Installing a PACS
This is a personal view of a Picture Archiving and Communication System (PACS) installation but there will no doubt be resonance with the experience of others who have gone through the process and hopefully some useful pointers for those who are about to embark on the journey.
At St George's Hospital we have been through a process of PACS procurement and implementation, which has been tortuous and at times difficult with differing demands from various NHS bodies which moulded the process over the past 5 years. This is a very individual experience but much was learned on the way. Fortunately, 18 months post implementation I can say that we would do it all again as PACS has revolutionized the way we work and has increased our organizational efficiency as nothing else could.
From late 1999 when we started out we progressed from a single Trust project to a South West London Sector Project (at the behest of the Regional Health Authority) to the installation of PACS at St George's only in June 2003. This was not because the Sector Project was problematic as six Trusts worked together in an exemplary way and unanimously selected a preferred supplier showing that a large project with mutual shared benefit can succeed. However, the establishment of the Strategic Health Authority resulted in re-evaluation of the project at a late stage and the National Programme for Information Technology (NPfIT) was looming into view. St George's implemented largely because of the imminent opening of a Neurosciences and Cardiothoracic PFI build designed to have PACS. Hopefully the remainder of the sector will now progress within NPfIT as all of the groundwork has been done.
It was, in our view, absolutely essential to appoint a member of staff to oversee the project and we appointed a Project Manager at the outset. This greatly assisted progress as other members of staff were already too busy to take on this huge extra task. The sector project also had a Project Manager which kept the entire sector on schedule. The employment of external consultants to assist with planning, consultation and outline and full business case was extremely helpful.
In the early stages clinical colleagues were involved in focus groups and later two were incorporated into the PACS Project Board, one a cardiologist and the other an orthopaedic surgeon. A neurosurgeon was involved in the final selection process of the system. It is essential to involve other disciplines and make the project a hospital project rather than a radiology one. PACS alters everyone's working environment and practices. It is, however, difficult to maintain the interest of clinicians over a lead up time as long as ours, but it is important at least to keep the PACS Board members informed of progress and consult with them when necessary.
The technical specification was drawn up partly using our own knowledge from reading, attending conferences and asking others about their experiences with PACS. We also employed an external consultant who had had involvement with other PACS installations and Medical Physics advice proved invaluable. IT upgraded the network to the satisfaction of PACS suppliers and we have a virtual local area network (VLAN) reserved for PACS. All storage is on RAID (Redundant Array of Independent Disks), which is a hard disc system, with backup on digital linear tape (DLT). The sector project specified a central DVD store with all examinations in working storage, but this aspect has not been resolved for the St George's site alone. Having everything in working storage is undoubtedly an advantage.