Botched software upgrade produces mass X-ray failure

This article illustrates what not to do for a PACS implementation.

by Crikey intern Nicole Eckersley (Original article from

A botched $8.4 million software upgrade in Western Australia public hospitals has left radiology departments in chaos, delivering false patient X-ray results and constant crashes.

Radiologist and imaging software blogger Doctor Dalai reported on the saga last Thursday, after a barrage of complaints from radiologists in WA. A source inside WA Health confirmed to Crikey a “dramatic impairment” in hospital procedure.

Dalai reported a litany of problems with the PACS software: unacceptable system down time, images that don’t match patient names and/or records, left-right reversed mammograms and non-chronological previous case lists, and processing slowdowns so severe that a Code Yellow — signifying a failure of essential services — was declared across all WA hospitals, including a hold on all new admissions and elective surgeries.

The WA Health source said the system failures impacted radiology departments across all public hospitals.

“Efficiency has been dramatically reduced, with departments now unable to cope with their daily workloads, and patient exposed to significant risk due to missed or delayed diagnosis,” they report.

“The unfortunate local PACS support staff at hospitals have been forced to bear the brunt of the anger and frustration of medical staff who are unable to do their job. In the current status, the system is basically not usable. I am aware of a number of staff who would be prepared to resign of this is not addressed.”

Kim Snowball, acting director-general of WA Health, admitted there are “problems”. The bureaucracy is “working closely” with the software manufacturer to iron out the bugs.

“We have also increased our in-house technical support for this software implementation and it is expected that all remaining issues will be resolved soon,” Snowball told Crikey.

“Radiology staff and doctors sometimes have to use alternative methods to view and report on images while the issues with the new system are being addressed. Studies continue to be prioritised with urgent cases being attended to promptly. When the technical difficulties are overcome it is expected that the upgraded PACS software will significantly out-perform the previous version.”

According to Dalai, this isn’t the start of problems with radiology software for Western Australia, with a previous implementation of the same product — IMPAX by AGFA — being so broken that practitioners resorted to bringing in private copies of a competing product in order to read images from private imaging clinics.

IT departments were unhappy, citing flimsy system robustness and warranty excuses, and deleted the competing software. After radiologists began carrying copies of the working software on USB sticks, one unnamed hospital threatened disciplinary action. Eventually, separate computers had to be bought.

“In a number of cases, the individual departments had to pay for these additional machines themselves,” said the insider.

“Before now, doctors in the hospital were in the ironic position where they could instantaneously, directly, access secure patient images and reports from non-government imaging services from pretty much anywhere with an internet connection, except inside public hospitals.”

The new version of AGFA’s software was chosen via restricted tender by WA Health’s Health Information Network — awarded to AGFA Healthcare Oceania, the existing provider. Why HIN decided to return to, and even expand, the reach of an unpopular product is unclear, with reports of input from radiologists in the decision being excluded or discounted.

Snowball told Crikey that “the existing investment in both processes and systems played a key part in the decision at the time”.

Meanwhile, Dalai reported that one of his readers tried to access his blog — the only source of information on the failure — from inside the public hospital network only to be greeted by the following message:

Access to the web site you requested has been restricted

The site you have attempted to access has been identified as inappropriate or unrelated to Department of Health business. All internet access is recorded and regularly reviewed by Department of Health accountability personnel.

If you require access to this site for Department of Health business, please contact your line manager to request access. All requests for access to this site will be reviewed by the State Health Executive Forum.

The Acceptable Use of Computing Facilities policy in question includes nothing that would warrant the banning of a blog on a work-related topic — unless WA Health believes that the blog “otherwise interferes in the proper operation of WA Health computer services” or perhaps could “expose WA Health to potential litigation”? Snowball suggests Dalai is the victim of a blanket ban.

“The WA Health IT network policy blocks access to sites which have been identified as inappropriate or unrelated to WA Health business. This includes social media sites, and popular blogging sites such as Blogspot and Livejournal. Where access to restricted sites can be justified for work purposes, staff may apply to be given access,” he said

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