Up to 80% of picture archiving and communication system and radiology information system contracts are due to expire over the next three years.
NHS organisations need to start planning now for how they will manage this significant change, at a time when both NHS and supplier capacity and capability in this specialist area will be stretched.
Questions for trusts
The majority of current PACS and RIS contracts were let under the National Programme for IT in the NHS, and it could be argued that trusts had little say in the contract, choice of supplier or what was delivered.
This time round it will be entirely the trust’s choice, but that means they will need to take the lead themselves. Some of the key decisions for trusts will be:
No two trusts are exactly alike and so for each the answers will be different. This means we are looking at a significant move away from the national ‘one size fits all’ implementation; which did deliver PACS and RIS to every trust and achieve efficiency savings.
Challenges for experts and suppliers
In the current financial climate, trusts are looking for more efficiencies and greater flexibility to deliver its services to meet today’s needs cost effectively.
The real problem is that there is a huge skills gap and lack of knowledge about the technology and what might be needed to implement a system that will undoubtedly create a very different way of working.
That isn’t a criticism of any trust or even the government; it is simply the case that the last PACS implementation took place more than seven years ago (and ten years ago if you include the specification procurement and contract time).
Many of those involved have moved on or even retired. They are also spread thinly across NHS trusts, so experience is rather hit and miss.
The same is true of the system suppliers. Many have been out of the UK market or operating from small bases due to the lack of activity in this period.
There are also new suppliers coming into the UK for the first time from different backgrounds; including electronic patient record suppliers.
They will also be challenged with meeting and managing the demand from trusts during the procurement and implementation phase.
Closing the gap with clinicians
The issue with the previous, national IT approach was that it left a huge gap between the IT and the clinical staff.
By taking control of PACS, getting expert advice to help map the way forward, and looking at the real needs of the trust as a whole, there is a real opportunity to close that gap with an innovative technology solution.
Of course, future-proofing is also a key concern. Standardising the way platforms operate or communicate with each other will allow further innovation and development to take place.
The internet era has shown that having an open standard means many different developers can work on new ideas and solutions.
This provides not only competition to drive down costs but also increases the options available. For PACS and RIS this means DICOM, HL7 and IHE XDS and XDSi profiles.
This collective development or ‘wiki’ approach opens up a world of new options for technology and means that trusts should be able to get a bespoke solution that really delivers for their specific needs.
Adding new services and upgrading technology should also be a simpler task, because all suppliers and developers will understand the standardised platform on which it is built.
Still, we must accept that technology and the NHS do not have a great reputation in the outside world at the moment. This is a shame as the NHS has a wide number of innovative and efficient projects that have really helped improve patient care.
PACS is one of these and, while there may be worries about how to get started or worries about potential savings there is no reason to think that the next generation of PACS cannot deliver further efficiencies across hospitals as promised.
Two years to take charge
The important thing remains; NHS trusts need to take control for themselves. Two years does seem like a long time - but planning and getting the right advice is crucial.
Start having the conversations now or it might be too late to make your voice heard and get the system that is right for you and your trust.
