PACS - jewel of the £12.7bn NHS IT scheme?

When Roger Conway, a company secretary, broke his arm at Bristol Airport, he came to understand that PACS x-ray systems cannot always talk to each other.

Ministers, loyal Labour MPs and Whitehall health officials cite PACS [picture archiving and communication systems] as an example of the success of the £12.7bn National Programme for IT. But integrating PACS so that images and radiology notes can be exchanged between hospitals remains a problem.  

On a Sunday last month, Conway stepped into a gap between a ramp and bollards where alteration works were taking place at Bristol Airport.

He was taken to Weston General Hospital, which is a pioneer of the NPfIT. It was one of the first hospitals in the south of England to install the Cerner Millennium system as part of the NHS IT scheme. It also installed a PACS system in 2006. Doctors and nurses were understandably enthusiastic, according to the hospital’s publicity.

Duplicated x-rays despite PACS

To Conway, PACS has some way to go before it’ll earn his admiration. He ended up having the same x-rays done twice because Weston General Hospital did not transfer the PACS images it had taken of his broken arm to his local hospital about 30 miles away in Taunton.

His local Musgrove Park Hospital in Taunton is in the in the same county as Weston – Somerset – and the two hospitals are controlled by the same PCT. But PACS images are not routinely transferred between the two hospitals.

Conway says that Weston was unable to put an electronic copy of his x-rays on a CD which he could take with him to Musgrove.

X-rays and radiology notes couldn’t be emailed

Weston’s staff had suggested to him that Musgrove would be able to access the radiology notes the next day. This proved incorrect and even an email with the x-rays attached was refused. He was told that Weston and Musgrove’s PACS systems were incompatible.

Implications for the £12.7bn NPfIT?

Today Conway could be forgiven for saying that if PACS is the main success of the NPfIT where does this leave the rest of the £13bn programme?

Conway said:

 “When I got to Musgrove Park Hospital, the A&E staff contacted WSM [Weston General Hospital at Weston Super Mare] and were told that there was no compatibility in the systems and that it would take some time to get the data across.

“The MPH [Musgrove] team were not prepared to wait, and ordered fresh x-rays. I made WSM aware of my clinical history as soon as I arrived there, so they should have understood the implications.”

Wasted time

I asked Conway whether it mattered that his x-rays were duplicated and whether any time had been wasted.

“In terms of extra staff time at Taunton A&E, my guess is – doctor, 30 minutes; triage nurse,  20 minutes; x-ray radiographer, 20 minutes; receptionist, 10 minutes; and me, three hours sitting around at WSM waiting for something to happen.”

PACS still a boon to Weston

There’s no doubt that PACS has been a boon to Weston.  Its efficiency brought down waiting times for x-rays, images don’t get lost, there’s no need for storage space for films, radiology staff don’t need to touch the dangerous chemicals they previously used for processing films, and patients don’t have to wait for, and carry around with them, packets of x-rays. Diagnoses are made more quickly and the working space is more spacious and airy. Clinicians can manipulate areas of the image normally lost to under or over exposure.

But …

One of the promises made for PACS in  2001, when it began to be installed by hospitals in earnest [before the NPfIT which was launched in 2002] was that images could be transferred to other hospitals, peripheral clinics, GPs and the homes of doctors, at least in a compressed format.    

Eight years after the promises, this sharing of PACS images has yet to become a widespread practice. In 2001 the sharing of PACS images was being promised even over  dial-up modems. Now the NHS has a data spine and broadband.

In March this year, according to E-Health Insider, a report of the Royal College of Radiologists said that PACS systems in England are largely successful in individual hospitals butcommunication between systems in different hospitals is poor.

Spin or justified praise for PACS?

The following is one of the many ministerial statements to the House of Commons on PACS. It’s by the then NPfIT minister Caroline Flint in June 2007:

“Perhaps the greatest example of the way in which the national programme for IT does listen to its end-users relates to the picture archiving and communication systems, or PACS.

“Today in London, every NHS hospital is now equipped with that type of system. That means that patients wait significantly less time for reports and follow-up consultations, that films are no longer lost and that care is delivered more safely and efficiently.

“Picture archiving was not part of the programme when the contracts were let in 2003. Those systems were added to the contracts in 2004 in direct response to feedback from front-line clinicians and groups representing patients, so the system has been updated and remains as flexible as possible to take account of new IT developments… 

“Would it not be wonderful if the media and other commentators talked more about where the system is working well for people? Then people in other parts of the country could ask their health chiefs and officials for the same service. That would be community engagement and patient engagement, which is what we want for people all over the country.”

Her loyal Labour colleague Andrew Miller MP made similar comments at the same debate on the NPfIT:

“…as of this week, 25.981 million digital images have been stored. That is a fantastic success. The roll-out has made enormous progress, complex though it may be.”

I’ve put Conway’s concerns to Weston General Hospital and await a reply.

[Roger Conway is the company secretary of a nationally known company, and a former university lecturer in management subjects.]


Clinical benefits of PACS – 2001

NPfIT harmed by poor communications – IT Projects blog

What can we learn from UK about EHR? – CIOzone [US]

IT spending will ride out NPfIT problems – Kable

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i could fix this WHOLE damn NHS system in 18 months for under £2 million and £1.2 a year thereon in it's a piece of utter p*ss this job honestly it makes me so angry.

I could do it myself with triple redundancy and insane access speeds (0.3 sec read times 0.9 sec write times) and I am not joking. With no help. 60,000,000 people is no problem

Another example of the government involved with poor IT systems? Never!

I live in London and I had a chest X-ray last month. It took two weeks for the picture to travel the mile and a half from the radiology clinic to my doctor's surgery. I don't know if they were using PACS, but I do know that it takes just as long as it did in the 70's.

this story probably reflects the difference between the programme in theory and in practice.

Over the past couple of years, I have seen some evidence of creakiness and poor design in the new systems.

As the years progress and NPfIT trundles ever onwards, I believe that far too much emphasis was placed on the politically-desirable 'patient choice' aspects - at the expense of effective systems design.

It's interesting that Weston Area Health Trust has decided not to comment on either the specifics or the generality of this case.

Therefore, can costly "communications" departments - of which there are hundreds in the NHS - justify their existence if they are simply issuing self-promoting material, and answering questions on "good news" stories, while refusing to answer awkward questions from journalists? Do taxpayers really want to fund such NHS enterprises?

So much is written on the wonders of PACs as a system, which nobody disputes, and so little on how images cannot always be shared even within a locality. The NPfIT was launched on the promise of the sharing of information; and PACS is trumpeted as the most successful part of it.

I plan to write a piece on the implications of Weston's approach to communications, given the Audit Commission's inquiry into NHS communications.