PACS rollout takes bumpy ride in U.K. connection program

The U.K. government promoted its effort to wire 150 English hospitals into the digital age as one of the largest PACS efforts in the world. But a year after the announcement of five successful tender offers to PACS vendors, two key contracts have yet to be signed. Questions have also arisen about whether the installation of these PACS will deliver the promised cost savings.

Digital radiology is considered a key part of the U.K. government's National Programme for IT (NPfIT) in healthcare. The program, now called Connecting for Health, is an ambitious project designed to bring information technology to English hospitals, clinics, and primary-care centers (GP surgeries). The U.K. government is committed to reducing the time from GP referral to treatment to 18 weeks. The assumption that digital workflow could increase efficiency in radiology departments was the rationale for a centralized procurement program.

Wales and Scotland are not included in the plan and remain free to negotiate deals with any PACS supplier. Officials in Northern Ireland, who are also contemplating a mass PACS rollout, reportedly turned down an invitation to join the wide-scale procurement process.

Centralized purchasing of PACS was expected to afford U.K. officials maximum leverage with vendors. The government divided England into five regions, or "clusters." Five designated local service providers subcontracted PACS deals to appropriate third parties. Government officials claimed to have won price reductions of up to 57% on diagnostic workstations, 65% on computed radiography, 71% on disk storage, and 82% on PACS servers.

But the road to these cost savings has been rough. Hospitals were instructed to purchase PACS through the centralized route or not at all, and two of the five clusters have chosen the latter. Contract negotiations in the North East and Eastern clusters are on hold due to a legal dispute, leaving radiologists in limbo.

The problem is the selection of a PACS supplier. A government announcement in May 2004 that GE Healthcare had won both tenders was premature. Agfa Healthcare has since become a likely alternative, but a pending legal suit lodged by Fuji Photo has delayed the signing of a contract.

Fuji is seeking a review of the PACS procurement process in the U.K. High Court. The company submitted its initial application for review in December 2004. Although that request was denied, Fuji is continuing to challenge the legality of the closed PACS market, which it sees as anticompetitive and contrary to EU law. An oral public hearing of the case should take place before July.

"Informed choice based on quality and value has effectively been denied the NHS Trusts, and continued delay and confusion about the extent of the NPfIT PACS offering and the financing of it is disappointing. Had the market been open, Fuji has no doubt that significant progress would have been made in the provision of PACS and CR over the last two years," said Bob Brown, director of Fuji's x-ray systems business in the U.K.

Government officials have expressed optimism that this latest snag can be resolved quickly.

"Precise terms for the delivery of PACS in the North East and Eastern clusters are yet to be finalized, but we remain hopeful that this can be achieved in the near future," an NPfIT spokesperson said.

Impatient radiologists have been advised to contact suppliers for the three clusters that have signed contracts. Those vendors are GE Healthcare (Southern), Philips Medical Systems (London), and Kodak and ComMedica (North West and West Midlands).

"In the interim period, trusts with urgent requirements for a PACS can obtain it from other LSPs to ensure they realize its benefits and have a compliant system," the NPfIT spokesperson said.

Whether this option is exercised will likely depend on how long the legal wrangling continues. Some radiologists are eager to get on with the process, having decided months ago to go filmless. Others, however, are still struggling to make the figures add up, even with the promised discounts. They remain frustrated that the government is not pushing the project forward.

Initially, PACS and radiology information systems were excluded from NpfIT's list of essential and centrally funded core services. Government officials issued a statement in September 2004 reversing this decision for PACS but not for RIS. In March 2005, however, they promised to fund regional archives centrally and to provide Pound Sterling 132 million ($245 million) over three years to assist with capital deployment costs. But these concessions have not completely allayed concerns about the proportion of the bill hospitals must foot, even for the core PACS technology.

The U.K. government has appointed an arbiter to smooth the rocky relations between disgruntled radiologists in England and officials responsible for PACS implementation. Dr. Erika Denton, a consultant radiologist at Norfolk and Norwich University NHS Trust, is working toward a timely nationwide PACS rollout. Her hospital has been spared any engagement with the NPfIT because it purchased a PACS of its own choice under a private finance initiative in 2001.

"The NPfIT has had a bumpy ride so far," Denton said. "I hope that I will be able to act as a conduit between the Department of Health and the hospital trusts, and, therefore, with clinical radiologists."

The pace will have to pick up dramatically if suppliers are to meet NPfIT targets on PACS installation. Just 25 of the country's 178 acute hospital trusts currently have a PACS, but all 178 are slated to go digital under the U.K. initiative. Government officials had originally scheduled the beginning of the PACS rollout for the summer of 2004, with 80% of installations to be completed by the end of 2005. The remaining 20% were to be up and running a year later.

Although this end point has been pushed back to March 2007, some progress has been made. PACS implementation activity at 10 early adopter sites-four in the Southern cluster, four in London, and two in North West and West Midlands-has begun, according to an NPfIT spokesperson.