College highlights poor PACS image sharing

Tags: CfH Community England Google Information iS London LSP NPfIT PACS Radiology Standards

30 Mar 2009

Picture Archiving and Communication Systems installed in the NHS in England are largely successful in individual hospitals but communication between systems in different hospitals is poor, according to a new position paper from the Royal College of Radiologists.

The paper, prepared by the college’s IT sub-committee, is critical of the National Programme for IT in the NHS’ record on image and report sharing in PACS and radiological information systems.

It says: “When local service providers were appointed to deliver the NPfIT in 2001-02, the contract was for one year of local PACS storage with additional archiving to Central Data Stores at a cost of £35m.

“NHS trusts were led to believe that these CDS would be pivotal to automatic image and report sharing. It subsequently came to light that radiology image and report sharing was not in fact a contractual requirement for LSPs.”

The paper says that trusts with existing systems did not replace their PACS with the LSPs’ solutions when it became clear they did not provide significant additional benefits. This has resulted in a ‘multi-vendor PACS environment’ where, for example, London has 21 trusts with an LSP PACS and 16 with pre-existing systems.

In the absence of automated image and report transfer, the college says time-consuming processes such as DICOM Push, remote web access and the transfer of information on encrypted CDs are required to get access to images and reports generated in other NHS trusts.

The college lists other weaknesses that it sees in the national programme, including a failure to realise the importance of document sharing that integrates radiology reports and images and the lack of a clear, long term strategy for integrating radiology reports and images into the electronic patient record.

In addition to highlighting the information sharing problem, the college has set out its solution. The position paper lays down a set of standards to overcome the problem of automated image and report sharing which include the adoption of the IHE XDS and XDS-I profiles for sharing images and other clinical information.

Embracing this approach would represent quite a radical departure from NPfIT’s CDS model. XDS (Cross-Enterprise Document Sharing) was developed by Integrating the Healthcare Enterprise to provide an internationally agreed and vendor-independent way of sharing general clinical documents.

The design includes a central location called a registry which keeps an index – the equivalent of Google – giving information about where a patient’s data is. Users then retrieve the data from the original store, reducing the need to store the data centrally.

XDS was further developed for imaging, with the help of Canada’s InfoWay project, resulting in XDS for Imaging (XDS-I) which allows access to images indexed in the main XDS registry.

NHS Connecting for Health commented: "We are already aware of the potential of XDSi and have been asking our suppliers to confirm when an XDSi compliant PACS will be available on their commercial roadmaps. Investigations as to how it could be incorporated cost effectively into the PACS estate in England are underway."

More generally, the CFH spokesperson commented: “The national roll-out of Picture Archiving and Communications Systems has been a major success for the NHS with patients benefiting from faster and more accurate diagnosis and treatment. Our focus is now increasingly on improving the sharing of images and reports across trusts to support clinicians in their care for patients.

"We welcome the views of the Royal College of Radiologists as to how best achieve this goal and will continue to work closely with both the radiologists and wider clinical community to realise all the benefits presented by digital imaging and scanning.”

Related article:

Data sharing: the next move for PACS

Linda Davidson

Readers Comments

Single points of failure

30 Mar 09 13:07

Not seen the report in full, but the royal college should have spotted that the long term store in LSP environment is supposed to function as a backup for the local short term store. Time for recovery of this data has been quoted at months to me, that and the design of PACS will assets in one frame and no duplication of the database means, its not resilient and the backup startegy is really non existent. Given the audits we all undergo, I am surprised the auditors have not spotted this weakness across the NHS.

Can somebody refresh my memory?

31 Mar 09 15:05

Please correct me if I am wrong, but didnt the original NPFIT PACS solutions offered not contain a very good concept for the sharing of images? However a number of trusts did not like the concept that the product was being written from the ground up and that the tight deadlines which had been set could not be met by a small UK based company providing services to the programme.

Instead to save face, Commedica were binned from the programme (and went bust), GE took over and offered an out of the box solution which kept a few people happy?

Now this article asks for something that could have been delivered a few years ago but was scrapped! Plus in other articles this week people are calling for software that is developed specifically for the UK is this not ironic?

Memory refresh

31 Mar 09 22:25

There are many inadequacies in what NPfIT bought with PACS.

At the time we were forced to abandon local plans in favour of theirs, we were looking at enterprise wide image storage. NPfIT PACS was only for Radiology.

We had established links with local hospitals, the NPfIT vision was that they would use the central archive (or one-way dustbin as it has become). We have had to recreate reciprocal access.

This was down to the complexities of legitimate relationships, the delays to the Care Record (which should have brovided the LR links) and apparent inability of CfH and the supplier to develop anything meaningful.

N3 capacity has been heavily strained by the supplier design, and separation of responsibilities.

We asked questions at a very early stage around how they would restore if a local archive were to fail. Never heard satisfactory answers, though I hear that carrying lots of disks in vans along the motorway is the latest method.

So much for NPfIT Success

02 Apr 09 20:00

NPfIT jumped on the PACS bandwagon when it looked like it might be an easy win (those running the NPfIT knew so little about health IT that they excluded it from their initial plans) and have trumpeted it as a NPfIT success ever since.

If NPfIT was going to add anything to PACS implementation we might have expected that it would have been in the area of image sharing, but with PACS as in so many areas it would seem that all NPfIT has done is add cost and reduce functionality from local implementation which would have happened better without them.

benefits?

03 Apr 09 09:53

Agree with most of the college report. They might have added that due to issues with the "oneway dusbin" many trusts have had to buy extra local storage at extraordinary cost from the LSP "catalogue".

The inability to share images effectively with other trusts cuts right across many of the other initiatives in the NHS and delays patient care. We have somebody more or less full time burning CD's and laboriously encrypting them. We gone from being a film library to a CD library.

In terms of benefits to trusts - the cost of overcoming these issues drives a coach and horses through the original business case.

A shambles.