During the first ten years of PACS sales, the customer
price/performance results were far from optimum. Was this due to
manufacturers selling equipment that did not completely meet
specifications or perceived specifications? Or was it the result of
customers not being willing to change their behavior in order to
increase the effectiveness of the new equipment? Perhaps it was a
little of both, combined with the manufacturers' not providing the
training required for the customers to achieve optimal value
through improvement in process. Additionally, the opportunity for
"seamless integration" of components also left something to be
desired. In the article by John Vanden Brink, in this issue of
Applied Radiology, he reports that the actual purchases of PACS are
much lower than the projected purchases. This may be due to the
impact of customers not achieving results that met their
expectations.
Here we are at the start of the next ten years of PACS and
related technologies. In this day and age, many of the technical
challenges have been solved. Seamless component integration is much
closer to a reality and, in many areas, it has been achieved.
However, some technical challenges are still present. As John
Vanden Brink points out, "moving images at 40 Mbytes/procedure at
millisecond speeds, integrating non-standard information systems
and replacing films with workstations on a cost-effective basis
have been formidable challenges to the integration of PACS." An
area of major change for the better during the next ten years will
be a more thorough knowledge of the customer. Manufacturers need to
facilitate change in user behavior in order for their customers to
achieve the most value from their products. The many PACS-related
courses and programs have contributed to this insight, and there
has clearly been a significant increase in the number of
radiologists, administrators and other personnel that are attending
educational programs.
Signs of success in utilizing PACS cost effectively are
beginning to appear. Examples such as improvements in report
turnaround time, improved physician access, and faster treatment in
emergency room applications have been reported. The study by Dr.
Eliot Siegel, at the Baltimore VA, suggests that the greatest cost
savings are realized at the hospital or enterprise-wide level
rather than in the radiology department itself (see article on page
15). The results achieved were based on a combination of applying
both technology and behavior modification to achieve the best
value. The "technology/behavior" tie will remain a key ingredient
in bringing PACS-related technology to fruition cost
effectively.
Dr. Schilling is president of RBS Consulting Group in Los Altos
Hills, CA. He is also a member of the editorial advisory board of
this journal.