U.K. government confirms cash support for PACS

At last, it's official. After months of uncertainty and confusion, U.K. government officials have confirmed a national investment package to bring PACS to all of England's acute hospital Trusts within the next three years.

Just 25 of the country's 178 acute hospital Trusts have a PACS at present. Government officials would like to see the remaining 153 start pursuing PACS solutions this summer. The proposed schedule, part of the National Program for IT (NPfIT) in healthcare, sees 80% of installations completed by end 2005. The outstanding 20% are expected to be up and running by the end of 2006.

Exactly how much money the government is pledging is still unclear. This week's long-awaited announcement stated only that £60 million ($100 million) of central funds would be available for PACS investment this year. Details of additional funding through 2005 and 2006 have yet to be released.

Of course, there is no such thing as a free PACS, and the deal comes with strings attached. Hospital Trusts seeking government finance for PACS must purchase their system through a designated local service provider. These LSPs, each serving a number of Trusts within regional "clusters," will be offering PACS only from vendors chosen by the NPfIT:
? Southern cluster: GE Healthcare
? London cluster: Philips Medical Systems (subject to contract)
? East and East Midlands cluster: GE Healthcare
? North East cluster: GE Healthcare
? North West and West Midlands cluster: Kodak and ComMedica

GE Healthcare is the obvious winner, gaining monopoly coverage in three separate clusters. Notable absences from the published list of contracted vendors include Agfa, Ferrania, and Siemens Medical Solutions.

"The selected suppliers fully comply with our requirements and provide a fit-for-purpose solution designed by clinicians and supported by the Royal Colleges. They are recognized major vendors with a global presence," said an NPfIT spokesperson.

Trusts wishing to bypass their LSP's choice of vendor will have to pay for the entire installation themselves. Those choosing the LSP route should receive a slice of government funding, though this is intended to supplement local funds and not finance the entire operation.

"Central funding is aimed at bridging the affordability gap, "said an NPfIT spokesperson. "This is going to be supplemented by capital and revenues from Trusts. The cash-releasing benefits from the implementation of PACS will fully meet this revenue requirement."

As a further incentive for hospital Trusts to play ball, NPfIT-approved PACS will be supplied at a discounted rate. Government officials have negotiated price reductions of up to 57% on diagnostic workstations, 65% on CR image acquisition equipment, 71% on disk storage, and 82% on PACS servers.

"The PACS solutions on offer via the LSPs are not only fit-for-purpose, but also demonstrate best value. We are confident that individual Trust boards will see the value of ordering PACS through LSPs," said an NPfIT spokesperson.

The government's confirmation of cash support for PACS is good news for both patients and radiology departments, according to Dr. Keith Foord, a radiologist at East Sussex Hospitals NHS Trust and secretary of the Royal College of Radiologists PACS and Teleradiology Special Interest Group. Many potential PACS projects were put on hold while Trusts awaited news of possible funding assistance. These bottlenecks can now be cleared.

Standardization of PACS within regions, by stipulating a sole vendor, has many immediate advantages, though weaknesses will likely emerge later, Foord said. He urges anyone taking the LSP route to insist on future-proofing features in their PACS. This should protect hospitals from prohibitively expensive charges and inflexible technical restrictions in years to come.

"I also suspect that PACS suppliers not chosen in this procurement may be prepared to do some very good deals to stay in the market," he said.

Radiologists should also be aware that the government's pledge does not cover RIS investment, although good PACS/RIS integration is essential to making the most from PACS, Foord said. The PACS systems on offer through LSPs are likely to be relatively basic.

"No finance director ever looks a gift horse in the mouth. But many Trusts will also need to invest in their underlying network infrastructure, imaging equipment, and possibly a new RIS, and these will be additional burdens," he said.