NIR Project Background

Across the project, the NIR team has repeatedly engaged with users, clinicians, PACS/Admin teams, suppliers, trusts, organisations and technical specialists. Discovery established the user needs. Alpha tested technical feasibility against those needs. Mapping revalidated the current experience. Workshops brought implementation partners into the conversation. Metadata work translated user needs into the information required for safe discovery and retrieval. Measurement planning created a way to assess whether NIR delivers value in real clinical and operational settings.

The project journey shows a clear thread: NIR has been shaped by evidence, direct engagement and iteration, not by technical assumptions alone.

Discovery gave the project its user-centred foundation. The research explored how diagnostic imaging is currently discovered, requested, shared and retrieved across organisations, and what users need from a future National Imaging Register. It used mixed methods, including interviews, survey responses, workshops, desk research and SME engagement, involving 98 participants or responses in total. Participants included radiologists, radiographers, sonographers, PACS/RIS specialists, operational managers, digital leads, MDT facilitators and other imaging stakeholders.

Key learnings:

• Users need to discover all imaging associated with a patient in one place, regardless of where it originated. 
• Current processes can be slow, variable and reliant on multiple hand-offs, incomplete information, file transfers and PACS team availability. 
• Discovery produced a clear set of user needs that informed Alpha and gave the programme a way to assess future NIR options against real user priorities. 

So what: Discovery showed that the project was grounded in direct engagement with users and stakeholders from the outset, rather than starting with a fixed technical solution.

Alpha built on the Discovery evidence base and tested whether the emerging NIR concept could work in practice. This phase was primarily a technical proof of concept, not a dedicated user research phase. It compared standards-based approaches for discovering and retrieving imaging and reports, including XCA/XDS and MHDS/NRL, with participation from imaging networks, trusts and suppliers.

Key learnings:

• Alpha showed that some early technical assumptions were not viable at national scale, including peer-to-peer image retrieval and the original MHDS/NRL query and retrieval approach.
• The work led to a revised architecture based on supporting both legacy and future-facing standards, using a centralised image retrieval approach and clarifying the role of the National Record Locator.
• Although Alpha was technical in focus, it remained connected to user needs from Discovery, including the need to discover prior imaging, retrieve reports and images, work within existing systems and rely on clinically safe metadata. 

So what: Alpha acted as the bridge between user need and technical feasibility, reducing delivery risk before Private Beta.

After Alpha, the project carried out further research and mapping to better understand the current experience of requesting and receiving non-local prior imaging. This involved remote interviews with clinicians and PACS/Admin users, focusing on how prior imaging is requested, received, matched, imported and used in practice.

Key learnings:

• The work revalidated the core need to make prior imaging discoverable and accessible without friction at the point it is needed. 
• It showed how current processes create delays, manual workload, workarounds and safety risks, especially where requests are vague, identifiers are inconsistent, or images and reports are separated.
• Mapping helped translate broad Discovery findings into practical current-state journeys and testable scenarios for Beta, including urgent care, MDT preparation, longitudinal imaging histories, cross-boundary care, duplicated results, partial data availability, patient matching and consent.

So what: This phase showed continued direct engagement with users after Alpha, helping ensure the project’s understanding remained grounded in real clinical and operational workflows

After the mapping work, the project ran an issue identification workshop to focus on the key friction areas emerging from current-state research. The session explored possible issues in an NIR world across two themes: how Admin and PACS team processes may be affected, and how duplicate data could affect NIR search results and clinical decision-making. 

Key points:

• The workshop group identified a range of possible issues, then prioritised them through voting before exploring the likely impact of the highest-priority issues if left unresolved.
• The top three issue areas were: annotation of images and source of truth; duplicate, potentially contradictory reports being presented to users where imaging has been imported and a local report added; and additional local PACS storage requirements for imported exams. 
• These issue statements were taken into the NIR Solution Design Group so they could be addressed through the right mix of product, clinical technical, policy, governance and guidance responses. 

So what: This workshop shows that the project did not just identify user and operational friction, it created a route for those issues to be prioritised and acted on. The programme response, through clinical and governance guidance and policy documents, demonstrates that user research findings were translated into practical safeguards and decision-making support.

The project ran separate technical engagement workshops with suppliers and trusts / organisations in March 2026. These sessions explained the NIR vision, technical direction, onboarding approach, safety model and metadata expectations, while also creating structured opportunities to capture feedback and evidence from the organisations responsible for implementation. We had close to 200 attendees across both workshops.

Key points:

• The workshops were not just broadcast sessions. They were used to educate, align, gather feedback and identify practical implementation risks. 
• They involved the people and organisations needed to make NIR work in practice, including suppliers, trusts, imaging networks, PACS managers, clinical leads, technical leads, implementation colleagues and standards specialists. 
• A major focus was metadata, with supplier and trust / organisation responses used to understand where readiness exists, where capability is partial or uncertain, and where further work is needed. 

So what: The workshops show that the project continued to engage beyond research interviews, involving suppliers, trusts and organisations in the practical work needed to make NIR safe, usable and implementable at scale.

Metadata became a key focus because NIR depends on users being able to understand what imaging exists, where it came from, when it was created, and whether it is the right study for the right patient. Discovery showed that users need meaningful metadata to search, filter and trust imaging results. Alpha then confirmed that metadata consistency was a key dependency for safe and effective delivery.

Key points:

• Supplier responses showed strong support for NHS Number and minimal patient information, but gaps around period, document creation date/time, practice setting code, anatomical region and placer order number. 
• Trust and organisation responses showed fewer concerns around study and technical metadata, but more uncertainty around practice treatment codes, anatomical region, local code mapping and historic data quality. 
• This evidence is now helping shape onboarding, supplier engagement, standards alignment, clinical safety and future testing.

So what: Metadata is not just a technical standards issue. It is central to whether clinicians can make sense of NIR results, select relevant studies, avoid unnecessary retrievals and trust that the imaging they are using is clinically appropriate.

The project developed a measurement approach to understand whether NIR is delivering meaningful value in practice. Because NIR does not have its own user interface, clinicians experience it through existing PACS supplier systems, meaning the programme cannot rely on standard in-product feedback tools. Instead, the approach combines service data, user feedback and observation to understand how NIR changes real clinical and operational workflows. 

Key points:

• The approach was developed around the needs of clinicians, PACS managers and Admin teams, recognising that success depends on both clinical value and operational sustainability.
• It focuses on whether NIR helps users access prior imaging, supports clinical decision-making, reduces delays or repeat imaging, and avoids creating new operational friction.
• It gives the programme a way to keep learning through Beta and wider rollout, using evidence from users and clinical settings to shape product decisions, onboarding, guidance and future improvement.

So what: Success is not being defined by technical go-live alone. It is being defined by whether NIR improves the experience and outcomes of the people it is intended to support.