EI provided the trusts with a unified imaging platform, complete with clinical tools, reporting functionality and a powerful workflow engine to maximise productivity. XERO, a web-based platform, offered clinicians the ability to share images with other XERO users across Yorkshire, as part of a new ‘XERO Exchange Network’ (XEN). “Enterprise Imaging is designed for our radiologists,” explains Bontoft. “It is extremely functionally-rich, and it will help us to meet the increased demand for our services. But the most important part of this project is XERO, because it moves us one step closer to achieving total workflow interoperability.”
The implementation process was divided into two phases.
Phase one saw the introduction of EI, starting with the Harrogate and District NHS Foundation Trust on 28th April 2018. The YIC planned to have all of its trusts live with the EI by the end of 2020, but the project has slowed as a result of the Coronavirus pandemic. Nonetheless, the YIC pushed forwards with its plans for phase two, to rollout the XERO Exchange Network. “All of our other programmes put on hold”, says Bontoft. “So I immediately took the opportunity to go and see my Programme Director and make a case for advancing the deployment of the XERO Exchange Network. I knew that radiology would be quieter than other departments because patient and routine appointments had stopped, and a lot of the routine imaging had stopped too. It was the perfect time for me to get hold of all of the people I needed and get them testing the new system.”
Early in 2020, the YIC began to connect the individual instances of the XERO Image Viewer at each site to form the XERO Exchange Network across eight trusts, as well as the recently established NHS Nightingale Hospital Yorkshire and the Humber. The network was live within four weeks. “We recognised the need to support each other, in particular, with the launch of the Nightingale Hospital Yorkshire and the Humber”, says Fedell. “If we needed to treat a high volume of patients at the new site, we would need the support of other radiologists across the region to support with the increase in patient volume, and we were so close to going live with the project anyway, we just turned it on.”
Bontoft adds: “XERO gave us the flexibility to plan for worst-case scenarios. If one of our hospitals had to be shut down because of COVID, we knew that wherever we transferred patients to — whether that was the Nightingale or another trust — it wasn’t a problem because the imaging could be seen anywhere.”
The implementation ran smoothly, particularly given the scale and uniqueness of the project. “We are the first to use the XERO Exchange Network”, explains Bontoft. “And we are the first group of trusts in the country to facilitate image sharing across an entire region. We are paving the way, and when you’re the first to do something you expect to encounter some issues. “But any issues we had are now resolved, thanks to the support of Agfa. From the beginning of our relationship, they have been responsive; they have talked to clinicians, and they have gone out of their way to build a solution that’s right for us. It has been a very collaborative experience.”
Empowering the workforce. Improving patient care
The impact of the XERO Exchange Network has been immediate, with the new image sharing capability helping staff and patients to navigate the complex conditions resulting from the COVID–19 pandemic. “During a pandemic, you don’t want patients coming into hospital unnecessarily”, explains Viner. “So one of the main benefits of the XERO Exchange Network has been quickly seeing if a patient has been imaged somewhere else and preventing repeat appointments.
“Rather than going through the process of transferring images from one place to another, I can look into other PACS systems across the region, without having to transfer anything. I have rejected and cancelled multiple imaging requests because I’m so much better informed.”
Avoiding unnecessary repeat examinations also provided financial benefits for the YIC trusts, but Viner and his colleague consider the improvements to patient care to be the most significant. “In emergencies, we now have the imaging immediately available, so there is no delay in patient care,” he explains.
“I have also had instances where a patient has been scanned, and we’ve noticed an abnormality. XERO has allowed me to look into other PACS across the region to get a more complete view of the patient’s imaging history. This means that we don’t need to concern the patient by unnecessarily re-investigating something that’s already in their records.”
Bontoft adds: “It’s reassuring to know that our consultants now have access to previous images. It gives them the confidence to know whether or not something they have spotted has been identified before, which prevents patients from being recalled to hospital and facing unnecessary exposure to radiation. But not only is it saving time for patients and clinicians, it is also leading to better clinical decision-making and better patient outcomes; clinicians have far more information than they had before, at the click of a button.”
The XERO Exchange Network has also provided significant time-saving benefits on administrative tasks, with less time spent transferring images via the IEP. “XEN cuts out administrative work”, explains Fedell. “Across all of our trusts, we had half a dozen people just moving images around — but now we can begin to scale back that resource and invest elsewhere.”
With fewer radiology patients during the peak of the national lockdown (March-May), trusts across the region were able to minimise their radiology backlogs, and no longer had to rely on outsourcing companies for support. But, as the number of COVID–19 cases declined, attention turned to restarting normal clinical services, and with it, the demand for radiology services started to increase.
“Demand has already started to increase as more people start coming to hospitals again”, explains Fedell. “And with more people visiting hospitals, we expect the demand for radiology services to exceed pre-pandemic rates. But XERO means that we can respond differently to sudden increases in patient volume, and it will become even more important as we come into different phases of the NHS recovery plan. Because of XERO, we have more capacity and a better understanding as a whole, rather than as individual trusts.”
The rollout of XERO has also allowed the YIC to restart some of its services more efficiently. “We’ve been using the Nightingale hospital for outpatient appointments, which has allowed us to restart our Oncology list”, explains Bontoft. “Three of our trusts are sending patients to be imaged at the Nightingale, those images are then reported on at the ‘home’ trust — without the XERO Exchange Network we wouldn’t be able to do that.”