U.K. government warns PACS vendors to cut prices

NHS threatens to develop its own PACS

The $9 billion program to bring IT to U.K. hospitals, clinics, and physicians' surgical practices, called GP surgeries, is not turning into the cash cow that PACS and RIS vendors might have hoped. One reason is that PACS was excluded from the list of centrally funded "core services" in the National Program for IT (NPfIT). This made PACS implementation optional instead of essential and subject to local budgetary constraints.

Making matters worse were widely reported comments by National Health Service (NHS) IT director Richard Granger that the NHS would "build its own" PACS, if established vendors failed to cut a better deal.

"There has been considerable confusion and some angst among the leading PACS radiologists of the U.K. over the intentions of the NPfIT concerning PACS," said Dr. Keith Foord, secretary of the Royal College of Radiologists PACS and Teleradiology Group. "In the end, PACS appears not to have been included in the core funding because the electronic integrated care record service (ICRS), electronic prescribing, and updating the largest intranet in the world (NHSnet) were seen as higher priority."

Responsibility for implementing the NPfIT in England is now in the hands of five local service providers (LSPs), each covering a separate geographical region. PACS and RIS have been included in the LSP contracts as "additional services" available to NHS organizations.

"This means that, at present, Strategic Health Authorities and Primary Care Trusts may choose to spend their own IT budgets investing in PACS and RIS," said an NPfIT spokesperson. "Additional funding for future years is currently under review."

Decisions to sanction PACS and RIS funding will be tied to the strength of business models, with investment weighed against economic and clinical benefits. The balance is too heavily tipped toward software suppliers' coffers at the moment, according to Granger. He is expected to push harder for discounted deals from those PACS vendors who have already partnered with the LSPs.

"The NPfIT contracting process has confirmed that there is scope for substantial savings on current IT costs for the NHS, when requirements are aggregated," an NPfIT spokesperson said. "PACS suppliers are expected to respond, through substantial price discounts, to this major commercial opportunity. If the suppliers are unwilling to participate on this basis, then we will have to seek alternate ways of implementing digital imaging systems across England, in a way that achieves best value for money for patients, the NHS, and taxpayers."

Relations between the NPfIT and prospective vendors are clearly at a delicate stage. PACS vendors approached by DI SCAN were reluctant to comment on the NPfIT's stance with negotiations still in progress.

"We are in continuous discussion with the NHS, to deliver a solution that is both state-of-the-art and cost-effective," said Wes Charlesworth, director of Agfa Healthcare in the U.K. "This process began when the NPfIT was set up and has continued ever since."

Agfa has a track record of providing fully integrated PACS in the U.K. These systems have allowed NHS Trusts to deliver clinical benefits within working budgets, according to Charlesworth.

"Agfa has every belief that this experience in the market will allow us to continue to develop at a national level with NPfIT," he said.

Government officials have been keen not to cut ties with commercial suppliers, at least not yet. The promise of multisite PACS/RIS implementations may still prove to be a bargaining tool.

"The national program recognizes the expertise that exists among the specialist suppliers and expects market forces to produce competitive prices for the NHS," said an NPfIT spokesperson. "However, we have to protect the taxpayer and will take the best value solution available. There are a number of vendors in the market, and we are expecting support from vendors for our plans."

Foord is optimistic that NPfIT threats to build in-house systems will not come to fruition. Further deployment of Web technology, according to the secretary of the Royal College of Radiologists PACS and Teleradiology Group, should help cut the cost of software development, while the price of hardware platforms and storage devices is also falling.

"The thought of the NHS developing PACS itself, while not impossible, will not be an attractive prospect to those of us blighted in the past by NHS in-house IT developments which never quite made it," he said. "There are excellent commercial products right now at good prices. Hopefully, the LSPs will have some of these products in their partners' portfolios, which NHS Trusts will be busting a gut to buy. I was never much attracted to reinventing the wheel."