Clinical Support Services
PREVIOUSLY CONSIDERED BY:
Quality Governance Steering Group, Trust
Management Committee, Integrated Governance
Committee
EXECUTIVE SUMMARY:
This paper provides an update on the progress with the implementation of the EMRAD
radiology system and the radiology backlog.
ACTION REQUIRED:
RISK TO THE TRUST (include reference
to BAF or Corporate Risk Register)
WORKFORCE ISSUES:
(including training and education implications)
EQUALITY & DIVERSITY
(What ‘Due Regard’ has been given to
protected groups, as regards to compliance
with the Equality Act, 2010?)
FINANCIAL IMPLICATIONS:
For information of the current position and action
being taken.
SR5 The Trust does not have information systems to
rely on which may impact on the quality of data to
manage effective decision making.
SR7 Workforce challenges relating to recruitment and
retention and staff experience.
Staff engagement and productivity due to the
challenges of using a system that is challenging
The new EMRAD system aims to ensure equality of
service for patients across the region.
Increasing cost of reduced productivity.
Specify No/Yes (Detailed within the report).
COMMUNICATION/CONSULTATION
ISSUES
(including patient and public involvement)
STRATEGIC OBJECTIVE:
(specify trust strategic objective)
CQC DOMAINS





Communication across the EMRAD is regular with key
stakeholders. In addition the Trust is communicating
with GP’s. The Trust is also dealing with inquiries from
patients
To provide appropriate and high quality care to
individuals, communities and the population we serve
and To be a strong effective partner in the wider
health and social care community
Safe, Effective, Responsive
safe.
effective.
caring.
responsive to people’s needs.
well-led
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EMRAD IMPLEMENTATION AND IMPACT ON RADIOLOGY BACKLOG
1.
INTRODUCTION
The Board of Directors have been provided with monthly updates regarding the
implementation of the new radiology and PACS systems as part of the East Midlands
Radiology (EMRAD) consortium vanguard. The impact of a number of technical
issues associated with the implementation has affected the level of radiology
reporting and has resulted in a reporting backlog.
2.
SUMMARY
In summary the cutover to go-live commenced on w/c 30th May 2016 and the Trust
went live on the afternoon of Sunday 5th June 2016.
An updated position for the technical issues reported in previous months is outlined
in the table below:
Issue
Lack of ability to
transfer images for
reporting to 3rd
party (4Ways)
User
access/productivity
Action taken
Residual risk
NOW RESOLVED
However intermittent technical problems,
on Trust, GE Healthcare and 4Ways
infrastructure, have impacted on
outsourcing volumes during October.
NOW RESOLVED
October 2016 – in response to GE
Healthcare diagnostic investigation into
the error 400 messages (eRC instability),
the Trust IT and Intrinsic Technology
(network managed service provider)
identified a number of improvements to
the Trust’s local area network.
Radiology
services are
processing the
outstanding MRIs
Loss of
productivity
impacting on
internal reporting
capacity.
Maintaining
engagement.
Improvements were implemented w/c 10
October 16, with noticeable improvement
in system stability is now being reported.
On-going monitoring continues.
Unable to view
studies from one
MR scanner within
PACS
None
NOW RESOLVED
All cases have now been reported.
Residual issues affecting transfer of this
batch of images via IEP remain with GE
Healthcare to resolve.
2
Further to the N3 upgrade which took place on 10th October 2016 (100meg
(primary)/100meg (secondary), on 7th November 2016, all non-PACS and Radiology
traffic was moved onto the second, active 100meg N3 connection.
The Trust was already dealing with a radiology reporting backlog prior to the cutover,
and since the introduction of the new system this has been further increased. Below
is a summary of the current position. The reduction and removal of the reporting
backlog continues with a completion date aimed at January 2017.
Figure 1: Current Radiology Backlog position
Modality
Number waiting
Waiting time for report
A&E plain film (Limbs)
A&E plain film (CXR /
AXR)
0
2805
Up to date
16 weeks +
OP plain film
5580
17 weeks +
GP plain film
550
10-14 days
MRI urgent
7
7-10 days
MRI 2ww
0
Allocated daily for report
CT Urgent
0
7-10 days
CT 2ww
0
Allocated daily for report
MRI routine
1637
11-12 weeks
CT routine
261
7 weeks
3
3.
GOVERNANCE
The Trust and EMRAD continue to closely monitor the situation as stated in the
previous reports. This includes weekly operational meetings, Trust Steering and
oversight meetings and EMRAD consortia board. In addition, a Board Assurance
group chaired by Mr Ramsden NED met in August and September with a follow up
meeting planned for November.
In summary since the last report:

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

The Trust continues to pursue the resolution of the technical issues including
improvements to the Trust’s local and wide (N3) area networks.
Outsourcing of cases to 4Ways has improved which is stabilising and helping to
reduce the level of reporting backlog.
o Plan in place to clear backlogs by January 2017
o Intermittent technical problems (on Trust, GE Healthcare and 4Ways
infrastructure) have impacted on outsourcing volumes during October.
o Recovery trajectory delayed by around 3 weeks
A second teleradiology provider (RRO) has been identified and plan to start
referring backlog work as soon as the IT links are set up (estimated end Nov)
There are currently 66 documented cases where potential harm has been
identified at the reporting stage. Harm reviews have been completed on 58 of
these.
o 1 harm confirmed (SIRI as reported last month).
o 25 confirmed as no harm
o 20 low harm – clinical confirmation required
o 1 moderate harm – for clinical review
o Harm reviews to take place on remaining 19.
VICKI ARNOLD
DIRECTOR OF IT
TRACY REID
GENERAL MANAGER FOR CLINICAL SUPPORT SERVICES
4