Question mark hangs over U.K. PACS funding

Who will pay for our PACS? This is the question many U.K. radiologists are asking after health service officials excluded digital imaging provision from an IT "must-have" list.

Radiologists and vendors alike have been holding their breath ever since the government announced plans for a $9 billion National Program for Information Technology (NPfIT), bringing modern IT to National Health Service hospitals, clinics, and GP surgeries throughout England.

The program's final structure, however, includes PACS only as an optional extra. Whereas designated "core services" will be implemented without question and funded from a central pot, decisions to equip hospitals with a PACS and/or RIS will be made and paid for locally.

"There has certainly been considerable confusion and some angst amongst the leading PACS radiologists of the U.K., or rather England, 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, electronic prescribing, and updating of the largest intranet in the world were seen as higher priority."

Widely reported comments from National Health Service IT Director Richard Granger, that the health service would build its own PACS if vendors didn't offer the NPfIT bulk discounts, have stirred the funding debate still further.

"The NPfIT contracting process has confirmed that there is scope for substantial savings in IT costs," said an NPfIT spokesperson. "There are a number of vendors in the market, and we are expecting support from vendors for our plans."

Foord is hopeful that Granger's threatened do-it-yourself approach will not materialize. Further deployment of Web technology should help cut the cost of software development, while the price of hardware platforms and storage devices is also falling, he said.

"The thought of the National Health Service developing PACS itself, while not impossible, will not be an attractive prospect to those of us blighted in the past by National Health Service in-house IT developments, which never quite made it," he said. "I was never attracted by wheel reinvention."

Members of the newly formed NPfIT National Clinical Advisory Group for PACS will be making the case for PACS at a high level and helping hospitals develop strong business models and specifications, Foord said. But they are not underestimating the task ahead, nor the investment required.

"Of perhaps more concern is the relatively inadequate DICOM status of much of the radiology equipment base in the U.K. and the plethora of 'not-so-good' RIS systems that exist," Foord said. "There is no doubt that to make PACS fully effective, these too need addressing. This may be a bigger financial challenge than a basic PACS."