N3 problems may hinder PACS use

Problems with the new NHS broadband links, known as N3, have left some NHS hospitals with computer connections speeds too slow for them to effectively use planned new Picture Archiving and Communications Services (PACS).

While BT, the contractor for N3, has delivered over 7,000 NHS connections at the speeds required – GP practices are getting connections at speeds between 512Kbps and 1Mbps, while acute hospitals are getting speeds of up to 100Mbps.

Problems, however, are thought to exist when N3 connections meet NHSnet, the private NHS network managed by BT that N3 will progressively replace.

An NHS IT manager told E-Health Insider that the problems related to what happened when N3 connections went into the NHSnet ‘cloud’. “The slowing factor is NHSnet, when the connection gets it gets into the cloud it isn’t working properly.”

While ‘up’ speeds into NHSnet were at up to the 87.5Mbs speeds contracted for, the ‘down’ speeds were as slow as 5Mb, for slower than the 47.5Mb speeds contracted for in the N3 contract. One hospital is reported to have experienced ‘down’ speeds as slow as 1.5Mb.

Speeds as slow as 5Mbs for an entire acute hospital would make it virtually impossible to access the digital diagnostic images over a network. Under the National Programme for IT (NPfIT) Local Service Providers are meant to deliver PACS across local high-speed networks with all images older than a year stored and retrieved from remote data centres known as ‘Cluster Data Stores’.

The IT manager said that not only did the problem with slow connection speeds mean that ‘Cluster Data Stores’ would not be usable, it also meant that a PACS system installed at a trust would not be readily accessible at remote clinics and hospitals. "We’re depending on N3 to get images from main radiology systems to remote offsite clinics".

He added that while there were set performance levels set in the contract for N3, the same levels did not appear to be in the original contract for NHSnet, signed before NPfIT was devised. “NHSnet was not supposed to support PACS.”

A spokesperson for Connecting for Health declined to confirm whether the agency had been made aware of the problems of dramatically reduced N3 connection speeds. “N3 bandwidth for all trust services is fully synchronous and can be flexed up or down as needs change. The core network for N3 is sized according to current and planned traffic demands and will be grown alongside the requirements of national applications.

The spokesperson added: “PACS operational traffic is mainly inter-site and is not normally transported across the N3 core network. PACS archive traffic to Cluster Data Centres is transported across the N3 core and adequate bandwidth is already in place to enable this overnight trickle.”

This final claim was contested by the anonymous NHS IT director who said it would take ‘months’ to transfer historic diagnostic images to the Cluster Data Centre.

The DH awarded a £530 million contract awarded to BT in February 2004, to provide 18,000 NHS sites with the high speed links needed to enable NHS staff to access new clinical services.

PACS was meant to be one of the early NPfIT services to be implemented, providing benefits to patients and clinicians, but has run into lengthy delays. Implementations were due to have begun last summer, but by the beginning of this month only two were underway.

PACS is meant to be fully implemented across England by 2007. In the North East and Eastern cluster no PACS supplier has yet been awarded a contract.

The value and desirability of ‘Cluster Data Stores’ has been questioned by radiologists and other NHS staff involved in developing PACS business cases. In March the DH announced that it would centrally fund the capital and revenue costs of five Cluster Data Stores to remove an obstacle to trusts signing off PACS business cases.