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back to article Medical scan record that the NHS says will cost £2k to retrieve: Detail

A hospital trust says it will cost the NHS £2,000 to dig out a copy of a patient's ultrasound scan of his heart and hand it over to him. The steep bill is, we're told, due to the data being held on a magneto-optical disc, and Worcestershire Acute Hospitals NHS Trust would need to fly in kit from America to access it. The figure …

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"The manufacturer quoted a price of £2,000 to the trust as the cost of sourcing this MOD unit."

They obviously never tried ebay ... http://preview.tinyurl.com/bbmjcs6

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Yep, my first thought too. Lo and behold, a fair few drives, nothing over £500, and most of it a damn sight cheaper than that.

Common sense: the NHS has heard of it.

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Anonymous Coward

Should have come to me. I'm sure I have a couple somewhere in my stash. I'd want it back though. It might come in handy one day.

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Yes, a refurbished item with no warranty is obviously the best choice.

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Warranty?

How long does it need warranty. It'll be used just once.

Though hopefully it will be used to convert all the other scans as well. Archive management doesn't seem to exist in the NHS, it's all managers and no brains now.

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Named Data Subject, Machine-readable Form?

What happened to "Any data held about a named data subject in machine readable form must be made available to the data subject for a nominal fee" Data Protection Act 1984 - did this disappear in the later revision?

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Re: Named Data Subject, Machine-readable Form?

"What happened to "Any data held about a named data subject in machine readable form must be made available to the data subject for a nominal fee" Data Protection Act 1984 - did this disappear in the later revision?"

I'm guessing they are talking about the "machine readable" bit...

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Re: Named Data Subject, Machine-readable Form?

That said, I am left thinking "Mountain ... Mohammed" just send the disk by courier to someone who still has a working drive.

Okay, it might be considered a data risk, but if this gent was reasonable he would waive it- I can't think of anyone doing something nefarious with this old scan data.

Can't people be reasonable?

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Anonymous Coward

Re: Warranty?

Yes because untested devices which then eat the thing you are trying to read will go down very well with the patient, let alone having to go through red tape for PAT Testing to ensure its safe, getting the software to read the files, etc...

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To be fair, I think the article title is a little misleading. It is quite clear from the article text that the £2000 figure is coming from Philips US as the cost to ship over a new drive.

It seems to me that the hospital is acting very responsibly - they are checking with the Information Commissioner what their obligations are, and they did the background work to see what would be required to comply even before they received an answer. They have said neither that they won't provide the image nor that they would pass on any bill to the patient, just that £2000 on this instance would not be an efficient use of public money - and on that I agree with them.

Of course, the question remains - if they have the disc in this format, they must have had a drive for it at some time, and presumably some other UK hospitals were using similair tech. Isn't there a single working drive in the whole UK they can borrow to just read the disc and get the file out, without needing to BUY a drive (new or eBay)?

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Anonymous Coward

"They obviously never tried ebay"

Perhaps they have tried ebay but expect that the hassle of any public sector procurement is going to cost them the remaining 1900 quid.

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Re: ... it's all managers and no brains now

There is a typo in your post, here is the corrected version:

it's all damanagers and noshit for brains now.

Does that look better?

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FAIL

What sort of idiot would use a format that could only be read by a...

oh yeah... answered my own question there :-)

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Re: What sort of idiot would use a format that could only be read by a...

Oh, do you mean like those ID10Ts who code web sites (or internal apps) to require IE6?????

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Anonymous Coward

What's the point of keeping records if they are unreadable? Surely as a matter of course either the legacy hardware/software should be maintained or the records updated to be readable with modern hardware/software?

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Just a thought

Because old scans aren't medically important and thus it would be a waste of public money?

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Re: Just a thought

Uh...how do you know that old scans are not medically important?

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Re: Just a thought

From the article "In the event that any patient requires future treatment all clinical decisions and treatment are based on diagnostic tests undertaken at the time of admittance and as required rather than from historical records"

Having just read the BBC article - its a shame theyre not allowed to just tell him to piss off or to recreate the image himself. He's just looking for attention.

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"He's just looking for attention."

Said jm83, in a string of postings...

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Anonymous Coward

As mentioned elsewhere in comments

There is an awful lot of research going into medical imaging (using some *very* big beasts - Oak Ridge National Laboratory, I'm looking at you). One of the threads is comparing scans from before, with scans from now. The software can spot minute differences which could be diagnostic.

Also, part of the research is to aggregate old scans and outcomes to build up an expert system (showing my age there) of what is "normal" and "abnormal" for future use.

So old data still has a value.

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Whats the point of keeping the records if they are never referenced and on admission new data is obtained...

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Re: Hplasm

I'm gonna assume thats a dig at me (certainly looks like one).

I would hardly compare two (now three) posts fairly anonymously on a story with demanding an ECG from 8 years ago, then threatening legal action and ringing the papers when they wont give it me.

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Re: Hplasm

What if the EKG was likely to have showed you had a heart abnormality that should have been easily caught and the subsequent eight years of non-treatment had resulted in permanent damage to your heart? Would you want a copy of the original now?

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Re: Just a thought

"In the event that any patient requires future treatment all clinical decisions and treatment are based on diagnostic tests undertaken at the time of admittance and as required rather than from historical records"

In some cases sure, a completely new scan is all that is needed, but I'm sure that in some cases there is some value to being able to have a before-and-after scan, and the comparison of the old scan with the new one can be medically relevant.

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Paris Hilton

Re: Just a thought

"Because old scans aren't medically important and thus it would be a waste of public money?

That would depend. In my case, I'm being denied an insurance claim on a severe accident which has left me with injuries to my back because I have no proof that the injuries shown in a recent MRI weren't present long before as I never had an MRI on that region. An MRI from just five years ago would settle the argument. Fortunately I have the recourse to sue the insurance provider and am doing so.

Paris, obsolete eight years ago, as well.

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Unhappy

Re: Just a thought

I'm suspicious of "old scans aren't medically important". They might be legally important if something that later transpired to be important was missed at the time of the original scan.

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@ An 12.28.

The simple answer is that non of the top heave management of the NHS has a technical background therefore they haven't a clew about technology - see the multi billion IT f**k ups.

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Paris Hilton

Re: As mentioned elsewhere in comments

Oh. Big beasts. I read that wrong.

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Happy

Re: As mentioned elsewhere in comments

Oops... me too!

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Re: Hplasm

It would be too late now to be of any use. Water under the bridge and all that..

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Why is the old data not migrated to new storage/format at the time of retiring the old kit?

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[Your title has not been migrated]

"Why is the old data not migrated to new storage/format at the time of retiring the old kit?"

Probably because migration is a costly and time consuming process. For non-essential records it's probably cheaper to take the risk that they wont be needed any more.

I'd say the real question is why doesn't the NHS use its buying power more efficiently. You want an £x million supply contract with the NHS for data storage? Well then you're required to keep one of each drive type, for occasional loan, for Y years after the contract ends.

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Working with some smaller medical offices has shown me that the cost is insane. I've seen quotes on conversion for many times what the already expensive costs. Many clinics do it on a patent by patient basis. If you visit the clinic or call in they will manually migrate the records over in the time the old system is still running, but if you call in 10 years later, it's pretty much 'gone'.

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A lesson to us all

> although the scan is still on file ... it is stored in a format that can no longer be read by the hospital's computers.

A backup (or archive) is only a backup if you can restore it. Just copying stuff to some other location/format is pointless until you've verified you can read it back.

Although the hospital says they can read the file (given access to the right kit), they can't be sure it hasn't been corrupted. So until they try to access the scan there's no guarantee the scan still actually exists - just that the physical medium on which it's stored is present.

You'd hope that if the NHS does go to the effort of acquiring hardware to read this scan, they'll take the opportunity of transferring all their other MOD media onto something a little more modern, rather than just doing a one-off and shipping the reader back from whence it came. Presumably there are lots of other NHS shops in the same situation, so with even the slightest use of initiative, the cost of this activity could be shared. I hold out very little hope ...

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Anonymous Coward

Re: A lesson to us all

WORN* type backup?

*Write Once Read NEVER! :D

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Joke

Re: A lesson to us all

backup > NULL

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Re: A lesson to us all

I am the patient in this story and if it was only my scan they couldnt access I might well have let it gho, but I established it is hundreds or thousands of scans and that is ( I think) a matter of public interest

in my locality

1. The NHS is supposed to back up and securely store data

2. 2006 guidance (NHS) required them to prepare for new platforms

and ensure readability of data

3. There are 200 disks s which they say they cannot read due to a lack of MOD drive

and these extend up to 2008 which isn't that long ago

4. Old ultrasound data is potentially clinically useful or even crucial, to compare one scan with another, to facilitate a 2nd opinion, to identify incompetent practice, or even for a NHS hospital to defend against

litigation

I have purchased MRI and X ray in the past, all managed efficiently and for a tenner a go

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But if I was the NHS,

I'd be tempted to make you a present of the disc. As-is. Framed, to hang on your wall.

You've got a point, though. But I work in IT and this stuff is hard.

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Another reason (if one were needed)

to avoid proprietary formats. Or insist that the system can export to a standard. Especially given the amount of research that is going into software to scan medical images.

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Re: Another reason (if one were needed)

I will say in the medical systems I've seen recently, that standards are becoming more common. One system I recently migrated to creates pdf files of most records as a copy outside the database and imaging is stored in a TIFF format. The previous version was a ball full of suck, it used an ancient ASA database that the images were stored in the database bloating it to huge sizes. The practice didn't migrate the records over from the old system because the costs were staggering, when you break it down to per record costs it was cheaper to have people manually move each record over. That's just gouging by the software firms. That's why we end up in situations like the article.

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FAIL

Re: Another reason (if one were needed)

PDF and TIFF? Can't say I'm a fan of that idea. That's again using proprietary stuff (are there any patents stuffed up the sleeve of PDF, a la GIF?) and, well, the whole thing is just fairly unmalleable. How best would you import into your new system from a PDF?

I don't understand what the NHS buys to make everything so incompatible. These days everything should be using the DICOM standard for storing, transmitting and sharing medical images. It's been around since 1985, so most people should have caught up by now!

DICOM, more usefully than TIFF (or PDF) stores the image but also stores several shitwads of metadata information about the picture, such as patient name/ID/age/etc, when the image was taken, what it was taken of (i.e. Right Knee), then lots of other useful information such as exposure time (in the case of X-Rays) or co-ordinates (in the case of MRI/CT scans). It also allows for annotations to be stored which can be superimposed on the other end if required.

Source: I implement and maintain PACS systems.

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Re: Another reason (if one were needed)

Wouidn't DICOM store the image part in something like TIFF though (or perhaps JPEG)... I vaguely remember DICOM offers a couple of alternative formats...

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Coat

Re: Another reason (if one were needed)

Tiff actually allows any amount of metadata that you want. It also supports layers and the layers suport degrees of transparency too. The layers can contain both bitmapped and vector content, and bitmapped content can be in different resolutions to each other. Oh and varying degrees of compression, which can be lossless. A Tiff file can also be multiple pages, and lower capability renderers tend to just show what they can, leaving out what they don't understand. Tiff has come along way since just being 1-dimensional Huffman coding.

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This is down to...

...good old fashioned stupidity on behalf of the purchasing authority.

I stumped up the cash for a CD containing the images of my MRI scans a couple of years ago, or this could have been the start of 2011.

The problem was that it didn't contain the images themselves, but bespoke files which needed a piece of software to read them and then generate the images from them.

The software (which came on the CD along with the files) was compatible with Microsoft and Apple, (I run Linux) but the real gut wrenching laugh was when I read the read-me on the CD that said that it needed IE 5 !!!

I mean ... excuse me?

Someone in the system needs shooting. I still have the CD, and the pictures of my MRI that I took off the consultants screen with my camera phone.

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JLH

Re: This is down to...

Are you SURE this was a proprietary format which needed IE5 to view them?

It is highly likely that they were in DICOM format, which is pretty universal for medical images.

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FAIL

Re: This is down to...

CD's never contain "images themselves" they contain files in a format that requires software to read them and generate images from them. In this instance, the NHS recognised that you probably wouldn't have the right software on hand, and supplied it without being asked, and ensured that it would run on a very high percentage of home computers. But because you run an OS that is in the vast minority, and couldn't find a way of getting to a computer running any other OS (really?) , you think someone in the system is failing...

Sorry, this storyis an example of the NHS getting it right, no need to turn your own failings on them.

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Re: This is down to...

"It is highly likely that they were in DICOM format, which is pretty universal for medical images."

... and even if you couldn't use the viewer they supplied, there are free DICOM viewers for Windows, OSX and Linux available.

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Anonymous Coward

Re: This is down to...

Someone needs shooting, because they only support ~98% of the workstation OSes used? Hyperbole, much?

As it happens, I know someone who has recently had an MRI scan and read the file on a Linux machine with standard FOSS software, then generated a 3D print of his brain, all using Linux. Did you even bother to look for the software to read the files, or just thought it was worth a good bitch?

As it happens, this came up as a link from THE FIRST HIT of a Google search for "foss to read mri files"

http://en.wikipedia.org/wiki/3DSlicer

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Anonymous Coward

Re: This is down to...

Well, as I didn't know anything about these types of files, I thoguht it was definitely worth a good bitch.

I mean, I paid for a CD of the images and I expected a CD of images. Even the hospital couldn't argue on that point.

As for Linux being a small time operating system ... that is a tired argument used by desperate people.

The whole point of this is proprietary lock in, as the hospital couldn't export the files to anyting like jpeg or tiff either. They were stuck. As operating systems move on, they're going to be eventually as screwed as the person in the original article.

So yes, as far as I can see it, it is an epic NHS fail and no messing.

Interesting education about the file types though. I'll see if I can get that working, although by the file numberings and sizes I doubt that there is enough to generate a 3d image of my brain.

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