Say you've installed a PACS network but it's just not working out, and the problems are more than cosmetic. Switching to a different vendor is a difficult but viable option, according to Dr. Barton Branstetter from the University of Pittsburgh.
"The transition from one PACS to another is complicated, but worth the effort if your current vendor is not providing the service that you need," he said.
Branstetter spoke about his institution's recent experience in switching vendors during a scientific session at the Symposium for Computer Applications in Radiology, held earlier this week in Boston.
One of the thorniest issues in switching to a new PACS may be how to handle the old archive and whether to migrate (either fully or partially) the legacy images. Exporting the data to a new archive is expensive, however, and as the need to access historical images declines significantly as they age, that might not be the best financial decision, Branstetter said.
Instead of exporting the old archive data over, the University of Pittsburgh chose to implement a temporary RAID cache, employing an intelligent pre-fetching scheme for access to comparison studies from the old archive.
"This allowed us not to have to pay for the transition to our (new) archive," he said.
The pre-fetching scheme, developed internally at the University of Pittsburgh, copies up to six comparison cases -- matched for modality and body part -- from the old archive to temporary cache. The new PACS can then access the images. Unused images are automatically deleted from the cache as it nears its capacity.
The pre-fetching process was aided by robust DICOM export functionality by the previous PACS vendor, Branstetter said.
Two months prior to conversion to the new PACS, the institution began routing studies to both its new and old PACS archive. This split-routing capability, set up to establish comparison studies for the new archive, eased network bandwidth requirements during the transition, he said.
A month after the radiology department converted to the new PACS, the institution converted its enterprise clients to the system. A month after that, the institution stopped routing images to the old archive.
Acceptance testing
Since they're already aware of the benefits of PACS, radiologists need to be sold on the incremental benefits that will accrue from the new system, Branstetter said. Many users had dramatically increased expectations of the new PACS, desiring new functionality, and wanting faster and better performance from the transition.
"The flip side is that you really have a set of expert users," he said. "Our radiologists knew what to expect from a PACS, they knew when it wasn't working right. They understood bandwidth constraints, and they understood the pre-fetching requirements. So that actually worked in our favor, because we got immediate feedback when something went wrong."
The PACS skills of radiologists -- even those who are less computer-savvy -- transferred surprisingly well to the new system despite the new radiology user interface, he said. To ensure the satisfaction of change-resistant enterprise users, the institution maintained careful control over the enterprise user interface. While cosmetic changes were implemented, the basic workflow was left unchanged and clinicians noted few differences, he said.
Support
The importance of support during the transition can't be emphasized enough, Branstetter said. The University of Pittsburgh has one PACS administrator and five full-time PACS support personnel who are on call 24 hours a day.
A failure in the intelligent pre-fetch process generated the most support calls in the months following the transition. In response, software was developed to allow users to also initiate retrieval of prior studies.
Clinicians frequently requested printed film; the new PACS printing capability had been insufficiently tested for applications such as use with orthopedic overlays, he said. Patches to the new system solved the problem, but the transition away from the old PACS had to be delayed.
Hardware support personnel, dedicated to the PACS network, are also needed due to the transition to PC-based workstations, Branstetter said. The institution's previous vendor had employed Unix-based workstations.
By Erik L. Ridley
AuntMinnie.com staff writer
June 12, 2003
Related Reading
Working through the politics of PACS, June 6, 2003
PACS brings benefits, with caveats, May 22, 2003
Web-based integration of PACS and RIS systems improves workflow, patient care, May 12, 2003
PACS archive techniques continue to evolve, March 18, 2003
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