PACS Passages

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Few processes in radiology are as dreaded as switching from a legacy PACS to a newer replacement. Often approached only when the former PACS is on its last legs, the transition between systems requires diligent selection from an ever-widening field of solutions, lengthy migration of complex (and sometimes flawed) data, and retraining of all affected staff. It’s also, however, the next step that many hospitals and practices have been awaiting to bring 21st-century clinical and business capabilities to their imaging operations.

As Tony Linkmeyer, director of medical imaging at Wilson Memorial Hospital, Sidney, Ohio, recalls, “Base systems now are three generations ahead of where we were,” with a PACS implemented in 1998. He adds, “We thought we were experts. We never even thought to ask whether the PACS we were considering could do certain things, and we found out about so many features that weren’t even on our radar.”

PACS technology has come a long way since its youth; as a result, the selection process is more complex than ever before, often requiring buy-in from several parties: radiologists, technologists, IT staff, administrative staff, and managers. In the case of Nebraska Medical Center in Omaha, Michael Battreall, director of medical information systems, brought in a wide array of end users. “We wanted folks from each of the different disciplines within the radiology department and the hospital,” he says. “We had people from outside of radiology, like the emergency department, taking a look at the pieces that would be affecting them.”

Alberto Goldszal, PhD, MBA, CIO of University Radiology Group PC, East Brunswick, New Jersey, recommends a different approach: While end-user reactions, desires, and aspirations must have considerable weight, he says, it’s best to let those who know their way around a PACS bear the brunt of the decision making.

For University Radiology Group’s PACS selection team, Goldszal assembled two radiologist champions (typically at the CMIO level), the practice’s RIS administrator, and its PACS administrator, as well as representatives from the IT departments of the hospitals that the practice serves. “Power users and administrators are in the best position to make those decisions,” he says. “It takes time to accrue this kind of knowledge. In reality, these things are best learned by doing.”

Strategic Decisions

During the more than eight years that Wilson Memorial Hospital was using its legacy PACS, the hospital saw its growth almost double—and noted another important change. “When we looked at where our patients were coming from geographically (by zip code), we saw that our radius approached 100 miles—we had patients coming from Columbus, Dayton, and Lima, Ohio, and from Fort Wayne, Indiana,” Linkmeyer says. “We knew we had to distribute our images better if we wanted to grow and attract business from specialists.”

Linkmeyer and his team started with 40 vendors, but they quickly were able to narrow that number down to six key contenders. From there, Linkmeyer eliminated potential vendors based on capabilities that Wilson Memorial Hospital knew it wanted (such as ease of integration and experience with various modalities), as well as on capabilities that the hospital hadn’t realized were available.

“I was surprised how much everything had changed,” Linkmeyer recalls. “As we went through the process, it took several meetings with each of the vendors because we didn’t ask the right questions, the first time, about all of the features. We started learning about 3D, storage methodologies, cardiac cine, nuclear-medicine cine, and all this stuff we took for granted didn’t exist. It was an eye opener.”

In the end, Wilson Memorial Hospital selected a PACS that enabled it to perform the kind of referring-physician outreach that the hospital needed without infringing on the IT staff’s protectiveness toward its network. “Our CIO was focused on letting people into the network without allowing them to touch it,” Linkmeyer says. “The image distribution of the PACS we selected has not disappointed.”

For Battreall and his team, the decision-making process was more deeply affected by prior experience. “There were a number of features and capabilities we didn’t have with our current PACS that we knew we needed,” he says. “With the previous PACS, there were different databases for the radiologists and Web-based users, and trying to keep those in sync was difficult, so we knew we wanted one