My first PACS project, many moons ago, was an installation at Eisenhower Army Medical Center in Fort Gordon, GA, near Augusta. At the time, we were removing darkrooms and wet processors and replacing them with a new digital system.
As is often the case with "new" things, there were many who weren't convinced it would be worth it. Of course, we all know how that turned out.
Today, after years of involvement in this industry's evolution, I must pose the question: Do most hospitals still need the foundational technology of PACS?
Kyle Henson.(Spoiler alert: I don't believe so, and I'm going to tell you why.)
First, to be clear, there are other clinical departments that are developing supplementary imaging systems particular to their needs and workflows. I am speaking specifically about the radiology PACS in nonacademic hospital settings.
Before we dig into the radiology side of the equation, let's talk technology. No longer is a 10 MB network high-tech; as data has become the lifeblood of organizations, the network has expanded.
Generally, there is a level of network robustness that, coupled with lossless compression technologies, makes data sizes manageable for long-term storage. Therefore, we find that many hospital systems are investing in "centralization," or storing all images in a central location. This central archive is key, as I'll touch on later.
Radiology, then and now
When I started installing PACS, radiologists had very particular roles in the care continuum, and they spent a great deal of their time sitting in darkrooms viewing films and dictating into a Dictaphone or cassette recorder. Later, once those recordings had been transcribed, radiologists would log in to the RIS to sign their reports.
Fast-forward more than a decade. Today, you find that only about one-third of a radiologist's time is spent interpreting images (Dhanoa et al, 2013). Today's hospital-based radiologist is often fully integrated into the care team and is expected to provide consultations, complete rounds, supervise intravenous contrast, conduct interventional procedures, and lead education sessions.
Radiologists who are on-premise wear many hats, and in multifacility hospital networks, we frequently find that radiology reading is being consolidated to one facility. This means we are moving images from various sites to where the radiologist is reading, versus putting radiologists at each location where images are created.
Ultimately, however, the trend in the industry is toward outsourcing radiology services to radiology groups, as opposed to keeping them on staff within the hospital. In fact, radiology groups are becoming regional- and national-level organizations.
While this may be a nontraditional approach to radiology services, it's definitely not a bad trend. These organizations are often able to recruit and manage scarce radiology resources more effectively while simultaneously providing specialty skills, higher levels of quality, and faster turnaround times.
Historically, the price of PACS made it cost-prohibitive for individual radiology groups to have their own system, but as these groups expand in size and scope, we are seeing many of the radiology groups with their own PACS.
When you add all this together, it begs the question: Why not just let the radiologists read on their own PACS?
A no-PACS trend
I propose that, instead of wasting resources by paying for and maintaining their own PACS, hospital organizations leverage the radiology group's PACS for interpretations. Indeed, when outsourcing a service (e.g., exam interpretation), it is customary for the service provider -- in this case, the radiology groups -- to provide the tools.
Not only are we duplicating tools but the radiology group is more efficient using their own; imagine having to set up hanging protocols and be proficient in five different PACS! It should go without saying that the organization retains control of its information by sending images for interpretation while storing them in a long-term archive that the hospital controls.
This no-PACS hospital scenario may sound like heresy to some, but I can tell you that it is already evolving. I have seen many radiology group contracts where the group offers reading from their PACS. It's also not unheard of for some groups to add a premium for reading on the hospital's PACS versus their own.
While a departure from how we've historically operated, the no-PACS trend is one I believe organizations should embrace. Not only do our radiology partners get to direct the quality and efficiency of their offerings but hospitals lower their operational costs while reaping the benefit of the radiology group's optimized focus.
That sounds like a win-win situation in my book!
After serving as an officer in the U.S. Army, Kyle Henson entered into healthcare IT. His 17-year career has included everything from the payor space to PACS vendor to imaging consultant and working in hospitals. This unique experience has allowed him to see the industry's problems and opportunities from all sides. He is currently pursuing his doctorate with a research focus on radiology operations, and he is the founder of Imaging Heartbeat, a company focused on proactive monitoring in imaging. He can be reached by email or through his blog.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
