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
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
4. Integrate your PACS with all IT systems currently
, 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
5. Make scalability and open architecture a
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
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
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
8. Remember that PACS works for more than just
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,
10. Every aspect of the imaging systems should be 100%