Electronic Integration in the HSE

Vorsprung

Starting 2 threads in one day, jesus I'm mad :pac:

While contacting a distant hospital today to get some CT images sent over for one of our patients who had been transferred over, I thought about the lack of integration within the HSE, and decided to have a little read.

So I came across this page on the HSE site. Not a whole lot of info, the rollout calendar only told of the 1st three hospitals who'll get the system (including Beaumont - can't believe they don't have PACS) and the press release link didn't work.

I'm a little confused about this project - anyone know anything about it? It seems like they're aiming towards a PACS rollout with ability to electronically transfer images. Presumably this will involve the use of a single system (eg by Siemens or Agfa) but will this system work with the existing systems the hospitals currently equipped with PACS operate? Are there any plans for GPs to have access to such a system?

On a related note, are there any plans to set up a nationwide labs database? Queensland uses a system called Auslab (being updated to a Windows system called Auscare) that works well. It would be nice to see something similar at home.

bleg

This is what you want

http://en.wikipedia.org/wiki/Microsoft_Amalga

lonestargirl

bleg wrote: »

This is what you want

http://en.wikipedia.org/wiki/Microsoft_Amalga

You don't need that, any decent modern PACS system uses DICOM and should be able to be transferred to any other system.

@ Vorsprung, I know a bit about this project. I'm in work at the moment but I'll come back later and fill in some detail.

lonestargirl

Ok, so I was never involved in this project but I worked in one of the initial hospitals and some of our clinical engineers were heavily into it. The contract went to McKesson.This is much bigger than the simple implementation of PACS in these hospitals, it is the beginning of the roll-out of a national intergrated medical imaging system. There are a couple if steps needed to make this happen:
1) the acquision of images needs to be digitised
2) need a structure for the integration, management and storage of the data.
3) need appropriate equipment for the viewing of the images - just because you can get a DICOM viewer for an iPad does not make it an appropriate screen for viewing these kinds of images
It is envisaged that when the project is complete that you will be able to access any imaging from any hospital at any other hospital. There are plans for GPs to be able to integrate within the system eventually, exactally how I'm not sure (it would be great if they could submit imaging orders directly).

I'm not surprised that Beaumont doesn't have PACS yet, it's such a big hospital it's a very big project to implement. Obviously they must, by definition, have a PACS-esque system for their volumetric imaging but it's the plain film that causes the problem as you have replace a lot of equipment. In fact Beaumont already has a tele-link with St. Luke's for sending MRIs directly, as we need CT-MR fusion for RT planning in the brain. St Luke's was one of the first hospitals too as it already handles a huge amount of imaging with very little plain film and all their plain film is digital already (i.e. they already have an internal PACS systemich doubles as a contouring system for RT). I think Sligo was selected as they didn't want to take on another big hospital as well as Beaumont.

Vorsprung

Thanks for that LSG. GPs having access to the system would be a nice touch. If Xray facilities get set up in Primary Health Centres, I wonder if they'll be uploaded to the national system as well.

Do you have any idea of the timescale for the project?

lonestargirl

Tbh, I'm slightly removed from the information loop these days. I used to get updates at departmental meetings, lunch chats etc but I've been in the US for a year now.

The GP part of the scheme is much further down the line. There are 2 possible ways to make it work: a simple RIS system which allows online orders and for radiology reports to be delivered electronically or full access to the PACS system with the option to actually view the images.

Also, given what has transpired with radiology services in Tallaght a properly designed PACS/RIS system would almost eliminate the possibility of this kind of situation happening again, i.e. if a consultant logs in it should produce an inbox of all the reports written by their team for them to counter-sign.

Vorsprung

Bit of good news for renal patients from imt.ie

New IT system for renal patients

The HSE and hospitals funded by it have invited tenders to supply, deliver and install a Kidney Disease Clinical Patient Management System (KDCPMS), initially in selected hospitals. The KDCPMS will facilitate the clinical management of all patients with kidney disease from first presentation to a renal centre, right through to renal replacement therapy.

The KDCPMS will provide a framework for performance monitoring in renal care provision, comparative clinical audit, enhanced delivery and quality of care, strategic planning and effective resource utilisation.

The successful suppliers must interact with third-party vendors in delivery of all interface requirements with associated cost, the HSE said.

Hopefully the cost will be reaonsable, and will provide a template for management of other chronic diseases

RobFowl

Vorsprung wrote: »

Thanks for that LSG. GPs having access to the system would be a nice touch. If Xray facilities get set up in Primary Health Centres, I wonder if they'll be uploaded to the national system as well.

Do you have any idea of the time-scale for the project?

GP IT systems are quite advanceds at this stage. At present we can access blood and radiology reports on-line. We can also refer to a limited number (so far) of OPD clinics. The ICGP and HSE currently approve GP soft ware and it has the capability to do a lot more than it does.

It would take much more for the GP software to link in far more closely.

One quick issue re X ray facilities in Primary care centres is that they are quite expensive to build as the wall have to effectively lead lined. I'm personally not convinced in an urban setting there is any huge advantage in moving them out of secondary care facilities.

lonestargirl

RobFowl wrote: »

One quick issue re X ray facilities in Primary care centres is that they are quite expensive to build as the wall have to effectively lead lines. I'm personally not convince in an urban setting there is any huge advantage in moving them out of secondary care facilities.

I agree that in most situations referring people to the local hospital is probably most effective. You don't need lead-lined walls for diagnostic x-ray equipment though, barium plaster would be fine usually.

lonestargirl

RobFowl wrote: »

. At present we can access blood and radiology reports on-line. We can also refer to a limited number (so far) of OPD clinics.

I didn't know this. Presumably the number of hospitals at which you can do this is limited?

RobFowl

lonestargirl wrote: »

I didn't know this. Presumably the number of hospitals at which you can do this is limited?

It is but the number is increasing all the times and where I'm based covers the majority. They include Beaumont, the Mater, St Vincents, St James, Limerick and the Mater private. It's via a secure system called healthlink (based in the Mater).
We can refer the the Breast clincs locally as well as neurology in St Vincents and the Lung cancer clinic 's but the number of these are increasing. Saved time at GP's end and the cost of paper referrals and correspondence. Also sometimes you can get an appointment back very rapidly.

http://www.healthlink.ie/services.htm

RobFowl

lonestargirl wrote: »

I agree that in most situations referring people to the local hospital is probably most effective. You don't need lead-lined walls for diagnostic x-ray equipment though, barium plaster would be fine usually.

Didn't know that thanks.
I was going on memory based on the build costs for various different spec's of health care facility and radiology and AE units were the most expensive. (Probably cheaper now of course :rolleyes:)

locum-motion

RobFowl wrote: »

GP IT systems are quite advanceds at this stage...

Rob, I don't know what system you use, but on the evidence I see (ie. computer printed prescriptions presented in the pharmacy), GP systems leave alot to be desired!

I regularly see prescriptions calling for things like 0.133333333 tablets to be dispensed, or a dose of 'twice daily at night' or 'three times daily in the morning', or mis-spelled drug names and long-discontinued preparations because the database the programmers used is hopelessly inadequate and many years out of date.


(Although, I concede that at least some of those problems could be caused by the user not using the computer properly)

lonestargirl

RobFowl wrote: »

It is but the number is increasing all the times and where I'm based covers the majority. They include Beaumont, the Mater, St Vincents, St James, Limerick and the Mater private. It's via a secure system called healthlink (based in the Mater).
We can refer the the Breast clincs locally as well as neurology in St Vincents and the Lung cancer clinic 's but the number of these are increasing. Saved time at GP's end and the cost of paper referrals and correspondence. Also sometimes you can get an appointment back very rapidly.

http://www.healthlink.ie/services.htm

This seems great, I'm sure an added benefit for you is that you know that the referral has reached the place it should have (remember those unopened DI referral letters in Tallaght)

RobFowl

locum-motion wrote: »

Rob, I don't know what system you use, but on the evidence I see (ie. computer printed prescriptions presented in the pharmacy), GP systems leave alot to be desired!

I regularly see prescriptions calling for things like 0.133333333 tablets to be dispensed, or a dose of 'twice daily at night' or 'three times daily in the morning', or mis-spelled drug names and long-discontinued preparations because the database the programmers used is hopelessly inadequate and many years out of date.


(Although, I concede that at least some of those problems could be caused by the user not using the computer properly)

I suspect the systems doing that are the older ones which are no longer GPIT approved (an ICGP and HSE working group).
I use "Socates" and it's updated every 2 weeks with the up to date ? IPU list of medications.

Health one and one other whose name i can't recall are the other approved ones. There are at least 3 other out there which are not approved .

locum-motion

RobFowl wrote: »

...
I use "Socates" and it's updated every 2 weeks with the up to date ? IPU list of medications...

The IPU database is pretty much as accurate and up-to-date as is possible. There are about four (whole time equivalent) people employed to keep it so. The updates are released (to pharmacies, at any rate) monthly.

pclancy

Hi all,
Old thread I know but just wondering how Ireland is doing with electronic integration between PACS or other systems across hospitals. Any EHR integration as well?

Working in the field of breast cancer imaging and playing around with DICOM tags and servers etc, anyone here into anything similar?

magicherbs

i am working on a cancer database but very early stages.

lonestargirl

pclancy wrote: »

Hi all,
Old thread I know but just wondering how Ireland is doing with electronic integration between PACS or other systems across hospitals. Any EHR integration as well?

Working in the field of breast cancer imaging and playing around with DICOM tags and servers etc, anyone here into anything similar?

NIMIS has been rolled out in a number of hospitals to date, you can watch a webinar on it on the IIRT website. I work in rad onc where DICOM RT is our standard, I try to stay away from getting involved in editing headers etc.

magicherbs wrote: »

i am working on a cancer database but very early stages.

Intrigued, what will you be recording?

pclancy

Who are the big PACs players in Ireland? Sectra? Carestream? McKesson?

drzhivago

pclancy wrote: »

Who are the big PACs players in Ireland? Sectra? Carestream? McKesson?

Mckesson

Vorsprung

Apologies for dragging up an old thread (thought I'd keep it all in the one place...)

Portlaoise has just been linked into NIMIS. I've only started using it since Christmas but it's a great system, albeit long overdue, and I've love to see it extended to lab/cardiac/pulmonary neurophysiology and other results and outpatient correspondence (don't worry, I'm not holding my breath).

Anyone have an update on which hospitals are left to connect to the system?

lonestargirl

Mullingar and Kerry general connected recently. I think it's supposed to be finished by June but a couple of big centres, e.g. Tallaght, haven't connected yet. We get a lot of external radiology in on CD and it all gets loaded on NIMIS so it does now contain scans taken in centres outside of the project itself.

Vorsprung

lonestargirl wrote: »

Mullingar and Kerry general connected recently. I think it's supposed to be finished by June but a couple of big centres, e.g. Tallaght, haven't connected yet. We get a lot of external radiology in on CD and it all gets loaded on NIMIS so it does now contain scans taken in centres outside of the project itself.

Good to have the external radiology on it. Will private providers be connected? Did Vincent's sign up to it in the end? I saw a list written a few years ago but remembered they weren't on it.

L1011

http://www.healthlink.ie/news.htm usually has updates about who and when hospitals go live on NIMIS but they haven't had a comprehensive newsletter since December.

Private providers already can (and some do) send HL7 formatted radiology results over Healthlink so there should be few reasons they couldn't connect to NIMIS also. If we do move to a insurance based model, having a system that's "national" for only state-controlled providers when people are able to go anywhere on state insurance would be ridiculous also.

masterboy123

Waterford regional hospital has NIMIS since I am working there (early 2014)

Dingle_berry

Vorsprung wrote: »

and I've love to see it extended to lab/cardiac/pulmonary neurophysiology and other results and outpatient correspondence (don't worry, I'm not holding my breath).

Never heard of this NIMS system in work but there is a national MedLIS (lab information system) project underway. I think the Vincent's & mater regions are to be the pilot sites. Dr. Miriam Griffin is the project lead I think. And of course just because the LIS can acess national info doesn't mean that the information will be available on wards etc or released by local Lab staff.