The national IT programme is proclaiming a triumph at last, says Lyn Whitfield

The national IT programme has its critics, but in the run-up to the New Year it was able to announce a genuine success. Picture archiving and communications systems, which digitally capture, record and display images, are now in use in every hospital trust in England.

"The benefits of the introduction of PACS in terms of improved patient care are massive," said health secretary Alan Johnson. "This innovative technology speeds up and improves the accuracy of diagnosis, saves time and improves the quality of care.

"Trusts are reporting that the time taken for radiologists and radiographers to issue reports to clinicians have typically halved from more than six days to less than three, and these turnaround times continue to fall, with some hospitals reporting all images within 24 hours."

These systems are often described as a technology whose time has come. As Mr Johnson said, they reduce the time taken to capture images and offer other clinical benefits: images can be sent around hospital departments, enlarged, rotated and easily compared with stored views.

They can also do away with film and the noxious chemicals needed to process it, reducing costs and freeing up physical space. For these reasons, there was considerable interest in such systems before roll-out became part of the IT programme in May 2004.

Indeed critics claim that this technology would have been deployed anyway and the programme's involvement prevented trusts from doing their own (that is, better) deals with suppliers.

But it should be said that while PACS had attracted interest before 2004, many managers were worried about the cost of systems and the difficulty of developing a business case for them, given competing priorities and the evolving modernisation agenda.

NHS Connecting for Health, the agency that runs the national programme, argues that just 50 trusts had any form of communications systems before local service providers negotiated contracts with suppliers to deliver systems across their areas, and that both the speed and scope of implementations "accelerated massively" once this was done.

Change programme

The systems' programme director Mary Barber says: "Feedback will always be mixed, because some people love technology and some don't and some welcome central direction and some don't.

"But the feedback I have had is that radiology managers and general managers in trusts are generally very happy [with what has been delivered]."

However, she argues that the trusts that have got the most out of deployment of the new technology are those that have "really engaged with the process" and looked at how it can change their ways of working. Those that have simply digitised existing processes have seen less benefit.

"Managers have to recognise that this is a change programme and not an IT programme," says Ms Barber, citing trusts that have used the systems to allow images to be reported from a number of sites, making better use of staff time and expertise, and to develop nurse-led clinics with technology-enabled support from specialists.

"Many trusts have had PACS for about a year, so now is a good time for them to look at whether it is being used effectively," she adds.

At the moment, images tend to be reported onto tapes that are sent for typing. Ms Barber argues that two developments trusts should be looking at are digital dictation and speech recognition.

The first system does away with tapes and so reduces the chance of reports being lost or held up by an individual typist. The second goes a step further and allows reports to be dictated into documents on a screen. Both can contribute to falls in turnaround times and so help to deliver on targets such as 18 weeks.

Another issue is the extension of picture archiving. Erika Denton, national clinical lead for diagnostic imaging at the Department of Health and medical director of the programme, says: "We decided to implement [these systems] for radiology and kept out other kinds of images, such as those created by breast screening. Now, there needs to be a big push to bring them in."

The government's new five-year cancer strategy promises£100m for digitising breast screening by 2010. Dr Denton says managers should start preparing now.

While the programme may have helped to get systems into trusts, it has failed to ensure that images can be shared "seamlessly" across clinical networks or exchanged with other centres when patients travel.

Dr Denton, a practising consultant radiologist, says many of her colleagues are impatient for image sharing to support multi-disciplinary team meetings, to access specialist expertise and to act as a teaching aid.

"We are building a radiology strategy to address these issues, but radiologists want things yesterday, so there are some challenges for managers in addressing expectations," she says.

The strategy will look at some of the technical issues around image sharing, such as the robustness of NHS networks and security. However, not all of the barriers to data sharing are technological.

"There is a pressure to create links to other organisations, but from a financial point of view, trusts might not always want to do that," says Ms Barber.

"So there is a real challenge for managers, and that is to think about how to use [these systems] in going forward and how to create business cases that will get past the board and get past the strategic health authority so we can deliver solutions that make business sense.

"Managers should never think 'somebody is doing this [delivering PACS] to me'. They should always be thinking about how to get the most out of it and what they can go on to do with it in business terms."