Pre-PACS assessment gives an edge in installation

Aug 3, 2004

BOSTON - The more effort put into planning, the better the eventual outcome of most projects. A successful PACS installation also begins with a thorough pre-PACS assessment, according to Jay Mazurowski.

"A PACS really isn't a cookie-cutter product," said Mazurowski, director of radiology at Concord Hospital in Concord, NH. "Every PACS installation is unique because each facility has its own mix of modalities, systems, and cultures that are different."

Mazurowski shared some important lessons on PACS implementation at three institutions at the American Healthcare Radiology Administrators (AHRA) meeting on Monday.

Reading areas

Diagnostic and clinical reading areas are the spaces that will be impacted by the PACS. Muzurowski recommended conducting an assessment of current reading areas to determine what modifications will be needed to support digital image viewing.

"When transitioning to PACS, you have to design your reading rooms to accommodate film as well as workstations," he said. "The reality is that you will have prior studies on film that will need to be compared to digital imaging."

Items for consideration should include indirect lighting, potential monitor glare, and noise. Ergonomic considerations of the radiologists must be taken into account. Mazurowski said that adjustable chairs, monitors, and keyboards would enable physicians to modify their workspace to suit their needs.

The physical space of the reading area will need to house the additional hardware associated with PACS, such as monitors, keyboards, mice, and computers. The area will also need to be assessed for its capabilities to support the needed number of diagnostic review stations, as well as future expansion, and network connectivity may have to be added or upgraded in the space.

Clinician review areas will also need to be assessed throughout a facility. A PACS team consisting of representatives from multiple departments will ensure that the specialties outside the radiology department get the access they need. Mazurowski emphasized that soft-copy review stations should be located in secure areas for clinician access to ensure patient privacy.

He recommended that reading areas should be designed to incorporate the following items:

Use sound-absorbing materials in the design of the room. This should include the carpet, curtains, acoustic panels, and acoustic ceiling tiles.

Use moveable partitions. They will enable the room to be reconfigured as needed, and will block sound and light.

Choose ambient room lighting and match its brightness to that of the monitors.

Select ergonomic devices such as adjustable computer carts, articulating arms to support monitors, adjustable chairs, etc.

Create an environment that will facilitate PACS-to-film comparison.

Modalities

All modalities in the facility will need to be assessed as part of the pre-PACS planning process. Administrators should document the manufacturer, model, and software iteration of each piece of imaging equipment. A DICOM assessment of each modality will need to be compiled -- particularly of the modalities that support DICOM modality worklist, Mazurowski said.

"Modality worklist, the capability of a modality to accept patient and order information from a RIS or HIS, eliminates manual data entry at the modality by the technologist," he said. "This reduces data errors, increases efficiency, and maintains data integrity. And the integrity of the database is critical for a successful PACS installation."

For older modalities that do not support DICOM, or are not DICOM worklist-enabled, Mazurowski advised that a site make connectivity of these items part of the request for proposal (RFP) to potential PACS providers. He suggested including a spreadsheet of the assessment of modalities as part of the RFP document.

He also suggested that facilities consider the following items for modalities:

Upgrade the modalities to support DICOM worklist capabilities, if possible.

Identify third-party solutions for legacy systems, and have the vendor demonstrate the modality worklist feature before the PACS goes live.

Standardize imaging protocols by study description and naming conventions across all shifts and across the enterprise prior to a PACS implementation. This will ensure study data consistency in the PACS database.

HIS/RIS

PACS will become an integral part of a facility's electronic information systems. As such, its potential interoperability with existing information systems needs to be scoped prior to installation of the system.

HIS/RIS products in place at an institution must be assessed for interface capabilities with a PACS. A facility will need to determine if its HIS/RIS will reliably pass HL7 data to modalities and accept updates from the PACS, Mazurowski said. It will also need to know if the HIS/RIS will interface with future PACS products.

Distribution options for PACS data should also be considered. The PACS team must determine how images from the PACS will be distributed to other clinicians, both on-site and off-site. The answers will need to be further explored with PACS and HIS/RIS vendors to ensure that image and information distribution needs are supported.

Network infrastructure

"PACS performance will only be as good as the network it is on," Mazurowski said.

A comprehensive review of network capabilities needs to be conducted prior to a PACS RFP issuance. Bandwidth and speed, switches and routers, network drop points, and the campus-wide network infrastructure all need to be examined for potential slow points or bottlenecks.

"A PACS will dramatically increase network bandwidth (demands)," he said.

The teleradiology needs of radiologists will also need to be examined, and a determination made as to the necessary infrastructure for remote locations to support multi-megabyte levels of image traffic, he said.

Expenses

A thorough assessment of expenses to support a PACS will ensure that the PACS team does not have to seek additional funding at the eleventh hour of a PACS installation, Mazurowski said.

The PACS support expense documentation should include the capital equipment costs for PACS hardware and software, as well as for storage devices and capacity. DICOM and HIS/RIS interface costs, telecommunication and teleradiology expenses, and any network hardware or upgrade expenditures should be noted. Reading-area enhancements, service agreements, software upgrades, and storage expansion costs will need to be determined and added into the expense assessment, he said.

Mazurowski said that a pre-PACS assessment is a powerful tool that provides a facility with multiple benefits, such as: