Established in 2008 and operating from its head office in Truro, Peninsula Ultrasound is formed from the partnership and experience of clinical professionals with many years’ experience in healthcare and the NHS. The company offers the primary care sector a diagnostic service – ultrasound examinations – all performed in a quality, cost effective, rapid and community-driven method which is closer to a patient’s residence for convenience.
Specialising in general Ultrasound, Gynae, Neurology, Musclo-skeletal and Vascular examinations, Peninsula Ultrasound scans from 25 locations and is commissioned by Clinical Commissioning Groups (CCGs) to provide scanning services for Cornwall with acute support from Royal Cornwall NHS Trust. An ambitious company with impressive growth, Peninsula Ultrasound has developed quickly in a geographically broad area; from the Isles of Scilly to Okehampton, the scanning centre operates across the peninsular of the South West and has grown in staff and team resources between 20-50% per year – a measurable sign of the company’s reputation and efficiency.
Peninsula Ultrasound uses modern scanning equipment and IT systems to integrate patients’ clinical images and records across the NHS network; enabling accessibility for NHS secondary-care clinicians and central storage within the NHS framework. This ensures that patients receive a local scanning service but with autonomy and integration with their district hospital for cross-referencing, specialist diagnosis and treatment.
Hospital-based RIS brings limitations
In 2014, the scanning centre used a RIS from HSS on which to report and an Insignia PACS system to manage clinical images. The RIS connection stemmed from the main RIS of the local hospital, Royal Cornwall in Truro, and was initiated to meet both the localised needs of the patient and lessen the imaging workload for the Trust.
This subsidiary usage of the main hospital platform allowed some elements of radiology tasks to be carried out, such as attending on a patient and reporting, however the Trust software was not configured for effective use by a remote site. Karl Sturtridge, Managing Director for Peninsula Ultrasound, found that the configurable CRIS settings were not accessible for them remotely, meaning that workflow was limited and the autonomy and management of information was non-existent. This lack of custom configuration resulted in Karl and his team managing their appointments separately, using a work-around process which was more time consuming and practically, caused issues when staff could not access patient data until the appointment day. Karl comments:
“Our RIS workflow was a very manual and pieced-together process. Each function had to be implemented separately – such as attending patients and accessing worklists – with no integration between each process. What should have been a single tiered process was multi-tiered with too many steps and room for error.”
In addition, Karl felt that Peninsula’s own commercial interests were not a priority in the current IT set-up; changing the process configurations was challenging in terms of timescales and, from a business perspective, the hosting Trust had full control of the RIS statistics and Peninsula’s performance data which posed a degree of commercial risk to a private company. Similarly, when Peninsula extended their services to several other NHS Trusts in Devon, new workflow challenges were introduced as synchronisation with these required additional configuration requirements (creation of rooms within the RIS) which could not be adopted with the current application.
Peninsula seeks localised RIS
Recognising the scope for improvement, Karl, together with Radiographer Alan Brimacombe, sought RIS vendors at UKRC (a national Radiology conference) for a system demonstration and recommendation. One software developer offered a RIS application which Peninsula adopted on a trial basis, but they were disheartened by the unreliability and slowness of the connections between both remote offices and from the main Peninsula office in Truro. The extent of this deficiency was so extreme that the whole operation experienced periods of downtime where nobody could work at all. As a small company with limited support resources, Karl and the team battled constantly with a failing system which offered little improvement on the previous CRIS system.
In 2015 the centre was carrying out over 25,000 examinations a year, and so Karl decided that the growth of the business warranted their own in-house hosted imaging workflow and identified that the company needed a more proficient solution to carry out procedures correctly and professionally. Previous systems’ failings had ascertained for Karl that he wanted a both solution and a vendor that was reliable. In addition, the new RIS had to be easy to use for his team, encompass workflow functionality and scalability to support the growth of the business. Importantly, integration qualities were also a priority; they required an IT infrastructure which was both embedded in the local hospitals but also offered new elements of clinical intuition and technical functionality hosted locally at their own Truro site.
Radiology+ from Soliton IT meets requirements
Karl sought guidance from three leading suppliers, initially seeking re-configuration of their existing CRIS system to allow for more control for Peninsula. He was met with frustrations in appointing a system that could fit their bespoke requirements and was cost-proportionate to the site’s size and privately funded set-up. Finally, in 2016, Peninsula contacted leading RIS developer Soliton IT for a system demonstration on their defining RIS, Radiology+.
Radiology+ is a workflow-driven application which incorporates the management of clinical images, patient planning, resource management, results distribution and statistical analysis all in a concise and content-rich interface. Formulated specifically for Radiology, its advanced workflow dynamic, including modular features which can be customised for both the scanning centre and individual users, allows not only the data collection of a standard RIS but also multi-site data sharing, patient scheduling and graphical statistical analysis for creating custom reports on inter/intra site operations and performances. Also integrated into the system is a flexible rules engine which allows users complete configuration control; workflows can be built, adjusted and customised according to site or departmental requirements.
Impressed with the flexibility of the system and development experience demonstrated by Soliton IT, Peninsula Ultrasound opted for Radiology+ for roll-out and inter-connectivity across their 25 sites. Karl comments:
“The biggest attraction for me was to have complete control of our operation. Being able to set up the clinics, manage worklists and tailor this to what was required. That was the difference with Radiology+ and Soliton IT – intuition. Someone has really given these processes thought and set about developing it effectively.”
Peninsula Ultrasound went live with Radiology+ in September 2016 with a “big-bang” implementation as opposed to the originally planned spread-out schedule; due to the smooth deployment and expert project management, the date for go-live was brought forward and staff were eager to start using the new technology. Integration with the Insignia PACS was not only fluid, but even resulted in improved worklist autonomy. Alan Brimacombe comments:
“Before, the lack of worklists meant that we had to manually type in the patient details which was laborious, caused errors and was time-consuming in a point of care environment – overall placing unnecessary pressure on Radiographers. Any errors incurred then marred the integration with PACS; the PACS didn’t recognise the patient being scanned. Now, Radiology+ automatically sends out the patient detail and the ultrasound machine would receive it – all the patient demographics would be already on the machine.”
With total staff adoption across their team of 30, including 12 Reporting Radiographers, Peninsula Ultrasound is already seeing the advantages of a truly integrated and intuitive RIS.