Piggyback PACS: Pursuing Enterprise Image Management

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Radiologists have become PACS experts, sometimes by default. Because diagnostic images made the greatest demands on early information systems in health care, the most sophisticated systems were first developed to handle these images and associated data. These systems became PACS, which grew out of the homegrown image-management systems of academic radiology departments to become commercial products; eventually, they became essential to the practice of radiology in hospitals and radiology practices.

Because PACS grew out of radiology departments, radiologists have never been simply consumers of a PACS product in the way that banks, for example, are purchasers of financial-transaction software. Radiologists were fully involved in specifying and troubleshooting commercial PACS, even after the systems had been widely adopted, and commercial PACS offerings could not have been developed without the input of the radiologists who used the first systems.

This did not mean, though, that the needs of radiologists always drove the implementation of PACS. For some institutions, the cost savings associated with eliminating film (and its libraries and associated staff) became the primary driver; the increased procedural volumes that could be handled when the film-based radiology department went digital were also powerfully attractive.

The increase in the quality of care that is likely to result from PACS use is another strong motivator, since the typical PACS installation can reduce the time that elapses between image acquisition and patient-care decisions, can reduce the need to repeat examinations due to the loss of films, and can provide better access to prior studies for comparison. In addition, PACS can keep referring physicians happy by providing rapid access to images and reports.

Many of the reasons to adopt PACS, therefore, were as compelling to the institution as to the radiology department. This continues to be the case—and now, the same cost, quality, and competition concerns have extended the need for PACS beyond radiology to every specialty that uses and retains images in the course of diagnosis and treatment.

Because radiologists are the physicians with PACS experience, they are being consulted in the process of expanding PACS use to the enterprise level. Sometimes, they are also being expected to allow other specialties to ride piggyback on their existing PACS. Because making PACS work outside radiology involves much more than simply enlarging an archive’s capacity or adding workstations in other departments, this piggyback PACS may be an idea whose time has not yet come.

According to “Enterprise Imaging,” which was presented on November 29, 2010, at the annual RSNA meeting in Chicago, Illinois, it could be too soon to expect a PACS solution that is perfect—straight off the shelf—for the entire enterprise. Because the need for the advantages of PACS is obvious to institutions, to specialists who use images, and to many of the physicians who refer patients to them, the search for the fully integrated enterprise PACS continues.

As information systems increase in processing power and archival capacity, that goal comes closer to reality, but as the three presenters report, each specialty has workflow and image-handling needs that must be taken into consideration as the enterprise PACS is built. Radiologists, to preserve the integrity and function of their own PACS, should be prepared to explain to cardiologists, pathologists, and other image users that they can’t just plug their departments into the existing PACS somehow. Planning, hardware and software outlays, and workflow adjustments are all to be expected first, and a thorough understanding of how each specialty uses images is required.

PACS for Cardiology

Benoit Desjardins, MD, PhD, is assistant professor of radiology at the Hospital of the University of Pennsylvania in Philadelphia. He is a noninvasive cardiovascular radiologist who works closely with the hospital’s cardiology service, he reports. “I have dual appointments in cardiology and radiology, and by knowing very well what IT is in radiology, I can appreciate that IT issues in cardiology are different,” he says. “The first major difference is cardiology data: It has another level of complexity, and there is a mix of both imaging and nonimaging data.”

He continues, “Cardiology information is inherently 3D in nature, in a way that’s quite different from radiology information. In radiology,