Industry data, such as the Royal College of Radiologists’ (RCR) 2020 annual radiology workforce report, shows that the UK radiologist workforce is now short-staffed by a third (33%), with the shortfall expected to hit 44% by the end of 2025. As a result, 70% of radiology clinical directors feel they do not have enough radiology consultants to deliver consistent care, and in order to bridge the gap between service delivery and demand, NHS trusts routinely rely on outsourcing, locums and overtime.
Reportedly, there is an ever-increasing demand on the radiology services, but the number of radiologists retiring is higher than the number of entrants into the profession. This meant that a large proportion of imaging studies acquired in Yorkshire were being reported by outsourcing companies, which is more expensive and administratively laborious than using an in-house resource.
The Collaborative found that the problems caused by the disparity between service demand and capacity were enhanced by the integration challenges between the multiple regional PACS. The lack of interoperability meant that trusts were forced to rely on an Image Exchange Portal (IEP) – a national image transfer service – which clinicians had found to be unstable at times. If a Consultant thought that a patient had imaging services performed at another trust and wanted to view these images, they had to contact their administration team for access. The administration team would contact the trust where the image might exist, ask them to search for it, and then send it via the IEP. From start to finish, this process would take between 24 and 48 hours, and so the IEP platform was particularly unsuitable in emergencies.
Market research associations estimate that the number of ‘suboptimal’ scans (with poor quality imaging) is approximately 20%, with outdated methods of image sharing being a significant factor. In some instances, trusts were burning images onto a CD and sending them in a taxi to save time, but in most cases, clinicians would instead re-examine the patient to save time. This was not only disruptive for patients, but it also meant unnecessary exposure to radiation.
With the contracts for several PACS systems across the region set to expire, and the YIC already committed to a joint procurement approach, the Collaborative considered how it could improve image sharing as a group. The trusts initially considered procuring one PACS, however, this wasn’t feasible due to geography challenges, so the Collaborative began looking into ways it could work differently to solve the problems. The ambition was total interoperability between each of the region’s PACS.
Dr. Daniel Fascia, Clinical Lead for the Yorkshire Imaging Collaborative, said: “With multiple contracts up for renewal, we quickly recognised the opportunity to do more than just replace existing technology. There was the potential for bigger disruption, to rethink how we delivered radiology across the region. Everything was in place for us to enact real and lasting change.”