The push is on for the implementation of EMRs in the United States, largely due to the passage of the American Recovery and Reinvestment Act of 2009, which allocated more than $19 billion in federal investment for the technology. This ambitious program seeks to implement interoperable health IT throughout the country over the next four years. However, as illustrated by recent reports from the U.K. and Canada, there are potholes and roadblocks that will need to be navigated to ensure successful EMR-PACS integration.

According to a position paper from the Royal College of Radiologists released late last month, PACS installed in the NHS in England are largely successful in individual hospitals “but has resulted in isolated local PACS with poor communication between systems in different hospitals particularly in England and Wales.”

The paper found that “when Local Service Providers (LSPs) were appointed to deliver the National Program for IT (NPfIT) in 2001-2002, the contract was for 1 year of local PACS storage with additional archiving to Central Data Stores (CDS) at a cost of £35 million (U.S. $52.2 million). NHS Trusts were led to believe that these CDS would be pivotal to automatic image and report sharing. It subsequently came to light that radiology image and report sharing was not in fact a contractual requirement for LSPs.”

The authors reported that trusts with existing systems did not replace their PACS with the LSPs’ solutions when it became clear they did not provide significant additional benefits. This has resulted in a “multi-vendor PACS environment” where, for example, London has 21 trusts with an LSP PACS and 16 with pre-existing systems.

In the absence of automated image and report transfer, the college stated that “time consuming manual processes such as DICOM Push, remote web-access and CD transfer with encryption for non emergency patients are required to get access to images and reports which were performed and issued in other NHS trusts.”

The college lists other weaknesses that it sees in the national program, including a failure to recognize the importance of document sharing that integrates radiology reports and images and the lack of a clear, long term strategy for integrating radiology reports and images into an EMR.

Meanwhile, across the ocean, Canada is reporting that its nationwide multi-vendor PACS roll out, under the auspices of its Canada Health Infoway, has been a resounding success.

The organization reported that “Canada's investments in digital diagnostic imaging technology will generate between $850 million and $1 billion in annual radiology efficiencies and cost savings and have already increased productivity to a level equivalent to adding more than 500 radiologists to our healthcare system.”

They also stated that Infoway PACS deployment has seen a 25 to 30 percent increase in technologists' productivity; the elimination of up to 17,000 patient transfers annually through remote access to images; the increased capacity of between 9 million and 11 million exams at current radiologist resource levels; and the expectation that up to $1 billion (U.S. $824 million.) a year in health system savings and efficiencies will be realized once PACS is fully implemented across the country.

“Infoway projects that by March 31, 2009, 79 percent of Canadians will be in a position to benefit from $340 million (U.S. $280.4 million) in PACS investments,” the organization reported.

The cautionary note from these widely divergent outcomes is for U.S. health IT architects to ensure that their institutions’ PACS are ready to integrate their reports and images across a nationwide health information network (NHIN). This may well require the adoption of the Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing (XDS) and XDS-for Imaging (XDS-I) profiles for sharing images and other clinical information in their PACS.

The IHE XDS and XDS-I design calls for a central location called a registry which keeps an index providing information about where a patient’s data is located. Users then retrieve the data from the original store, reducing the need to store the data centrally.

Not surprisingly, Infoway played a major role in the development of XDS-I, which allows access to images indexed in the main XDS registry. In the meantime, NHS Connecting for Health stated that it is aware of the potential of XDS-I and that it is asking its suppliers to confirm when an XDS-I compliant PACS will be available on their commercial roadmaps. In addition, it said that investigations as to how it could be incorporated cost effectively into the PACS estate in England are underway.

In other news, if you’re looking to add or bolster the PACS capabilities of your practice in the coming months, please stop by our Healthcare Tech Guide. We have listings for vendors, systems, training, services and white papers for a variety of products spanning the healthcare environment.

In closing, if you have a comment or report to share about PACS in your practice or hospital, please contact me at the address below. I look forward to hearing from you.

Jonathan Batchelor, Web Editor
jbatchelor@trimedmedia.com