SAN FRANCISCO - One of the earliest adopters of PACS technology provided some insight into his facility's experience with PACS in a presentation at last week's Computer Assisted Radiology and Surgery meeting. Dr. Reuben Mezrich explained that while installing a PACS network can help a hospital operate more efficiently, the technology can also create unforeseen dilemmas in hospital operation.
Mezrich was involved with one of the earliest PACS implementations, at the Hospital of the University of Pennsylvania (HUP) in Philadelphia. He recently took a position at Massachusetts General Hospital in Boston.
HUP added to its PACS in modular fashion, over the years installing viewing stations, computed radiography systems, and archives. The hospital also experimented with some technologies, such as satellite-based image distribution, that didn't quite pan out.
Mezrich cited four critical developments that have led to the acceptance of PACS:
Of the four, DICOM and RIS/PACS integration were the most important, according to Mezrich. Prior to the integration of RIS and PACS networks, some 160 studies of the 1,000 conducted every day at HUP were lost, which the facility defined as being unavailable on the day of the exam. That dropped to zero once the RIS and PACS were connected.
"When RIS was integrated with PACS, all of a sudden the number of lost films dropped dramatically," Mezrich said. "If you don't have a good RIS/PACS match, you can't do PACS."
What effects has PACS had on the radiology department's operations? Prior to PACS, HUP radiologists read studies in batches. Now studies are read in online mode, as they are conducted, which results in much quicker turnaround times, Mezrich said.
Not all of the changes wrought by PACS are positive, however. The system has created a physical separation between radiologists and referring physicians, who don't visit the radiology department as often now that they are able to get images sent to them digitally.
"This has a negative effect on radiology," Mezrich said.
There can also be a steep learning curve to PACS. Hospitals installing PACS networks hope to improve efficiency, but HUP found that, at least initially, the time from the beginning of an exam to its completion went up dramatically shortly after the implementation of PACS. Those times came down, however, as radiologists grew accustomed to the new system.
"At least at Penn, there was a six-month learning curve in getting used to soft-copy reading," Mezrich said. "This is not a trivial thing."
A new trend in the PACS industry is the move toward application service providers (ASPs). In the ASP model, hospitals contract with a vendor that maintains nearly all of the hardware and software necessary for PACS at their own locations, allowing hospitals to outsource much of the infrastructure required for digital image management. Typically, only routers and image display stations remain at the hospital.
A facility that uses an ASP can significantly reduce capital and personnel costs, but it is also taking a risk by relying so heavily on a third party for its image management requirements. Facilities considering an ASP should compare their image management costs with those of an ASP: A hospital's typical costs are $14 to $16 per film, so if the ASP is a trusted, reliable company and offers a rate less than that, it could be a good option, Mezrich said.
A number of developments will affect PACS technology in the future, including increased network bandwidth, Web-based image distribution, encryption issues, and better integration between PACS, RIS, and hospital information systems (HIS). Radiology departments should be examining any technology that enables them to transmit reports quickly and securely to referring physicians, Mezrich believes.
Technologies to accomplish this could include the Web, email, personal digital assistant (PDA) computers, and even pagers. Mezrich highlighted a slide of a chest radiograph displayed on a Palm PDA -- not diagnostic, but most of the important information was there, he said.
As more PACS networks are installed, the technology will continue to change the practice of radiology. The continued absorption of Internet technologies into PACS will bring the greatest changes, Mezrich believes, potentially making radiology departments less centralized.
"In an efficient PACS operation, with images available throughout the department, do you need a department?" Mezrich asked. "Yes if radiologists add value, no if all you do is quality assessment."
By Brian Casey
AuntMinnie.com staff writer
July 3, 2000
Related Reading
New HIPAA rules portend sweeping changes in medical data security, June 27, 2000.
Cable modems prove viable for teleradiology, June 6, 2000.
SCAR keynote speaker sees radiologists in the driver's seat of future healthcare, June 5, 2000.
Freestanding PACS: Implementing a PACS network could soon become a necessity
Image data repository meets needs for EPR image access, April 13, 2000.
RSNA and HIMSS renew IHE project for improving healthcare data exchange, April 10, 2000.
Let AuntMinnie.com know what you think about this story.
Copyright © 2000 AuntMinnie.com
