Ultrasound and related issues

Waiting for an internal review by Worcestershire Acute Hospitals NHS Trust of their handling of this request.

Dear Worcestershire Acute Hospitals NHS Trust,

Regarding the period 2004 to 2008 in so far as the Trust is able to answer

1. Can you please advise how many magnetic optical drives the Trust had, in relation to storing echocardiographic recordings from Sonos ultrasound machines/other machines?

2. Did the Trust have a budget for repair or replacement of such hardware in case of failure. If so please provide details

3. Did the Trust have a budget/personnel with a brief to migrate old to new formats to ensure continued readability of ultrasound data ? If so please provide details

4. When were Sonos 5500 replaced ?

5. How many ultrasound recordings are currently said to be unreadable because of the failure of a MOD drive ?

6. Is it only cardiac ultrasound or are other ultrasound studies also affected

7. It has been stated that hardware failed in 2008, why was nothing done to repair or replace that hardware at the time or since, or to make other arrangements for conversion of the echocardiographic data to another format in order it could be read by clinicians/obtained by patients.

Yours faithfully,

A Brown

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Dear Mr Brown

Please find attached response to your FOI enquiry.

FOI Team

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Dear FOI, WAHT,

I have been asked to clarify my request. However, the time limit has nonetheless been exceeded and I have been advised today to this effect by the Information Commissioners office. If a request for clarification was to be made, it ought to have been within the required timescale of the Act

However, in so far as clarifying is concerned

1. I am interested to know how the archiving system was introduced in relation to cardiac ultrasound recordings and specifically as regards the archiving of cardiac ultrasound for the period 2004 to when the archiving came in.

2. What was done to archive these older recordings, specifically how was it done ? I mean if you had recordings from 2004 in an old format on old disks what did you do to archive them in a manner that could be available to patients on request/clinicians
especially given that in 2006 guidance from the NHS suggested that preparations should be made in such a way that under new platforms old records would still be readable

3. Please refer to any Board minutes on the subject/agreed policy as regards archiving

4. Notwithstanding my attempt to usefully specify my request, I hope the context of my request which relates and refers to a reply on the subject of echo and dicom (December 2011) is such that you can usefully reply

Thank you

Andrew Brown

Yours sincerely,

A Brown

Dear FOI, WAHT,

I have just sent a reply to a request for clarification to the wrong F of I thread of my two current ones concerning you, for which I apologise. I intended the below text for the F of I request concerning the question about the introduction of the archiving system which is my other current request with yourselves
I had both open in two windows and wrote inadvertently to the wrong one.

My text below Dear FOI, WAHT,

I have been asked to clarify my request. However, the time limit
has nonetheless been exceeded and I have been advised today to this
effect by the Information Commissioners office. If a request for
clarification was to be made, it ought to have been within the
required timescale of the Act

However, in so far as clarifying is concerned

1. I am interested to know how the archiving system was introduced
in relation to cardiac ultrasound recordings and specifically as
regards the archiving of cardiac ultrasound for the period 2004 to
when the archiving came in.

2. What was done to archive these older recordings, specifically
how was it done ? I mean if you had recordings from 2004 in an old
format on old disks what did you do to archive them in a manner
that could be available to patients on request/clinicians
especially given that in 2006 guidance from the NHS suggested that
preparations should be made in such a way that under new platforms
old records would still be readable

3. Please refer to any Board minutes on the subject/agreed policy
as regards archiving

4. Notwithstanding my attempt to usefully specify my request, I
hope the context of my request which relates and refers to a reply
on the subject of echo and dicom (December 2011) is such that you
can usefully reply

Thank you

Andrew Brown

Yours sincerely,

A Brown

Yours sincerely,

A Brown]

Thank you for your reply

I request that it be internally reviewed in the light of the following observations

1. I do not agree that there is no clinical need to retain echocardiographic data. It may be indeed be clinically required at a later date to facilitate a second opinion or to defend litigation, or (administratively ) required to supply it to a patient on request within their rights under the Data Protection Act . On occasions within the NHS cause for concern has arisen about the welfare of patients, often many years after the episodes of clinical work up, diagnosis or care, and in such cases old data (that you term here 'historical' / distant' becomes crucial evidence
to establish the reliability of diagnosis /treatment in
cases often where health has been severely damaged or worse. In such cases it is a graphic audit trail to health critical outcomes.
For example, in cardiac ultrasound, a potential example that could arise might be a patient who is described as having a structurally normal heart, who later dies suddenly, post mortem shows a diseased heart and relatives take action and establish the clean bill of cardiac health was based on a inadequate/misinterpreted echocardiogram.
Archived evidence of this type also proves critical for NHS clinicians/bodies
to defend against litigation

The use of the 'term' clinically required' might be true in so far as everyday functions at the hospital is concerned, but the scenarios set out above are important and give weight to the need to retain, indeed in a readable format it is a legal requirement to provide copies to
patients subject to a max fee of 50 pounds. Clinically required does apply
if one is speaking of a major retrospective review of patient records, or a second opinion sought by a patient, or indeed when trust lawyers act for you and need to seek outside clinical opinion

A major hospital would know the above are possible reasons to require old echocardiographic data . It is also the case that the Department of Health guidance does recommend retention for 20 years in the case of ultrasound images. Such advice is based on the guidance of expert bodies. That alone suggests a strong rationale for retention of ultrasound images. NHS guidance in 2006 also advised the need to plan for migration to new platforms to ensure continued readability of data

Your Trust;'s reply in this regard is ( in my opinion ) cavalier as regards the rights of patients to get copies of their ultrasound within their rights as well
as playing down the importance of maintaining readable original (2D) images.

2. In your response it is said that the failed hardware was replaced
But yet it is said you do not have the in house hardware to make these echocardiograms readable. Therefore if this is accurate, on/following/prior to replacemernt of the Sonos 5500 in 2009 you must presumably either
have (a) had a further failure of hardware so that these could not be read (presumably your service contract reinvigorated storage arrangements foillowing the 2008 breakdown before the eventual 2009 replacement of Sonos 5500
(b) disposed of such remaining 'reading' hardware with the consequence that they could no longer be read
(c) failed entirely or decided not to make arrangements to convert these images to a currently readable file pending the anticipated replacement of the Sonos 5500 or following it if the hardware making
old echo's readable was functioning after that replacement of 5500

3. You say that images are not irretrievable but that this could not be done 'in house'

In such circumstances, how would you retrieve them if a person, be it a patient wished to access their record or acquire a copy, or a lawyer pursuing litigation against the trust, or a another Doctor instructed to provide a second opinion on a Trust physicians clinical opinion ?
Where would they be read if not 'in house'
You would not be able to provide a floppy disk containing the data of a variety of patients along with the individual record because that would include
other patients records.

It defies credibility and integrity that an era of records was abandoned as
unreadable when perhaps hundreds/thousands of them were not truly historic/distant but daysd/weeks/months/one or two years old and so entirely contemporary and with the potential for a clinician to decide he/she wishes to review the echocardiogram, as indeed happened in my own case in 2011.

In point 7 of your reply you state that action was taken at the time to
replace the failed storage equipment with the 'current technology of the time' However this does not mention what sort of technology (being current ) Current technology is vague. I not dealing with whether this involved readability of 5.25 disks (of which there were apparently hundreds) or indeed whether the current technology (presumably it means technology of a generation ahead of Sonos 5500 albeit that 5500 was available from suppliers with DICOM as a option \

You also state that Sonos 5500 images were stored in a single storage
solution. However, you have said in a reply to the Information Commissioner that my own echocardiogram is amongst those stored on
200 disks, and in the December 2011 reply you say those from 2004 are on a 9GB
drive in DICOM (a universal format)
I woiuld suggest there is inconsistency here

It is noted that you did not answer the question about how many echocardiograms are unreadable .

You have stated it is not a 'cost effective ' process to migrate
all data to new formats. However 'cost effectiveness' is not so simplistic to qauntify when you consider the cost vs benefits. eg: a few thousands for a migration of data could give you the quick and reliable access to data

I am sorry but this is simply not a satisfactory response from the Trust

Andrew Brown

Dear FOI, WAHT,

Yours sincerely,

A Brown