ViewPoint 6 – The Rotherham NHS Foundation Trust

Prior to the implementation of ViewPoint 6, the Trust used the existing Radiology Information System (RIS) solution for obstetric reporting. This system works on a free text and voice recognition software basis to produce a block textual report examination report.

Whilst the RIS system is quick and efficient at producing textual reports, which are preferred in other imaging areas (CT, MRI and plain film) it didn’t allow for a structured template based report. 

This meant that it wasn’t ideal for ultrasound reports which included multiple figures based data sets, such as the measurements captured during foetal biometry reporting.

The voice recognition system also struggled with accurate dictation of obstetric measurements, this had the potential to lead to transcription errors. The resulting reports were also unable to demonstrate graphical data – a result of which meant all measurements had to be hand drawn and plotted on to paper graphs.

These drawbacks also meant that there was only one copy of the graphs which was then kept within the patient’s handheld notes. If these notes were subsequently lost or damaged or the patient failed to bring their notes with them to the appointment, then that information was unavailable.

The previous workflow was much less efficient and relied heavily on operator accuracy and the availability of the paper based notes for review of previous scan information.  This system was therefore at risk of error in data capture which could ultimately affect patient management and care. 

The ultrasound department recognised the need for a more appropriate reporting solution and approached the current RIS supplier for suggestions as well as investigating the marketplace for potential software solutions. ViewPoint 6 was suggested by the current RIS supplier as an appropriate obstetric add-on to work in conjunction with their current RIS reporting workflows. 

Attempts were then made to convince the Trust of the importance in procuring a more appropriate reporting solution, these attempts were further supported by an external Quality Assurance visit from the NHS National Screening Committee who also made the recommendation that the risks associated with the current workflow should be addressed. 

These factors supported the case to proceed with the implementation of an ultrasound specific reporting solution. In response, the Trust chose HNC and ViewPoint 6 as the preferred solution, the go-live was then completed successfully in October 2015.

“The project management team at HNC were incredibly supportive and able to meet our needs and requests in all aspects of the implementation project.”

A New, Simple Workflow

The Solution and The Technologies Used

The Trust subsequently chose HNC as its technology partner to create an integrated patient care record for obstetric ultrasound, by using the ViewPoint 6 ultrasound reporting system. 

The implementation project was led locally by the Deputy Superintendent of Ultrasound, working in conjunction with the project management team at HNC throughout to successfully deliver the requirements. 

The project team initially worked to assess and categorise the various clinical requirements to enable the system to be implemented in a structured manner and deliver the following clinical benefits:

Centralised Capture of Ultrasound Data

Once the ultrasound examination is completed via the ultrasound machine, the exam images and measurements are sent directly to the central ViewPoint 6 server. 

The ViewPoint 6 software instantly matches the received ultrasound study data with the correct patient and joint work list record. This integration enables the ultrasound observations to be automatically available to the reporting user for inclusion within the ultrasound report.

EPR & ICE Enterprise Integration

The ViewPoint 6 system is further integrated via the Talk2 integration engine with the Trust PAS system to allow for additional demographic updates which are not normally available via a standard RIS interface; namely referring doctor details and other patient demographic and record updates.  

The ultrasound report is also then sent back to the trust Cerner EPR for incorporation into the Sunquest ICE reporting system.

Clinical Reporting and Workflow

HNC worked to tailor the software and integration workflow to meet the Trust’s reporting requirements. 

Report templates were defined to reflect the current radiology examination codes and quick reports were then installed to enhance the efficiency of the system. Drop down question answers were custom built into the report pages to provide answers appropriate to unit and local tertiary referral centres.

“There didn’t seem to be anything they couldn’t do/adjust to meet our reporting needs and even as challenges arose weeks after implementation they were able to quickly help us resolve these teething troubles.”

RIS & PACS Integration:

The new ViewPoint 6 system is integrated via the HNC Talk2 integration engine with the existing Trust Agfa RIS & PACS systems to allow for an improved electronic ultrasound information workflow.

The automated RIS work list automatically includes all demographic and examination data required for rapid selection of the correct patient for examination within the ultrasound clinic. 

This automated process improves reporting times by removing the need for any manual entry of patient information at point of capture and allows the sonographers primary focus to stay on the patient during examination.

Once the report is finalised, there is an automatic data export which contains both the ultrasound images and clinical findings along with the graphical charts to the Trust’s PACS system. 

A copy of the same ultrasound report but in textual form is also then sent to back the RIS via HL7 results messaging for inclusion within the originating RIS patient record.

The ViewPoint 6 server also uses the Agfa PACS system as a long-term image archive, lowering the total cost of ownership due to not having to support a long-term file store on the ViewPoint 6 server.

Standardised Reporting:

Reports are now standardised, with the addition of mandatory fields crucial clinical information cannot be inadvertently omitted from a report. The system has flexibility built in to allow unusual or complex cases to be reported appropriately. The addition of mandatory fields such as ‘impression’ and ‘follow-up’ ensures that reports form a conclusion and the next step in patient management is highlighted to the clinician.

Other Workflow Benefits include: 

• Minimal disruption 
• Faster reporting 
• An intuitive system 

Clinical Benefits: 

The key benefits that the Trust is now experiencing by using a fully integrated ViewPoint 6 ultrasound reporting workflow include: 

• Increased standardisation of obstetric reporting with inclusion of mandatory data items.
• Improved exam times, with automated transfer of the ultrasound measurement data.
• Central storage of ultrasound report data including images, measurements and reports.
• Improved reporting allowing embedded ultrasound images and charts into the paper reports. 
• Improved availability of ultrasound reports with inclusion within Agfa RIS & PACS.
• Ultrasound reports available within the Integrated Clinical Environment ICE system.
• Ultrasound reports available within Cerner Electronic Patient Record.
• Lower cost of thermal paper with electronic archive and storage of ultrasound images.
• Improved quality allowing for better trend analytics and reporting of examination outcomes.

Looking Towards the Future: 

Following the success of the implementation of the systems, the Trust is also now looking forward to the future, with plans to work with HNC further to roll out the ViewPoint 6 system for reporting of gynaecological ultrasound scans. These make up a small proportion of the workload in the shared antenatal and gynaecology out-patient department allowing for a fully integrated ultrasound care record across the full OB/GYN service.