Report: Radiology, cardiology PACS still worlds apart

Nov 5, 2007

"Oh, East is East, and West is West, and never the twain shall meet."

That line, coined by Rudyard Kipling in "The Ballad of East and West," originally described the gulf of misunderstanding between the British and their colonial subjects on the Indian subcontinent. But it just as easily could refer to the gulf that exists today between radiology and cardiology picture archiving and communication systems (CPACS).

Although they perform many of the same functions in terms of image management, radiology and cardiology PACS operate in vastly different worlds, with little integration between the two. That could be starting to change, however, with consolidation among vendors and a broader healthcare trend toward integration starting to break down barriers.

That's among the findings of a new report on cardiology PACS by market research firm IMV Medical Information Division of Des Plaines, IL. The firm queried cross-discipline decision-making administrators from 202 hospitals in the U.S., with most of the sample size consisting of cardiology or cardiac cath lab administrators. Also included in the survey were PACS managers, CPACS managers, and radiology administrators.

The challenge of CPACS

One of the primary challenges of managing cardiac images and information is the disparate nature of the data, which is being produced by a variety of modalities. Static and dynamic images, as well as print data, some digitally acquired and some still in the process of being converted from analog to digital, fill the diagnostic requirements of any busy cardiology practice.

Traditionally, a CPACS has been used to manage data from the cardiac catheterization suite, as well as echocardiography images. Current practice requires the integration of that data with a deluge of images produced on a variety of new imaging modalities that are coming to the fore in cardiac imaging.

For example, the cine loops produced in the cardiac cath lab must now be stored and retrieved alongside reconstructed images of multislice cardiac CT angiography exams (CTA). Even cardiac MRI is becoming more widespread, adding more requirements for CPACS archives, to say nothing of nonimage data such as patient demographics and scheduling functions.

In general, the IMV report found that CPACS has had a greater level of market penetration at larger institutions, especially academic centers, many of which installed CPACS after a radiology PACS was put in place. Those facilities are now dealing with issues of interconnectivity and integration for the purposes of managing and storing data, and are in the process of upgrading both hardware and software, and adding features such as new modalities and structured reporting capabilities.

Of the facilities currently using CPACS that were included in the IMV report, 45% of them have not integrated any of their CPACS functions -- such as archives, databases, workstations, and advanced visualization software -- with their current radiology PACS. In most cases the vendors are not even the same for the two systems, the report found.

The reason for that startling finding? Cost, and the complexity of integration with other existing systems in the hospital such as the radiology PACS, RIS, HIS, and electronic medical record (EMR), were mentioned as obstacles to the effective integration of CPACS.

Another possible impediment has been the fact that radiology and cardiology PACS networks are often managed by different departments, rather than operating under a single unified command. More than half (53%) of respondents to the IMV survey reported that the CPACS budget is managed by the cardiology department. More than a quarter (26%) revealed that their information systems department managed the budget, while 20% said that the CPACS budget falls within the realm of their radiology department. The smallest hospitals (those with fewer than 100 beds) were most likely to say that their CPACS budget is managed by radiology.

Analysis of the survey data confirmed that the later a hospital implemented its CPACS, the more likely it was to have a functioning radiology PACS. In other words, for the typical PACS user, their radiology system was implemented one to two years earlier than their CPACS.

When asked about the relationship between vendors for each system, while there was some correlation between the vendor of radiology PACS and CPACS systems within hospitals in the IMV survey, that correlation exists only among a few of the largest vendors, according to Mary Patton, director of online market research at IMV.

"In the past, there have been different market players for CPACS and radiology PACS, as well as a different mix of influencers regarding the purchase of CPACS and RPACS in many large facilities,” Patton said. “This is changing, at least in part because PACS and CPACS markets have undergone a seemingly continuous series of consolidation activity and market integration since early 2005.”

Future CPACS plans

Generally among smaller institutions, planning activities are paramount in their consciousness, probably as a result of the experiences of others that they have been hearing about over the past several years.

The IMV study revealed that an institution's radiology department will be more likely to manage the budget for new CPACS installations than for existing ones.

“This finding is related to the observation that smaller hospitals are most likely to be new CPACS users,” Patton said. “For example, 46% of respondents representing hospitals with fewer than 100 beds said that the future CPACS budget is most likely to be managed by the radiology department, as compared to 22% for the overall sample.”

In those larger institutions that were early adopters of CPACS, often the radiology department did not have access because decisions were driven by the cardiovascular/cardiologist and information systems groups. In the future, in terms of control or management of budgets for either upgrades or for initial implementation, radiology will assume more of a role.

Future issues will involve management of which departments -- both inside and outside of the institution -- will have access to images and information on the CPACS. By making the system Web-based, accessible only with an authentication password, there is potential to widen access to CPACS data. In addition, facilities are planning for future upgrades, including the addition of structured reporting, as well as hardware and software upgrades to improve functionality.

Integration and interconnectivity remain primary challenges to the seamless management of cardiology images and information. Those institutions that are planning installation of CPACS will probably involve radiology departments more fully, and are taking great pains to plan appropriately to decrease integration challenges and provide all data that are required to benefit patient care.

By Cheryl Hall Harris, R.N.
AuntMinnie.com contributing writer
November 6, 2007

Disclosure notice: AuntMinnie.com is owned by IMV, Ltd.

Options grow for treatment of prostate cancer, August 9, 2007