Portsmouth NHS Trust Introduces First Digitised X-Ray System on Thin Client Platform

The Client Portsmouth Hospitals NHS Trust (PHT) provides medical support to approximately one million residents in Portsmouth and the South East of Hampshire. The Queen Alexandra Hospital hosts the accident and emergency department for the Trust treating over 100,000 casualties a year and is responsible for the majority of the Trust's admissions. The Ministry of Defence also rely on Portsmouth Hospitals NHS Trust to assist in the operation of the Royal Haslar Hospital site across the water at Gosport.

The Challenge

The ability to provide X-Rays is an essential service for the Trust. X-Ray provision to ensure that doctors and clinicians have a patients X-Ray at their finger tips during diagnosis, treatment and recovery impacts their budget massively. Portsmouth NHS Trust sacrifice nothing in the provision of patient care, so when an attempt to reduce the cost of X-Ray provision was undertaken the goal was also to increase the quality and frequency of service that a patient receives.

A system for the electronic management and distribution of digital images used for clinical purposes known as Picture Archiving and Communication Systems (PACS) had been deployed. It replaced a film-based approach to imaging (e.g, X-ray films) with images that can be held digitally and viewed electronically. One image can be made available reliably to many different clinicians in different places at the same time.

Project Leader, Andrew Kern, stated, "Deploying PACS meant that from a central electronic storage system we could make X-Rays available simultaneously, at any time of the day to any person involved in providing care to a patient." The benefits of this were immediately obvious to Kern and to the management of the Trust, the only problem was the PCs required to view the X-Rays were in excess of £10,000 each, so only a limited number could be made available.

Already a user of Thin Client and Server Based Computing the Trust had benefited from the reduced total cost of acquisition and ownership that this type of solution offered and wanted to assess the suitability of the technology for the PACS deployment.

Server based computing involves the deployment of applications that are installed and executed centrally on a powerful server, the display being sent to a thin client device that remotely views the application over a low bandwidth network connection using Microsoft Windows 2003 and terminal services.

The IT department at the Queen Alexandra Hospital asked thinstore to assist them in creating the necessary environment for PACS to function in the hospital. "Members of the thinstore team have been providing us with thin client and server based computing knowledge for many years and it was logical that they were asked to assist us with the project to ensure its success" said Andrew Miles-Keay, Development Manager for Queen Alexandra Hospital.

The Solution

A PACS web application had already been created to access a web server hosted in the Trust IT department which stored the patient records and other vital information. The records could be accessed from any device that had the PACS viewer installed in their browser. The proposed solution was to deploy the Internet Explorer browser to Neoware thin clients using terminal services to over 400 users at a fraction of the cost of using expensive PACS workstations or PCs.

There were a number of architectural decisions to be considered when deciding on the platform needed to deliver images to doctors and clinicians. Would the images be of sufficient quality? Would the servers and operating systems cope with the load of many users accessing patient records through a browser?

The browser based PACS solution did not render images as detailed or precisely as the PACS workstation and the thin client devices added a further reduction in both speed and quality of the resolution, but after a short trial within the PHT it was decided that the images were of sufficient quality for most hospital staff to use without compromising a patients treatment in any way. Only a small number of PACS workstations were needed for those who needed very detailed images. The fact that patient records would now be available throughout the hospital would contribute to even better patient care, a primary goal of the project.

The Technology

When designing a solution for Portsmouth NHS Trust there were a number of fundamental requirements to consider:

The server platform needed to be resilient, powerful, cost effective and expandable to allow the solution to grow.

"We recommended HP Blade technology as it offered many benefits over traditional servers," said thinstore's technical architect, Paul Robinson, "Their scalability, ease of use and management software, Altiris allowed us to create build images and easily deploy them across all servers to establish consistency. We ended up with a software version and build number that could easily be modified, revised and re-deployed at will."

It was important to choose the right thin clients as they needed to be manageable, have a fast display refresh, small form factor and be aesthetically pleasing. Cost was an issue as the devices needed to be less to buy than a PC and have a longer life span.

"Whilst the decision to choose Neoware was logical because their management software was able to manage existing PCs and devices as well as Neoware thin clients, we also chose Neoware because they fulfilled all of the Trusts additional requirements," said Robinson, "We conducted heavy testing with a number of manufacturers' products to ensure they could display the images produced by PACS with the fastest picture refresh and were satisfied Neoware was the right choice."

The Bottom Line

Using server based and thin client computing the PACS browser deployment took a little over three months to plan, test and implement. A PC solution would have taken considerably longer, been less secure and involved significantly higher budgets for both acquisition and total cost of ownership.

In summing up the solution Andrew Kern stated that the Trust had achieved most of their overall objectives for the project. Choosing the server based and thin client environment to deploy PACS had reduced the cost of the solution to the hospital whilst allowing them to deliver this important medical system to more staff than ever before.

"This surely led to a better quality of service to our patients whilst keeping within our budgets and delivering the solution on time," said Kern, "We are impressed with our thin client environment and whilst we have had to make compromises within the project these have not been to the detriment of our patients, our staff or to our constrained budgets. In the future we will be offering more centralised patient information to our doctors, clinicians and other staff using the thin clients and our new farm of servers in a bid to maintain our high quality of service to the residents of Portsmouth."

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