In August 2007, the HSE initiated the National Integrated Medical Imaging System (NIMIS) project to implement the Picture Archive and Communication System (PACS), with Radiology Information System (RIS) and Voice Recognition (VR) into 33 hospitals across Ireland.
PACS and RIS systems are at the heart of radiology departments, where patient images and reports are stored and distributed electronically. McKesson and the HSE began working together in 2010 to significantly re-engineer Ireland’s radiological imaging services through the delivery of the NIMIS programme.
The successful deployment of NIMIS would result in a filmless and paperless radiology service, enable secure, rapid movement of patient image data throughout the health service, and allow doctors to view their patients’ diagnostic images quickly and easily, anywhere, anytime; electronically.
In diagnostic imaging a patient may require multiple examinations, from simple X-Rays to advanced CT and MRI scans, all must be interpreted, stored and shared across a number of healthcare services and professionals. Medical imaging technology is designed to operate optimally in a digital environment and has moved to a point where all new medical imaging systems now acquire their images digitally.
The NIMIS Solution
NIMIS creates a framework for the delivery of radiology services across the country. A centralised database will manage 3.5 million studies annually and support the provision of radiology services to approximately 4.2 million patients across Ireland. The system architecture will enable hospitals to achieve cost efficiencies, improve the quality of patient care and increase levels of productivity and efficiency.
The implementation of NIMIS represents a notable step towards ensuring the highest patient safety standards, with wide reaching impacts that will contribute considerably to the experience of patients, healthcare professionals and radiology staff, as well as the operational workings of the entire hospital system.
The McKesson RIS/PACS is integrated with many of the HSE clinical data systems, data is stored and retrieved from a centralised data repository. Local data is replicated to the central data repository for archiving and on-demand distribution. All hospitals have real time access to images, even those acquired at other locations.
NIMIS also provides clinicians with a voice recognition reporting solution for instant clinical reporting, advanced 3D diagnostic tools for image manipulation and exploration, Orthopaedic templating solutions for pre-operative planning and radiation dose tracking tools.
The HSE’s NIMIS project is Ireland’s most successful deployment of a truly National Healthcare IT System, the project has received multiple awards; IMSTA recognised the project’s success in improving patient safety standards, Techexcelllence awarded NIMIS public sector IT project of the year in 2014, and in 2013 NIMIS was awarded by Biomnis for bringing Innovation to Diagnostic Imaging. Globally, NIMIS moves Ireland to the forefront of Medical ICT Systems innovation. NIMIS is the largest implementation of an enterprise imaging solution, on a central database, in the world.
In February 2013, the HSE’s contract with McKesson was extended to include a further six hospitals that elected to join the national solution, these additional sites brought the total number using the solution to 39.
In July 2013 UCD School of Medicine & Medical Science, Ireland’s national centre of excellence in radiographic education and research, invested in a contract with McKesson to align the facilities, resources and ICT infrastructure at UCD with the roll-out and implementation of NIMIS, and in October 2014 a further seven hospitals were added, this brings the total number to 47 hospitals at project completion.
As of December 2014, 33 sites are live and using the system; more if you consider satellite sites, whilst new sites continue to go live at a rate of one per month. There are 20,000+ users, of which approximately 5,000 are active, there are 6 million studies held on archive, with over 7,000 additional studies added each day, as well as 9 million reports and over 4 million orders.
Returning benefits to the Irish Healthcare System
Prior to commencement of the project 46 areas of benefits realisation were identified as achievable post implementation, these areas are closely monitored to help ensure that NIMIS is successfully returning benefits into the healthcare system.
Benefits achieved to date include:
Reduced report turnaround times due to faster delivery of medical images to the radiologist for reporting. A major academic teaching hospital boasts turnaround times that were nearly impossible to achieve in the film based environment.
- Improved clinical consultation, as evidenced by a radiologist based in Sligo hospital. A radiologist can request an image is reviewed and reported on by a colleague. In this case a neuro-radiologist in Beaumont recorded a second opinion on the system which then became part of the patient record.
- Reduced time spent sourcing and retrieving images and reports. The centralised data repository of NIMIS helps to reduce the time NCHD’s (Non Consultant Hospital Doctors) could otherwise spend sourcing radiology images and reports.
- Radiology work processes are streamlined through adoption of a best practise, standardised approach to workflow, such as, a single order catalogue, common user name convention and national GP list.
- Providing of Out-Of-Hours Cover / Remote Reporting for multiple facilities by a single radiologist on call, regardless of their location.
- Images and reports follow the patient through the Care Pathway no matter what facility they attend.
- Reduced errors caused by multiple entries of patient and exam details. Information is entered into the system once, reducing administrative tasks undertaken by radiographers.
- Ability to provide National data sharing and workflow regardless of location. Results of examinations are received electronically and associated images are available to view at every stage of the patient journey. Current and historical images are available electronically in the radiology department, outpatient clinics, hospital wards and if required, results are sent to the patient’s GP.
- Electronic requests for diagnostic tests make clinical information available to the radiographer and radiologist at the time of the examination.
- Teaching hospitals use PACS to export anonymised images into presentations and create electronic teaching libraries