A bidder's view

The Integrated Health Information System (IHIS) Malta project was initiated in May 2005 through a pre-qualification exercise. Eventually six candidates were selected, but only three contested the tender bid on January 17.

Two months ago, the Contracts Committee recommended that the financial package of two bidders were to be opened for further evaluation. Following this 'recommendation' the third bidder raised an 'objection' and an appeal hearing ensued, during which it transpired that Government's estimated cost for this project was around €50 million.

Sizable IT project

At the onset of the announcement of this intensive IT (IHIS) project in Malta, a number of international companies became interested, and it was clear that this kind of project had to be carried out either by a group of companies forming a 'consortium' or else by a prime bidder supported by 'sub-contractors'. The IHIS project was made up of various modules, organised in three phases and spread over a maximum period of seven years.

The first phase, which is important as it has to coincide with the opening of Mater Dei Hospital in July 2007, consists of Patient Master Index, Electronic Medical Record, Order Management and Fulfillment, Laboratory Information System (LIS), Radiology Information System (RIS), and Picture Archiving and Communication System (PACS).

The other two phases included other common health care information modules, in-patient and out-patient care modules, clinical and non-clinical support services, and resource management information.

This resembles the much talked about UK National Programme for IT or the NHS Connect for Health (www.connectingforhealth.nhs.uk/)

In the context of the Malta IHIS project, one of the bidders, iSOFT plc, was joined by Microsoft, GE Healthcare, Accenture, HP as well as their local partners Exigy Ltd, Joseph F. Spiteri & Co., FGL Information Technology Ltd and Healthcare Logistics Ltd to form a strong and effective team of major global players and local experts.

The other bidder is made up of a 'consortium' which includes AME International Gmbh of Vienna, INSO SpA of Florence and Intercomp Ltd. of Marsa. According to an AME Website, they also lined up Siemens, Oracle and HP as technology partners. (INSO spa are also the present turnkey equipment contractors for Mater Dei Hospital)

An important module is the Picture Archiving and Communications System (PACS) which has to be fully functional when Mater Dei Hospital opens, considering that the new Radiology Department will be fully digital and the concept is that it should be a "filmless" hospital.

PACS

PACS is a computer system that allows the digital capture, viewing, storage and transmission of medical images. It replaces conventional x-ray film and greatly improves access to patient information by providing the ability for referring clinicians to review their patient's images on PCs in the department, as well as from their own offices.

The system represents a network of computer servers and Web-based workstations that will be interfaced with the hospitals' diagnostic imaging equipment such as x-ray systems, CT scanner, MRI, gamma camera and ultrasound.

PACS presents several advantages. Digital images can be seen in more than one location at one time and can be manipulated to enable more accurate diagnosis. Film processing chemicals and film processors are no longer required, which is better for staff health and the environment. The system eliminates the use of x-ray films or other printed media and saves costs. Retrieving images becomes automatic and instantaneous so there are no more delays in searching for x-ray films and no more lost films. Additionally, the need for storage space (for x-ray films) is radically reduced. Overall improved efficiency leads to improved patient care at lower operational costs.

The NHS Connect for Health aimed to digitalise healthcare throughout the UK at a cost of £6.2 billion over 10 years, the world's largest civil information technology project and one of the largest change programme ever.

For this project the UK was divided into five clusters, and contracts were awarded to various local service providers: Capital Care Alliance (BT) for the London area (offering PACS from Phillips), Fujitsu Alliance for the southern cluster, offering GE Centricity PACS, ACCENTURE for northeast and eastern clusters offering Agfa PACS, iSOFT Computer Sciences Corp (CSC) Alliance for the northwest and West Midlands, offering ComMedica PACS (recently changed to GE Centricity PACS).

From this short list, it can clearly be seen that iSOFT solutions were selected for three out of the five clusters making iSOFT the biggest winner gaining three of the five clusters. It can also quickly becomes evident that the PACS provider for the AME Consortium is not included in any of these important projects, and therefore one concludes that they were not eligible to be part of this vast UK IT programme. This is an essential point which should carry a lot of weight, since in Malta we have to rely on well proven and tested systems which have been accepted in other countries and particularly in the English NHS system.

From available information, the southern cluster is the largest cluster in the national programme of IT, covering seven strategic health authorities, with a population of 13 million and 156 organisations, and includes 81 primary care trusts, 63 hospital trusts and 35 social services.

All the eligible hospital sites in the southern cluster are to be equipped with GE Centricity PACS (Enterprise Edition) and to date some 22 sites have gone live, which represents 60 per cent of the sites, making this cluster the highest performer, and system availability is 100 per cent. This proves that GE Centricity PACS comes from a 'reliable partner' and can implement and deliver on time.

In last March UK's Healthcare Computing 2006 the NHS-IT director general Richard Granger praised GE Healthcare for its rapid progress in deploying their picture archiving and communications systems in the southern cluster and other sites in the UK.

Eventually a few hospitals from other clusters decided to switch their NHS-appointed PACS provider and went for GE Centricity PACS, such as the one at King's College Hospital, which is part of the central London cluster and incidentally also have iSOFT system in operation.

It was interesting to learn that the IT management team at King's College Hospital had pushed their recommendation to the Radiology Department to go for a GE Centricity PACS, instead of the NHS Philips PACS. A similar example took place at James Paget Hospital, Norfolk (which is part of the Eastern cluster) whereby they switched from an Agfa PACS to a GE Centricity PACS.

However the best example for GE Centricity PACS' superiority and acceptability was when last May the NHS announced that Computer Sciences Corporation (CSC) had appointed GE Healthcare as their prime sub-contractor for the supply and implementation of GE Centricity PACS to the northwest and West Midlands cluster (visit: http://www.connectingforhealth.nhs.uk/news/pacs_update_090506)

A spokesman for GE Healthcare in Malta says that this clearly proves that the UK NHS have recognised the success story of GE Healthcare in the southern cluster LSP and were chosen again as a reliable key player in an Integrated Information System.

At the same time, it is pointed out that the AME PACS provider in the Malta bid were again left out of this unique IT project.

The GE spokesman said that it is good to note that in just two months from signature, two GE Centricity PACS in the northwest and West Midlands cluster have already gone 'live'.

The current statistical status of the 'NHS Connect for Health' can be viewed at: http://www.connectingforhealth.nhs.uk/delivery/servicemanagement/statistics/service/comms_report_july.pdf

iSOFT products are used by more than 8,000 organisations in 27 countries for managing patient information and driving improvements in healthcare services.