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Not worth the RISk? (reported on EHI)

5th August 2014

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The end of national digital imaging contracts was an opportunity for trusts to change suppliers and refresh their IT. But few have chosen to try and implement something as essential and complex as a new RIS. Those that have tried have found the going hard – but they are now seeing benefits that others may want to emulate. Kim Thomas reports.

It’s been a year since the first contracts for picture archiving and communications systems and radiology information systems negotiated under the National Programme for IT came to an end.

Under the National PACS Programme, delivered by NPfIT in 2004, 128 English trusts that needed new systems were divided into four regional clusters.

They were then allocated to three local service providers (CSC, Accenture and BT), which set up regional data stores and supplied RIS from just two vendors.

HSS supplied the RIS for the two clusters managed by CSC and the cluster managed by Accenture. In London, BT supplied trusts with a RIS from iSoft.

The Health and Social Care Information Centre, now responsible for the PACS / RIS programme and its end, arranged for a staggered exit from the national contracts, so that vendors wouldn’t have to cope with 128 trusts all going out to tender at the same time.

By the time the contracts ran out, some trusts had been using the same RIS for ten years; even though RIS technology has moved on. In addition, some trusts felt the LSP structure had run its course, and were saying they would prefer to deal directly with their RIS supplier.

In principle, therefore, the refresh gave trusts the opportunity to switch suppliers and to adopt innovative technology suited to their particular requirements.

HSS emerges as winner

In practice, just as with the PACS refresh, trusts have played it safe. The two clusters served by CSC (the North West and West Midlands, and Southern) were the first to move off the national contracts and onto individual arrangements with suppliers.

Of these, the vast majority opted to stay with HSS (either directly or through a prime contractor). In all, HSS won 59 contracts, though a handful of these were new contracts.

Trusts in the clusters served by Accenture were given the option to extend their contracts at a discount, and 26 out of 32 did so. Of the 26, the majority have since opted for further tactical extensions, usually for a period of three or five years, and so are still using HSS.

Seven trusts in the Midlands, however, formed the EMRAD consortium and decided to procure a new PACS and RIS through the Official Journal of the European Union. The consortium has shortlisted two suppliers acting as prime contractors: Accenture, which is offering the HSS RIS, and GE Healthcare, which is also offering the HSS RIS.

Change is hard

So, what of the trusts that swam against the tide and didn’t select HSS? Both Carestream and GE Healthcare won several contracts (usually to supply PACS as well as RIS), while Soliton, a smaller company and relative newcomer to the market, also won a handful of contracts.

Their fortunes have been mixed. RIS implementations have proved challenging, particularly when it comes to migrating data from the legacy system.

The GE RIS selected by a consortium of four Kent trusts has been beset by problems since going live in June 2013 – and they remain unresolved.  A GE spokesperson says that the company is “working very closely with the customer to achieve a positive resolution to the implementation of the RIS system. This continues to have our highest priority.”

Imperial College Healthcare NHS Trust – which exited NPfIT early – also experienced problems with its GE RIS. The system is now at least partly operational. A statement from GE says that it has “received acceptance for three phases of the RIS/PACS/VNA installation. There are further phases to follow and we are working closely with the trust to complete these.”

Taunton and Somerset NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust, which joined forces for a collaborative procurement, opted for a Carestream PACS and RIS.

Although the RIS is now live, the two trusts are still – more than a year after implementation – using the old HSS RIS to view historic patient data.
Single or shared instance?

Although the majority of trusts will continue using CRIS, the HSS product, there have been variations in the way the new RIS has been implemented.
One of the features of the original NPfIT implementation was that, because a single LSP managed the data store for a whole cluster, trusts in the same region could share RIS data without too much difficulty.

Some trusts, such as those in Cheshire and Merseyside, have grouped together to purchase a shared instance RIS, which enables them to continue with this model. It has worked well in cases where patients may move frequently between general and specialist care.

Dave Burns, senior buyer for NHS Supply Chain, says that some trusts who have gone it alone have now regretted the decision. “We have seen cases where organisations decided initially that they didn’t want to be a part of a shared RIS instance, and now, a year or so down the line, they are actually coming back to us to say, ‘Hmm, maybe we made a mistake, how can we become part of the instance?’”

Reaping the benefits

Although trusts have been largely cautious in their approach to RIS procurement, they have still been able to implement upgrades offering new features such as voice recognition, single sign-on or the ability to use the RIS on mobile devices.

Some trusts, such as Doncaster and Bassetlaw, and Southend, have worked closely with their suppliers to create a tailored product.

Chris Yeowart, director of Wellbeing Software Group, which provides HSS, says that being able to deal directly with customers has been positive.  “Moving away from the LSP models helped us innovate because we can now be close to our customers. Instead of having to go through a bureaucratic change process, they can tell us what they want and we can give it to them.”

For the full story please visit the EHI website