'Health Informatics' (HI) is the term used to describe the science of information management in health care and its application to support clinical research, decision-making and practice, Pearson C,and Severs M (1999).
McCormick, Saba, (2001) state nursing informatics and information technology to be an integral part of the nursing information system and the nursing profession. Improving IT is an essential part of delivering patient centred care in the NHS. Ball M, Hannah K, Newbold S, (2005) state that the extent to which nurses use computers to assist them in performing complex and increasingly challenging duties is rapidly increasing.
Within this assignment I will be discussing the introduction of the National Programme for Information Technology, its aim, along with the introduction of Picture Archiving and Communication Systems (PACS) which is one service which the programme aimed to deliver.

The National Programme for Information Technology (NPfIT) is a national 6 billion pound programme implemented by the NHS to improve IT infrastructure and services. It began in 2000 and aimed for completion by 2010, aiming to introduce a set of new services to support the continued modernisation of the NHS (Anon,NHS, 2004). It is about supporting major improvements in care, by using technology to improve patients experiences, with information being available at the right time, in the right place, for the right person. Dr S Eccles (2006) stated the aim of the programme is to create a health service designed around the patient, providing better access to information, delivering high quality care fit for the 21st century. Moore (2009) agreed and went on to say that it has a key role in helping the NHS to meet the demands of an ageing population, a pressured workforce, and an increasing prevalence of lifestyle-related long-term conditions. D.O.H.(2002) said the aim of the initiative is to connect delivery of the NHS plan with the capabilities of modern information technology, designed around the patient, delivering services quickly, conveniently, and seamlessly, as well as supporting staff through effective electronic communications, better learning and knowledge management therfore reducing the time taken to find essential information, and making specialised expertise more accessible. The programme will deliver a number of key systems one of which being picture archiving and communication systems (PACS).
D.O.H (2007) report, the roll-out of PACS as a major element in the NpfIT, using this technology images such as x-rays and scans can be stored electronically and viewed on screens at a touch of a button.
Baker (2007) describes Picture Archiving and Communication System (PACS) as something that will enable the digital storage and distribution of Radiology images across NHS Trusts.
White (2005), describes PACS as an important part of NPfIT as it will provide ready access to all types of medical images using standard computers and web browser technology.
Jpihealthcare.com (2009) report principles of PACS were first discussed by radiologists in 1982, with Dr Andre Duerinckx reporting in 1983 he had first used this term in 1981. Hammersmith hospital were the first film-less hospital in the UK in the early 1990s.
PACS is a combination of hardware and software dedicated to the short and long term storage, retrieval, management distribution and presentation of medical images. These images are reported and digitally transmitted via pacs, eliminating the need to manually print, file, retrieve and transport film,Ganapathy, Sagayaraj (2010).
Mellor (2006) states PACS as being one of the aspects of the NpfIT set to be a success.
Connecting for health (2011) state the national roll-out of pacs is enabling; ensured access to images, future proofing, support of the technical capabilities of NHS, wide impact dealing with a range of specialities, guaranteed service, guaranteed performance and support, and future intergration of images with patient records, providing a single source for patient and clinical information.
Image acquisition, Pacs core, and interpretation workstations are the basic elements of pacs, Smith (2006) cited by Dreyer et al (2006). Acquisition is the first point of image entry into pacs. Once images are acquired they need to be managed ensuring storage, delivery, and retrieval all occur without error, this is where the pacs core initiates. Followed by interpretation workstations where the clinicians and radiologists can interact with the data contained within the pacs.
Dreyer K, Mehta A, Thorall J, (2009) discuss the development of Pacs means different things to different people. To some it doesn’t extend past the system that acquires, and stores medical images. However to others it represents an incredible resource for research, education and future development.
Benefits of PACS include rapid access to information, elimination of film, easily shared images, and the archive and retreval process. Advantages are well known and grouped into three areas, those for the patient, staff and the NHS.
White (2005), reports benefits for the patient include more effective and efficient care, secondary to improved availability of images. Mellor (2006) states patients in more rural areas will especially benefit as viewing systems will be available in minor injury units and other diagnostic locations, saving them on lengthy trips to hospitals. Health Secretary Alan Johnson reporting for the D.O.H (2007) said the benefits of the introduction of PACS in terms of patient care are massive, this innovative technology speeds up and improves accuracy of diagnosis, saving time, and improving quality of care. Moore, R (2009), agrees PACS operating throughout the NHS allows quicker and more accurate diagnosis for patients.
Dr Downie (2011) at nhs glasgow states that for some patients the most obvious difference will be the fact that images are available when they attend clinics, saving patient time of repeat imaging and delayed appointments due to lost film. Pacs can also reduce the increased radiation exposure risks that comes form repeated examinations when x-rays are lost at clinics or on wards, Rahmam M (2005).
Andrew Harvie (2007) recalls his experience with PACS stating, 'I recall thinking how quick processing time was, as when I returned from x-ray the consultant was already viewing my image on screen, I felt better informed and from my experience of pacs it is a great improvement on old methods of x-ray'.
White (2005) also reported benefits of PACS to staff. Those including images being more readily available, with the capability to view images simultaneously in different locations. This enabling greater effective multidisciplinary care. Dreyer et al (2002), agree with White (2005) and go on to say that for referring physicians it means easy and remote access to patient imaging as well as improved turnaround times and patient care. Saving time in preparing for clinics, and ward rounds means that time can be spent and re-invested in our patient in our care which is the real benefit. Cook (2004), reports improved staff morale with the feeling of providing a better service to the patient.
Nood M, and Scott H, (2006), state another benefit will be the ability of nurses to see images rather than just reports, allowing nurses greater knowledge to provide evidence-based quality care. D.O.H (2007), states Pacs will also give clinicians access to old images, enabling comparison of old images with new. Shaw, G (2001) reports other benefits for clinicians are no loss of films, and increased speed and quality of reporting. Cooke (2004), reports turnaround times for imaging have decreased, showing patients benifiting from clearer clinical pathways and reduced delays.
Image manipulation is another advantage, digitally enhanced images provides more detailed, sharper images, improving diagnostic capabilities at radiological examination, biohealthmatics.com (2006). However Anon (2009) reporting for jpihealthcare states concerns were expressed by clinicians as to the quality of these images, due to the quality of equiptment used in the ward enviroment.
Alex stoker an A+E registrar states on connectingforhealth.com that for him the main aspect of pacs that enhances is practice is the ability to manipulate images. This making interpretation and diagnosis much easier.
Benefits of Pacs to the NHS include, reduced film and processing costs, reduced storage space, along with more efficient use of staff. Yiu, T (2006) states Pacs improves hospital efficiency reducing diagnostic time, eliminating film development, storage, possible image loss, increasing the overall efficiency of the clinical process.
Chapman,N and Denton,E (2008), state that pacs deployment phase completed in december 2007,127 trusts have received pacs in three years. The national pacs programme was hailed as 'public sector programme of the year 2007'. However the implementation and development of pacs hasn't occure without problems.
Fratt (2010), states the findings of Kennedy,R (2010), when reporting problems encountered with pacs. These include: High levels of staff expectation, network/dicom issues, availability and uptime, scaling issues, performance management, archiving and configuration problems, and high initial costs. Yiu, E (2006) reported other problems including issues of no commercial tool developed to help pacs administrators, and radiologists and technologists not knowing how to operate the systems.
“Some of the most difficult problems encountered in pacs, invlves workstations, archieves, media and database migration”. (Reed,G and Smith.E. 2002).
Due to the growth of data input pacs performance can decrease. Ganapathy and Sagayaraj (2010) state to optimize performance the cache needs to be cleared at regular intervals, and a increase in ram size is needed.
Potential image loss and reliablity is anothre problem faced by pacs administrators. If the whole system was to fail a whole outpatient clinic would need to be cancelled, and delays in treatment and results may occur. However Shaw (2001) states, system failure is unlikely to cause emergancy treatment to stop, since each image reader can operate independent of the main system and can print directly to a printer.
Upgrading in pacs is difficult, due to so many other systems and devices interacting. Horil, S (2008) suggested that complete understanding of the movement of information across interfaces is needed to avoid such problems occuring.
In a report by Pilling (2003) Hamersmith hospital reported the most obvious disadvantages hinges around the problem of old images being available and the ease of comparison of new pacs images to old film ones. However old archieved films are able to be uploaded to pacs, however it can take around one hour to archieve each image.
Another major problem expressed in the implementation of Pacs was cost. Hardware is often expensive as high-end systems are required to provide this facility. Pilling,J (2003), state it is an expensive piece of technology. However Greaves (2010), reports a benefit for hospitals to be the reduction in cost. Grainger cited by Mellor (2006) state a substancial reductyion in cost had been negotiated with hardware/software providers to lower the average price of a pacs system. However the D.O.H (2007) report the introduction of pacs is also saving money with trusts reporting an average saving of £250,000 with the first year of implementaion.
A case study in a mid-sized general hospital identified a problem with there pacs system when a patient was admitted with an unstable fracture. An x-ray was taken and viewed using pacs showing the need for immediate surgery. One key issue was that no pacs monitors were placed in theatres during imlementation. A request for hard copies were made only to find out the printer was broken. With no other way of accessing the image in theater the operation was delayed until the printer could be repaired. Due to this experience PACS workstations have now been intergrated into nhs theatres.
Rahman (200-) states to achieve all benefits imaging can offer, many things need to change. Working practices need to change with time set aside for staff training, and availability of equiptment and devices are needed for clinins, wards, and offices.
Dundas (2005) commented that at st georges hospital pacs procurement and installation has been torturous and difficult at times. However 18 months post implementation he would do it all again as pacs revolutionised the way they work and increase organization and effieceny as nothing else could.

The roll-out of PACS has been a major element in the National Programme for IT, which is helping the NHS to deliver better, safer care to patients via new computer systems. PACS is now operating in all acute trusts in England, Denton, and Chapman (2008). A review in 2010 by D.O.H stated that pacs systems no longer need to be managed as a project but instead as an I.T service under NHS control. Researchers are constantly exploring current perfromance and future potential, however research suggests that most if not all experiences of pacs are positive, providing a good omen for the future.
Pacs is an essential tool in hospitals today and percieved benefits outnumber disadvantages. The abilty to provide timely efficent access to images is a benefit to both patients and professionals, leading to quicker diagnosis and faster efficennt patient care.