Examining: Changing PACS in the South West

A consortium of five trusts in the South West of England has nearly finished implementing a new picture archiving and communications system from Insignia.

Of the five, three implementations have now been completed, one is underway, and the final one is planned to go live in mid-June. The £6m contract is initially for seven years, with an option to extend for another three years.

The five trusts – Plymouth Hospitals, Northern Devon Healthcare, South Devon Healthcare, Royal Cornwall Hospitals and Devon and Exeter – formed the consortium 16 months ago, initially with a further two trusts.

At the time, an imperative was to make sure that they would have a new PACS in place by the time the existing contract came to an end in June 2013.

The consortium went out to tender using the Official Journal of the European Union, allowing nine months for the procurement process and nine months for implementation.

The other two trusts – Taunton and Somerset and Yeovil District Hospital – pulled out near the end of the procurement process, when the shortlist of nine suppliers had been whittled down to two: Insignia and Carestream.

They opted for a PACS from Carestream, which they felt better met their clinical needs. Andy Blofield, director of the Plymouth ICT Shared Service, and senior responsible officer for the consortium, says it was the right decision to go out to tender early.

“It was very time-consuming, mainly because you’re evaluating a very large specification, and we initially had seven trusts doing it.

“With an OJEU, you’ve got to make sure it’s completely open and transparent; and therefore you have got to give feedback to the unsuccessful suppliers.”

To help with the complex task of scoring the bids, the consortium enlisted Peninsula Purchasing and Supply Alliance, a local organisation offering procurement support. PPSA made the process “more straightforward,” says Blofield.

An innovative solution

Insignia, a relative newcomer to the UK PACS market, albeit one that has made disaster recovery PACS and breast screening its own niches, was chosen because its solution was seen as more innovative than that of some of the more established suppliers.

“We had huge clinical involvement, and they very much favoured the Insignia approach,” says Blofield.

“They’re very new and the new organisations tend to be very innovative. And they’re very keen to work to develop their product, whereas the bigger players tend to have a very mature product, which they’re less inclined to customise.”

A major requirement for the new contract was that it should offer good disaster recovery mechanisms.

The initial tender made it clear that the winning supplier would either need to provide a system that could plug into existing disaster recovery solutions, or offer its own disaster recovery if no solution was in place.

The fact that the previous solution was not resilient, says Blofield, had been a cause for concern: “PACS really is our only truly mission-critical solution, because it’s the only solution we’ve got absolutely no business continuity for. If PACS goes down, we can’t treat patients.”

Regaining control of the contract

The consortium also felt it was important to be able to manage the new contract without outside intervention.

“The national programme added a degree of complexity into the relationship we like to build with the supplier,” says Blofield.

“NHS Connecting for Health serviced the previous contract, and it was pretty much invisible to us as a trust exactly what that contract said or contained.

“So that was our first requirement when we started – we wanted to have the dialogue directly with the supplier, we wanted to service our own contract, so we can actually influence how it develops.”

This inability to influence the terms of the contract had made for an unsatisfactory experience with GE Healthcare, the supplier under the NPfIT procurement.

None of the seven members of the consortium wanted to continue the same contract with the existing supplier, says Blofield.

Under the new contract, the consortium will be able to exercise far more control: “We will have quarterly contract reviews, as we do with all of our other systems, and have KPIs that the supplier and ourselves can sign up to.

“We weren’t able to do that before – it was pretty much, ‘There it is, guys, there’s your solution, it’s been bought for you, get on and use it.’”

The implementation so far has been reasonably smooth. The biggest piece of work has been the process of migrating the data from CSC, the local service provider under the old arrangement.

“To get it off the CSC datacentre, where it is held in a very proprietary format, into a vendor neutral format is proving challenging for everybody.

“CSC is coming under a lot of pressure. The timeframe to get it all done for every trust, by the end of the contract period, is extremely demanding,” says Blofield.

Don’t underestimate the scale of the task

A consortium approach saves costs and makes it easier to share data across trusts if they use the same supplier.

It does, however, add a level of complexity to the procurement process, Blofield warns. His advice to others taking a consortium approach is that they should start early.

“Don’t underestimate the level of time and commitment that’s required. We’re very comfortable with an OJEU procurement as a single trust – we know how long it takes.

“When you start adding in other trusts, it’s very different because different organisations tend to have different ways of doing things.

“When you try to co-ordinate the placing of a shortlist, for example, you’ve got to go through a board and that process can take two months because of the way the board dates fall.”

This added complexity means that it’s important to do a lot of planning at the start: “Make sure everybody shares the same vision initially and all commit to the timeframe.

Map out the timeframe from day one so you can get the clinicians on board whenever you need them. Most organisations need to give clinicians at least six weeks’ notice.

“With most OJEUs, if we’re just running them for one organisation, we don’t tend to plan the entire nine months up front.

"Whereas with the consortium we did: we planned the entire roadmap, we booked the venues, we gave clinicians notice, and it made it a lot more straightforward.”