The roll-out of picture archiving and communications systems and radiology information systems is generally counted as one of the few, big successes of the National Programme for IT in the NHS.
But the national contracts for these core digital imaging systems will come to an end over the next couple of years; leaving trusts with some difficult decisions about what to do next.
Whether they decide to make tactical or strategic investments at this point, trusts will need to be confident that they have control of their imaging data.
So it was not surprising that vendor neutral archiving systems featured prominently in the exhibition at EHI Live 2012; alongside innovations to help trusts get the most out of that data, and to mobilise it on new devices and across healthcare communities.
Not just a pretty picture
For example, Agfa HealthCare used the show to demonstrate IMPAX 6.5, its latest generation PACS, its integration with the IMPAX RIS, and the Xero-Technology Viewer, which gives clinicians access to imaging data on web-enabled devices.
But the company’s line-up at the show, delivered under the banner of ‘insight: delivered’, also included developments in vendor neutral archiving, enterprise imaging management, and portals.
Notable among these was the Imaging Clinical Information System (ICIS), a workflow-centric services platform designed to make all radiology and multi-disciplinary imaging data instantly available across the enterprise.
“As trusts seek to consolidate their imaging fire-power under the imminent contract shake-up, ICIS supports their electronic patient record with a comprehensive image management strategy,” said Paul Jackson, UK marketing manager at Agfa HealthCare.
“It essentially liberates imaging data from disparate silos by managing all types of multimedia patient records - in ophthalmology, retinology, cardiology and any other ‘ology’ where there’s a multimedia image.
“It’s rather like an imaging version of an EPR that enables trusts to bring together and structure complex data, such as video footage from keyhole surgery and other types of non X-ray or imaging-related data.”
Agfa announced a partnership with Orion Health back in September. Following on from this, it also used EHI Live 2012 to demonstrate an image-enabled clinical portal based on Orion’s electronic health record and ICIS.
Jackson said this will give healthcare organisations point-of-care access to complete patient data and seamless access to the best unified view of clinical data and medical images in a single, secure unified environment.
“It will mean less cost and time, with no need to install client software, he said. “What’s more, they will be able to use their existing infrastructure and even connect across non-healthcare IT environments.”
New kids on the block
It wasn’t just the established players that had something to offer. One newcomer was TeraMedica, a Milwaukee-based provider of VNA systems for medical image management.
According to vice president for business development, Eddy Brown, the company’s new Health Imaging Exchange bridges the gap between the structured data elements typically found in electronic medical record systems and the unstructured data residing in proprietary silos across many PACS, multimedia and reporting systems.
“HIE handles non-DICOM data in its native format, so we’re not wrapping it in DICOM,” said Brown. “It means users are therefore no longer bound to a particular PACS view station to access the information.”
He added that the system can manage and store jpegs, video, audio files and so forth in their native format, making them easily accessible via the standard horsepower on a Windows PC.
“Images that previously only existed at department level can now be shared trust-wide, giving hospital clinicians and GPs, for example, prior and current views of an entire inventory of patient data.”
Another relative newcomer to the UK, Acuo Technologies, chose this year’s show to highlight its partnership with Philips Healthcare in the implementation of a multi-site vendor neutral archive across six trusts in Surrey and Sussex.
“Under their existing contract, these trusts have been using separate PACS to manage radiology images, but have been unable to effectively share clinical data as patients move from one department or hospital to another,” said Acuo’s European business manager, Mark O’Herlihy.
“This lack of interoperability and mobility of data has caused a host of clinical issues, driving up costs and delaying treatment for patients.”
He says the combination of Philips’ IntelliSpace PACS with Acuo’s Universal Clinical Platform system for both DICOM and non-DICOM medical image content, plus a centralised Rowthorne RIS from Healthcare Software Systems, will bring improved clinical collaboration to the trusts’ systems.
Under the contract, Acuo will migrate existing clinical image data - several million studies held in disparate PACS archives - and manage over a million new studies annually when the new five-year contract takes effect next year.
"As the national PACS program comes to a close, this NHS consortium is the first to procure a next-generation clinical content management system, bringing many hospitals together around a fully-interoperable solution,” said O’Herlihy. “It represents a blueprint for VNA growth in the European healthcare market."
Robert Childe, clinical informatics commercial manager for Philips Healthcare in the UK and Ireland, adds: "We chose Acuo as our VNA partner in the UK based on their global experience with Philips customers and their extensive track record in migrating from and to the major PACS and data storage products.”
For its part, Philips used EHI Live to promote advanced clinical 2D/3D/4D viewing applications and its new IntelliSpace PACS Anywhere ‘zero footprint’ image viewing solution.
Cloud-based medical imaging
Other established players at this year’s show included BT Health, which unveiled an innovative cloud-based medical imaging service it says will provide faster and easier access to patient images such as X-rays and scans.
Images are stored on a secure archive hosted on BT’s health cloud and made available to authorised staff via any web browser, thereby enabling clinicians to access images faster and helping speed up diagnosis.
BT claims the new service is also more affordable; pay-as-you-go tariffs will be available, so no upfront investment is necessary; which is particularly attractive given the efficiency challenges faced by the NHS.
For those seeking vendor neutral archive (VNA) solutions to unify patient images and documents across multiple vendor systems, departments and locations, GE Healthcare claims its Centricity Clinical Archive holds the key.
Unlike vendor neutral archives that only support departmental DICOM consolidation, the company says its solution helps streamline enterprise-level and community-wide collaboration through a breadth of interoperability standards, including IHE-XDS, HL7 and DICOM.
Rather than forcing trusts to custom-build their own solution involving multiple vendor relationships, GE Healthcare claims to deliver a “360° go-live experience” enabling solution planning, implementation, service and management through a single team of clinical and IT experts.
General manager Mike Jackman said: “Our solution is the key to enable effective collaboration, bringing benefits across the organisation to the IT department, the physician and ultimately the patient.”
Small can be massive
Policy changes are also having an impact on digital imaging systems. Former health secretary Andrew Lansley’s ‘Liberating the NHS’ reforms are intended to shake-up both commissioning and providing; with existing providers subjected to more competition through the ‘any qualified provider’ process.
The advent of AQP has prompted Burnbank Systems, a recent EHI award winner, to announce new functionality on the National Image Sharing Network (formerly and perhaps still better known as the Image Exchange Portal) to enable diagnostic imaging in the community from mobile units and primary care locations.
The company claims this will allow secure transfer to 98% of NHS hospitals and over 100 independent hospitals. It means diagnostic images and accompanying reports can be transferred quickly and securely to secondary care specialists, thereby reducing time and costs significantly. It says typical uses of the technology are likely to be ultrasound, MRI and echocardiograms.
Markus Bolton, co-founder of Shearwater Healthcare Solutions, says that with the end of the national programme NHS IT procurement managers should be able to take advantage of innovative and entrepreneurial companies when it comes to making purchasing decisions; in imaging as in other areas.
Speaking at EHI Live 2012, he said: “Smaller suppliers in this market have been starved of opportunity during the ten years of the national programme. Now trusts and care providers are making significant strategic investments in solutions that will bring clinical benefits and deliver cost savings.
“I still hear procurement staff saying they only want large suppliers, but there’s room for both.
"If you automatically cut out smaller providers, you’re cutting out agile, smart ideas. Their input to your procurement can be massive, even if you don’t choose them or simply include them as partners with a larger contractor.”