James Paget Healthcare NHS Trust in Norfolk has become the first hospital trust in England to go live with an out-of-cluster PACS system – one supplied by a local service provider from outside the trust’s region.

Although the trust sits within the Eastern region of the NHS National Programme for IT (NPfIT), last Thursday it went live with a GE PACS system supplied by Fujitsu Alliance. Fujitsu Alliance is the LSP for the Southern region of the English NHS.

EHI understands that the GE PACS system was supplied by Fujitsu Alliance as an ‘additional service’, outside the core LSP contracts for each cluster.

A spokesperson for Fujitsu Alliance confirmed to EHI that it had successfully implemented the GE PACS system at James Paget.

David Easter, the trust’s PACS project manager, told EHI: "We have implemented the system and it went live last Thursday. We’re the first in Eastern to go live with PACS." The trust had already implemented a Radiology Information System – supplied by HSS – two years ago.

The PACS system at James Paget is the fourth to be delivered by Fujitsu Alliance, but the first it has delivered outside its ‘home’ cluster in the South. Accenture, the LSP for both the Eastern and North East regions, has yet to deliver a PACS implementation.

In September Connecting for Health (CfH) awarded Accenture a contract worth £235 million to deliver PACS and Radiology Information Systems (RIS) to trusts across the Eastern and North East clusters – the award of the contract was delayed by an unsuccessful legal challenge by Fuji.  Accenture has sub-contracted with Agfa to deliver PACS. 

PACS forms a core part of the LSP contracts that every trust is obliged to take. It is unclear at this stage how the out-of-cluster deal at James Paget fits with the cluster-wide PACS contracts awarded by CfH.

Explaining why the trust has implemented the Fujitsu PACS solution, Easter said: "We couldn’t wait for our LSP’s PACS solution, we’d already been ready to go to business case approval for our own PACS procurement when the national programme for IT launched."

As requested by NPfIT, the trust waited for the Accenture PACS solution, but delays began to mount, and eventually the trust decided it couldn’t wait any longer. "Eventually we got permission to go with another solution from another cluster," explained Easter.

The trust’s director of corporate services, Elaine Guest, added that the decision followed "some fairly high-level negotiations with the SHA and Connecting for Health".

A CfH spokesperson said: "The James Paget Healthcare NHS Trust was permitted to seek PACS from an LSP supplier other than the one that is contracted to provide the national PACS service for the cluster in which it is located."  The spokesperson added that the deal was signed before the Accenture PACS deal was completed.

"It’s been an extremely successful implementation and that’s due to our commitment and that of our service provider who were extremely helpful and co-operative. Our Regional Implementation Director and NPfIT have also been very helpful," said Easter.

He explained that the eventual decision to go with the GE PACS system was largely influenced by the fact that the neighbouring Cambridge University Hospitals Foundation Trust (Addenbrooke’s) and Norfolk and Norwich University Hospital Trust, which form part of the same local cancer network, both already had GE PACS.

"We do work in conjunction with Norfolk and Norwich in particular with some of our clinicians working at both trusts and patients receiving some treatment there and some here." He added that having a common PACS system would make it easier to share digital diagnostic images, improve patient care and prevent clinicians having to learn how to use two or more systems.

Phase one of the project has gone live in the trust’s radiology department, with the aim of becoming filmless by February 2006. "We will build a library of images over the next three months before we roll out across the hospital," said Easter.

The library of images will be built up on the Southern cluster data store, which will be used until the Eastern cluster data store becomes available. Although the new PACS system links to a central data repository it has begun by using the trust’s patient administration system for patient demographic details.

At the moment the trust has no plans to migrate to the Agfa PACS solution for Accenture when this becomes available.

Easter said that implementation of the new solution has taken three months, a process speeded by already having the necessary network infrastructure in place. "Our radiology department have been waiting for this for four years." He said the system is already delivering benefits to patients and clinicians.

The CfH spoksperson added: "NHS Connecting for Health and the James Paget Trust sought a common sense solution pending the appointment of an Eastern LSP PACS provider due to an ongoing legal case with an unsuccessful bidder that caused a severe delay in the cluster contract negotiations. The Trust faced a severe shortage of radiology capacity and urgently needed PACS in order to outsource work to neighbouring hospitals."

In total, six PACS systems have now begun implementation under the NPfIT. Four have been delivered by Fujitsu – at West Dorset, Salisbury, Milton Keynes in the South and now James Paget in the Eastern cluster.  In London BT has implemnted PACS at two sites, Hillingdon Hospital NHS Trust and Mayday Healthcare NHS Trust.

The CfH spokesperson told EHI that a total of ten PACS installations are expected to be live by the end of the year.  The current prediction is for one PACS implementation in London, four in the North West and West Midlands and five in the Southern cluster by the end of the year.