Considerable benefits accrue to the institution when approaching PACS outside the radiology box.
PACS took 20 years to mature as a technology in radiology, and it is a necessity today for cost-effective, productive imaging operations. In the early years of development, PACS was largely a radiology-centered endeavor with an emphasis on improving image accessibility and lowering film (and related) expenses.
As the technology has matured, so has the need to integrate PACS with radiology workflow, so that today’s PACS are shifting to solutions centered on the radiology information system. The benefits of PACS have been clearly demonstrated, and now other service areas want in on the action. DICOM, the ACR–NEMA image-communications stan - dard, has moved beyond radiology to address the needs of other imaging service areas as part of the standard.
Integrating the Healthcare Enterprise is an initiative by health care professionals and the industry to improve the way that computer systems in health care share information. The initiative encompasses the intersection of image and textual data, and will further extend the application of PACS beyond radiology.
These enterprise PACS initiatives can be viewed as either a boon to or the bane of radiology, depending on one’s perspective. I believe the case is strong for radiology to benefit from enterprise PACS.
A Framework for Enterprise PACS
To assess the impact of an enterprise PACS, one must first put the concept in perspective. Figure 1 illustrates a framework for consideration of an enterprise PACS by defining five basic functions associated with PACS activities. The requirements for acquiring images, managing their workflow, and interpreting results are unique for each service area, and are therefore departmental in nature.
In the case of radiology, the workflow is structured around an order; studies are read sequentially until all the work for the day is complete. Radiologists read cases through a sequential review of images. In the case of a radiograph, this might be done by reviewing a series of panels of images, comparing the prior studies with the current image. In the case of a multislice CT study, this might be done by rapidly moving through a stack of images, building up the anatomy in 3D. In some instances, special analysis is performed (such as the review of 3D reconstructions or representations), but essentially, interpretation is similar in that it involves largely sequential image display.
In the case of cardiology, the workflow process is less structured than in radiology, as many cardiology procedures are not done based on an order. In terms of acquisition, multiple elements of information are simultaneously recorded, including images, pressures, and other procedural data. Interpretation is frequently done immediately following the study, and it involves a review of all of the information acquired. The cardiologist may want to view images from a cardiac catheterization procedure while also viewing the associated hemodynamics and medications administered. In most modern cardiology PACS, a structured report is created interactively at the time of interpretation.
Beyond departmental requirements, there are two additional needs: secondary image access for supporting staff and the long-term management of the image data. These requirements are more appropriately defined on an enterprise level to avoid redundancy and enhance the capability of electronic medical record (EMR) systems. If image distribution and management are treated as part of a departmental solution, the result is the creation of data silos that may not be as accessible across the enterprise.
An enterprise framework allows for uniqueness within departments to meet specialized needs, while accommodating the need for integration of image information at the enterprise level. Sociopolitical requirements must be taken into consideration as well. Departmental desires to own and control access to data must be weighed against patient security and rights regulations, in addition to what is best for the treatment of the patient.
An examination of several issues relating to image accessibility and management, in light of this framework, should enhance the case that the enterprise PACS is beneficial to radiology.
Enhanced Image Distribution
One key point of using an enterprise PACS is to improve the accessibility of patient information across the enterprise. As providers move closer to EMR solutions,