Picturing a way to make big savings

On 13 March,2015 | In Features

Consultants at 108 Medical Chambers, Harley Street, have saved themselves £55k by developing their own upgrade of a picture archive and communication system (PACS) in house. Hamish Millar shares how they did it

108 Medical Chambers is an independent diagnostic and imaging centre within the heart of Harley Street.

PACS lightboxAs with most independent centres, we found the cost was historically a restriction to gaining access to hospital PACS systems. Patients often also wanted their films in hard copy to show other doctors who did not have access to digital readers – although all had access to a lightbox (right).

But, as time went by, it became more complex, and costly, to set up the various imaging devices to talk to printers.

We found the reduced supply of X-ray film and increasing use of CD-ROMs being brought to clinic by patients from other centres, meant that we had to explore new ways of producing and storing our own data.

Cloud solution

We knew we needed a solution to be able to consolidate our studies both for internal purposes and increasingly for external access and reporting by our doctors or others. So we looked at a PACS ‘cloud’ solution.

This seemed to fulfil quite a lot of our needs – especially regarding external access, as all the data is stored on external computers linked through the internet.

But it soon became apparent that the large number and size of the studies meant the costs of this started to increase incrementally. A different solution was required.

We met with a number of established PACS providers, but they were still wanting us to pay in excess of six-figure sums – including unrecoverable VAT – plus significant annual licensing fees.

If this was to be our only option, then so be it, we thought. But, to explore further, we put a small team together including our director of radiology Dr William Teh, consultant surgeon and medical advisory committee chairman Mr Simon Marsh, head radio­grapher Sally Bucklitsch and our IT network management company 24-7-it Ltd, which had managed our network for many years.

Amalgamating archives

Research and networking identified a well-respected and affordable open-source PACS solution called ClearCanvas. It is used extensively in Canada.

Our IT company worked with all the relevant people internally and set up a demonstration which we all played with and liked.

24-7-it also enabled connectivity to all our existing equipment and came up with a strategy to amalgamate all our existing archive studies from the past two years.

Happily, within two months, we had a facility available to all the consultants on their desktop.

It allowed them to see all the imaging for a patient both historically and across the range of imaging that we offer, from mammography to ultrasound and original computed radiography X-ray imaging.

We are also able to take studies from patients off CDs that were taken elsewhere and import them directly into PACS, so the consultants are able to see these instantly.

Large saving

And we can also export any imaging from a patient that we have done, of any type, directly to a CD so they can take it away if they require.

PACS monitorWe are enjoying a large cost and administrative saving, although film is still used occasionally when patients are going to certain theatres, for example.

The reporting doctors and consultants are also able to access images remotely because part of the PACS system includes a web-based retrieval and viewing facility.

We are lucky enough to be in a geographical area with a high-speed fibre connection. This means access to the entire system, including archives, is available to external consultants.

The system was specified to cater for the next three years’ worth of imaging requirements as well as the two years of archive –more than 16TB of storage on some impressive high-speed network attached storage (NAS) devices using RAID (redundant array of independent disks), a way of storing the same data in different places on multiple hard disks. Archiving and back-up facilities have been added to make it robust.

There is also the potential to transfer studies to other systems, although we have not really used this aspect yet.

The icing on the cake was that our IT company managed to source some reasonably priced Ultra 4k 28” monitors (pictured above). These are high enough resolution to use as review and diagnostic screens and they cost us a fraction of the price for conventional diagnostic viewing equipment.

So what did it cost? At £45,000 it is less than half the price of many quoted systems, and that included all the work of transferring the systems and consolidation of all the imaging.

The solution has worked brilliantly for us.

Hamish Millar is managing director at 108 Medical Chambers, Harley Street