Applied Radiology

PACS (picture archival and communications system) has made significant strides in the past 6 years. Medical professionals understand that long-term archiving is the backbone of a filmless solution. Pilot programs where PACS were integrated into the existing IT structures (HIS, RIS, etc.) of clinical facilities have enjoyed benefits of increased efficiency, cost savings, and enhanced patient care. Cutting-edge technology breakthroughs continue to lower the cost per terabyte for storage, which frequently is the single largest expense in a PACS acquisition. The expansion of Web dissemination technology for hospital-wide image access is lowering the cost of fast networking topologies, such as FDDI (Fiber Distribution Data Interface) and ATM (Asynchronous Transfer Mode). More medical practices are learning that price shopping saves hundreds of thousands of dollars. In choosing hardware, cost may not be an accurate determination of quality, usability, or service. These increased benefits, along with the price-reducing technological advances, are making it easier for medical centers to cost justify a PACS conversion as a valid IT expense.

There has never been a better time to start the process. But where does a medical center begin?

The following is a checklist of sorts that can help with the initial planning for a PACS conversion:

1. Get your CIO involved. There is no bigger ally than an Information Officer who truly understands the advantages of PACS integration.

2. If you don't have a CIO, use a consultant . A good one can save thousands of dollars on hardware decisions. The Henry Ford Health System found that all flat-panel display manufacturers use the same glass (LCD) component. The only major differences were the price and the display video driver. They went with the less expensive bid and saved approximately $600,000.

3. Have your PACS keep 12 months' worth of acquired image data in a local short-term storage solution , such as a RAID. The price of a RAID system has dropped considerably in recent years. This will reduce the expense of requests to archival storage, and make the process much more time-efficient.

4. Integrate your PACS with all IT systems currently installed , including HIS, RIS, CIS, ACP etc. If everything is integrated, a patient's complete information can be viewed during any diagnosis, or call for information to a PACS. For example, a radiologist could view patient history, clinical information, symptoms, examination history, etc.

5. Make scalability and open architecture a priority. Technology changes are fast and furious. You'll want to avoid the "boat-anchor" syndrome. Look for hardware and software that will be able to grow, develop, and change as advancing technology delivers better solutions. Always keep to an open architecture platform. No dead ends allowed.

6. Choose vendors that will support your IT choices. As you add infrastructure to the network, there will be compatibility issues to work out. This can be anything from devices not connecting to the network, to a CT scanner's inability to interface with an existing display. These issues tend to be more prevalent in smaller practices where equipment purchases are "phased in" over time. Jeff McCuen, head administrator of Cody Diagnostics, learned a valuable lesson when their existing flat-panel display company left them to fend for themselves, or pay through the nose. "We have some unusual protocols running our RIS," said Jeff. "Our flat-panel provider told us we needed to change the way we do things. That wasn't what I wanted to hear. We had to find a new display manufacturer (NDS) that was willing to do some extra troubleshooting. And now that we have, we will phase them in as the new display of choice. I wish we went with these guys (NDS) from the start."

7. Plan traffic strategies during development. Keep inexpensive RAID servers close to where the imaging and diagnosing will happen. This way the network is saved from unnecessary traffic.

8. Remember that PACS works for more than just radiology. It's a digital image archiving solution that can work well for ultrasound, fluoroscopy, computed tomography, magnetic resonance, and even nuclear medicine.

9. High price does not mean better quality. In some cases you get what you pay for, but not always. Dr. Zachary Zimmerman, MD, of Kaiser Permanente learned this rule while shopping for medical flat-panel displays. "I was particularly intrigued by a price quote from NDS that was roughly half the cost of the others," said Dr. Zimmerman. "I decided to demo them, since display quality plays such a large role for PACS success." The demo proved very convincing and the lower cost display company (NDS) is now the standard for Kaiser Permanente. Dr. Zimmerman requested that these displays be integrated into their ultrasound equipment, too.

10. Every aspect of the imaging systems should be 100% DICOM compliant.