Central archive moves to forefront for national PACS

Significant early design and implementation errors have not derailed plans to bring digital image management to every acute hospital Trust in England, according to Dr. Nicola Strickland, radiologist at Hammersmith Hospital, London. Several practical issues must still be resolved, however, if the added promise of centralized archiving and data sharing is to be achieved.

The England-wide rollout of PACS is part of an ambitious government-led plan to improve healthcare efficiency through IT. Over 50% of healthcare Trusts in England are now using PACS, with the remainder expected to go live by December 2007.

The project faced considerable problems in its early stages, Strickland told delegates at this year's European Congress of Radiology. No radiologists with PACS experience were consulted when the initial PACS specifications were drawn up. The decision to divide the country into five regional clusters and contract one PACS vendor per cluster led to delays and queries over the systems' true value for money. Delivery of basic or so-called vanilla PACS, with no RIS integration or features such as voice recognition, caused additional disquiet.

"PACS is now being deployed at the majority of hospitals throughout England, and I think the rollout will be on target or very close to target. But so many of these problems could have been avoided if the experience of legacy PACS sites in England and around the world had been sought right at the beginning," she said.

The national plan envisages that individual Trusts will store one year's worth of digital images locally. The rest will be outsourced to large regional data warehouses, where they will be accessible on demand to hospitals nationwide.

Moving radiological data across cluster borders could be difficult if the different vendors' systems are not compatible, Strickland said. The future of data stored at sites with a legacy PACS is also uncertain. Assurances that this data could be migrated and stored free of charge in the new regional image archives have now been withdrawn. Consent issues have caused additional problems, with officials initially suggesting that patients should agree to data sharing before each and every imaging examination.

"Sense has now prevailed, and consent to data sharing has become the default option. Nevertheless, there will be an opt-out policy, and as far as I can gather, nobody has much idea what is going to happen when a patient refuses to allow sharing of his or her data with another institution," Strickland said.

Dr. Robin Evans, a consultant radiologist at the Mayday Healthcare NHS Trust in southwest London, is hopeful that the arrival of clusterwide warehouses will make it easier for local hospitals and cancer centers to share information. This is one reason why doctors at Mayday were so keen to get PACS in the first place.

"That is obviously enormously valuable for patients who are transferring between specialist and nonspecialist centers in terms of continuity of care and seamless decision making," he said.

The standards-based approach used to build regional data centers will ensure that data can be shared between Trusts and clusters, said Mary Barber, national head of the PACS program. Once the planned PACS rollout to individual healthcare Trusts is complete, then steps to make these wider connections will begin.

"The timing of this has yet to be defined," she said. "In the short term, though, where we have known care pathways, we are putting in the technology for point-to-point links, and these can be put in across any boundaries."