France may be the latest European nation to pursue a large-scale PACS initiative if a digital image management proposal is adopted by the French government. If approved, the plan would implement a countrywide framework for storing medical image data, encompassing national, regional, and local levels.
France currently produces more than 61 million radiology exams a year (more than 5 petabytes worth of data), read by more than 7,800 radiologists at 1,845 sites. Although 70% of private radiology practices in France have PACS, only 20% of public institutions do. Overall, 910 sites, including 250 private practices and 660 public hospitals, currently do not utilize PACS.
With the goal of achieving widespread adoption and saving money over current practice, the proposal would include the creation of a national image archive. In addition, hospitals without PACS could gain access to a Web-based PACS through a common regional PACS deployed via a software-as-service model. As for hospitals that currently have PACS, they could archive their images for long-term storage in the national archive.
The goal is for all long-term images (older than five years) generated at private practices, private hospitals, and public hospitals to be stored in the national archive, according to project director Laurent Tréluyer.
"We chose that because archiving is an IT project, it's not a medical project," he said. "We know that after five years, the utilization of [images] is very small. It's for a legal point of view that we need to archive the exam."
Images will be stored for five years on either a local or regional basis. Regional and national platforms would communicate via DICOM standards, and studies from the long-term national archive will be available to be fetched as needed, Tréluyer said.
University hospitals would be inclined to use local storage for their recent images, while the regional platform might be more suitable for smaller hospitals, he said.
On a national level, the ASIP Santé (agency for shared health information) would establish the general framework for interoperability and provide the specifications for common PACS functions. It would also manage the archive program. The regional PACS would be managed on a regional level, with their own tender programs for vendor consortiums.
The separation of the archiving function of PACS is a key element of the proposed program, Tréluyer said. The project will also emphasize the use of a vendor-neutral archive (VNA) and standards such as DICOM, HL7, and the Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing XDS-i profile.
The proposal estimates savings of more than 70 million euros ($90 million U.S.) a year from the program. The average cost of a radiological exam with a shared PACS software-as-a-service model would be 2.15 euros ($2.76 U.S.), compared with 2.63 euros ($3.38 U.S.) with a standardized PACS on an institution-by-institution basis, and 3.23 euros ($4.16 U.S.) with the current archiving methods, according to the proposal.
A pilot project involving 24 hospitals in the Paris region is currently in development, with a vendor consortium including GE Healthcare of Chalfont St. Giles, U.K.; storage firm EMC of Hopkinton, MA; and Orange (France Telecom). Launched in May, the five-year, 30 million euro ($38.6 million U.S.) pilot project will test the PACS software-as-a-service model on a large-scale basis, handling 1.3 million exams per year.
The economic model for the overall project relies on savings from current storage methods and is not dependent on government funding, but some initial investment is required to begin, Tréluyer said. A decision is expected by the end of the year.
Under the proposal, radiology practices would not be obligated to join the program. However, public funding would only be provided to those who fall within its framework, according to the proposal.
By Erik L. Ridley
AuntMinnie.com staff writer
September 14, 2010
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GE lands Ontario archive deal, June 22, 2009
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