Richard, I agree with the advantages of DR and this has been raised at cluster and national boards. It is difficult to get to the bottom of this but I think the reason DR exchange is not permitted is that DR was not included in the original OBS and suppliers were therefore not invited to tender on this basis. In view of the cost of DR this may put the programme in breach of EU competition laws if it were possible to exchange CR kit or vouchers for the DR equivalent from the same supplier. It is an example of where bulk purchase orders may not provide best long-term VFM, although it could be argued that if DR had been included and trusts insisted on it then the overall financial burden on the NHS would have been prohibitive to the rapid deployment of PACS. Does anyone have a better explanation?
"Monitor, who regulate Foundation Trusts have produced some guidance on how Trusts adherence to NPfIT will be measured"
Foundations Trusts saw a glimmer of hope when this guidance initially came out. Hopes were dashed when C4H came up with a penalty clause for not taking on the LSP solution (amounting to 70% of total of LSP PACS) if Trusts did not comply.
At a meeting I did ask C4H why all penalities are directed towards the Trusts, and none at LSP/their suppliers. I was asked to send my concerns in writing which I did, but like Nicola I have not heard anything so far.
I enclose my e-mail
"At the last -----meeting, I raised the issue of the penalities for PACS imposed on Trusts. I asked why similar penalities were not in place for LSPs, if they did not fulfill their requirements towards the contract. ------- asked me to write to you regarding the issues that I had with the LSP PACS solution.
1. Orthopaedic Templating- As you know our Orthopaedic surgeons do not like the templating solution from Agfa. A recent e-mail from Agfa states "Firstly, if you decide to to take an alternative solution I just want to make clear that this would be a non-standard deployment and we would therefore address this after the core deployment. All non-validated 3rd party solutions will be treated as a separate project." There is a contractual requirement for LSPs to provide Dicom Connectivity in PACS. The 3rd party Orthopaedic Templating solution requires is a Dicom QR and Dicom C-send to the LSP PACS. Dicom Connectivity needs to be provided part of Core PACS deployment (and not as a separate project later), otherwise this is clinically unacceptible and LSP are not fulfilling their contractual obligations, and hence they too should be penalised.
2. Bi-directional Desk-top integration There is a contractual requirement for providing a DTI with LSP PACS. As you are aware we are planning to upgrade our McKesson RIS, and I have concerns about LSP refusing to co-operate with DTI as we have not taken an LSP RIS. This would be clinically unacceptible to have PACS deployment without a desk-top integartion with RIS. I would like to know what kind of penalties would be imposed on the LSP, if there is a failure to provide a Desk-top integration with McKesson RIS.
3. Single sign-on LSP products are supposed to provide a single sign-on for NHS systems as per the LSP contract. Agfa Impax 5.2 is thick client workstation based solution. A recent e-mail from Agfa states: "N/B We do not allow non-validated software to be loaded onto DS or CS workstations." Hence, they are basically saying that they are unable to provide a single sign-on. From a clinical point of view, we would like to have a single sign on to all local Trust systems from PACS workstations. If they need to validate the Trust software they should do it before deployment, and should be penalised in the same way for their inability to provide a single sign-on."
"Barnsley is actually one of the first in a sense as it is the first NEEM LSP deployed solution, and they seem to have deployed this very rapidly." Rhidian, you need to ask barnsley how long they have had Agfa CR (in years), Agfa Impax workstations (in years), yes DTI is new!!!
Thanks Neelam. Are you suggesting te Barnsley implementation is not 'new' but an extension of the existing AGFA PACS, under the auspices of CfH? That would explain how they have achieved it so rapidly.
Neelham - I have forwarded your recent posting to Gavin Mander, who, as you know, has promised to post to this website a reply to your questions and those of many of the rest of us - as yet unanswered. He said he would make this posting before UKRC, so just 7 working days to go now!
At the last IT subcommittee meeting of the RCR held on Wednesday 26th April 2006, we drew up a list of 4 issues to be formally submitted to Michael Thick, who chairs the CfH National Clinical Reference Panel (but despite many requests from me and others regrettably does not read this website and is therefore oblivious to the concerns of the radiological and clinical community on the receiving end of CfH implementation) in an attempt to obtain some written answers to pressing problems. FYI, amongst the 4 issues to be tabled for inclusion on the agenda of the next NCRP meeting on 23rd May, we have included:
1. An explanation, with specific examples, of how the CfH programme is providing VFM in PACS implementation, and an explanation of why individual Trusts are not allowed to buy add-on items (such as orthopaedic templating) independently of their LSP, in order to secure the most favourable financial deal and to obtain the software/hardware most appropriate to their clinicians to perform their clinical work.
For the general interest of SIG members the other 3 items we have requested be included on the agenda for discussion at the 23.5.06 NRCP meeting are:
2. What steps are being taken to allow PACS users to communicate directly with their PACS vendor, and vice versa, post PACS deployment in a Trust (instead of the users being forced to address all their questions to the PACS vendor, however trivial, via the LSP as intermediary). A direct line of communication is desired on both sides between PACS users and PACS suppliers in order to speed up resolution of functionality issues and to improve efficiency of communication so that the nature of the queries and responses are not inadvertently modified by being "processed" by an intermediary ignorant of the problem being discussed.
3.What mechanism is being set in place to establish "PACS housekeeping" of the CfH PACS installations at every site for the lifetime of the PACS. Legacy PACS sites have taken years to realise that such full time posts are required (in addition to a "PACS project manager") to maintain the integrity of the databases, to correct errors, to "clean up" database problems such as unreported exams inadvertently marked dictated, patients who did not attend for examination appearing on PACS, dual entries on PACS for a study with one study containing no images (eg in multipart CTs where the report of a study may become associated with an entry containing no images etc)
4. An explanation of exactly how patients who refuse permission for their images and reports to be stored digitally, or refuse permission for those data to be accessed, are to be dealt with. One proposal from CfH was that such patients are to be given a CD or hardcopy of their images and reports to look after and it would become the patient's responsibility in such cases to provide these data on subsequent hospital visits. We would like to know how, in cases of child abuse (which as we all know often rely heavily upon imaging evidence for conviction) the involved parents or guardian are to be prevented from refusing permission for their child's images and reports to be digitally stored and readily accessed by medical and legal professionals. If such data are returned to the parent/guardian refusing consent for them to be stored/accessed on the cluster store, this will clearly threaten the child's well being since these data could be readily destroyed. It is well recognised that the parents/guardians in such cases frequently present to multiple different hospitals with each episode of trauma to decrease the likelihood of being detected.
Put simply the Australians have banned the excuse of "we can't tell you how much public money we're wasting, and how badly written our contracts are, as they're commercial secrets". Unsurprisingly (of course!) they found that making such arrangements open to proper public scrutiny improves their value for money (shoudln't have taken an academic paper to make such an obvious point really!)
Shame that we (the taxpayers and users) are unlikely ever to see the same degree of openness about the LSP contracts!
Very interesting, thanks Dave. Yes, it makes the point that the reason for outsourcing to the private sector is negated by the secrecy. I.e. VFM not delivered, plans not scrutinised, etc. Obvious, "school syllabus" stuff, really, as they say.
Just for info: you will all recall that I was told (by Michael Thick, who chairs the NCRP) to submit any points to which we wanted answers in writing to the National Clinical Reference Panel. I submitted the 4 points I posted last week to this website as agenda items for the next NRCP agenda, and this it the response I received from Michael Thick, and my subsequent response: Dear Michael Please would you let us know to whom in the "central team" you have passed these first two points on, since I and my colleagues do believe that they are very much clinical matters and we would like answers to these points. Thank you. Best wishes Nicola
>>> "Thick Michael" 05/08/06 8:18 am >>> Dear Dr Strickland, Thank-you for your email. The first two points, whilst of great interest, are not clinical matters, and therefore the NCRP is not the correct forum to discuss them. I have passed them on to the central team to make sure that your questions are answered. Your third question has a direct bearing on clinical governance, and is on the agenda. Your fourth point will be addressed in the review of information governance, which was already on the agenda. Thank-you for bringing these to our attention.
Kind Regards Michael Thick.
.............. I leave you to draw your own conclusions! There appears to be no way of getting the VFM question (or many others) answered. I wonder why that could be??!!