Cardiology PACS gain momentum in Europe

Enterprise-wide cardiology PACS are designed to improve efficiency and reduce operating costs by interfacing with hospital information systems, electronic patient records, and radiology PACS and information systems. These integrated enterprise systems have been commercially available in Europe only for the past two or three years.

Like the deployment of enterprise radiology PACS in the 1990s, actual implementation has been slow, due to the newness of the product and the substantial costs involved. Expenditures include not only system purchase, but robust networks and efficient digital storage to handle very large data sets. Furthermore, other hospital departments do not use cardiology PACS as extensively as they use radiology PACS.

Self-contained miniPACS providing cardiac IT solutions for echocardiography suites and cardiac catheterization labs were commercially introduced in Europe about 15 years ago. These miniPACS provide department-level efficiency at a more affordable price.

"A miniPACS within cardiology is a real alternative for most institutions," said Prof. Gabriel Krestin, chair of radiology at Erasmus MC, University Medical Center in Rotterdam, the Netherlands. "Whereas radiology is a service for other specialties, dissemination of cardiology images is needed primarily by cardiologists. Enterprise cardiology PACS will not add significant value until a hospital needs to integrate this information in a central electronic file."

Even in U.S. hospitals, where cardiology departments typically provide a major source of revenue, implementation has been considerably slower than industry initially predicted. According to a June 2005 report from the Healthcare Information and Management Systems Society, only 26% of 4000 U.S. hospitals have cardiology IT systems deployed. Most of these are believed to be self-contained miniPACS. Based on analysis of vendors' Web sites and news published about enterprise installations, it seems feasible that fewer than 200 U.S. and Canadian hospitals have enterprise cardiology systems in operation.

On June 30, 2005, KLAS Enterprises announced the availability of its first cardiology PACS systems vendor comparison study. According to the company's press release, its research found few truly integrated solutions for cardiology PACS in use.

No reliable statistics about cardiology PACS in Europe exist. Interviews with the leading cardiology vendors-Agfa/Heartlab, GE Healthcare, Philips Medical Systems, and Siemens Medical Solutions-suggest that fewer than 100 hospitals are in various stages of enterprise cardiology PACS deployment.

Like radiology PACS, early adopters are predominantly large, prestigious research hospitals such as Heidelberg University Hospital in Germany, Leuven University Hospital in Belgium, Haukeland University Hospital in Norway, and King's College London.

Vendors report that clients have either purchased complete systems or budgeted for cardiac IT upgrades for 2005 in hospitals in Austria, Belgium, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Spain, Sweden, Switzerland, and the U.K. No single country is leading the initiative, although the much-publicized National Health Service Trust IT initiative in the U.K. provided the funds for the three hospitals in the Leicester NHS Trust to acquire comprehensive cardiac PACS.

Two key factors are driving purchases: replacement of analog with digital cardiology equipment and massive IT conversion initiatives within hospitals. Cardiology workflow from patient admission through discharge can be efficiently monitored and managed. All data are consolidated, enhancing staff productivity and expediting patient treatment.

The modality vendors offer attractive incentives to add PACS to major diagnostic radiology or cardiology equipment purchases. Because GE, Philips, and Siemens also offer tightly integrated radiology and cardiology PACS solutions, the "one-vendor-provides-all" option is compelling. Agfa's acquisition of Heartlab has enabled the company to position itself as a powerful modality-independent IT solutions provider. It is too early for any vendor to claim market dominance.

Choosing the same vendor for cardiology and radiology PACS provides definite clinical, technological, and financial advantages. Data storage can be shared, overall scalability is easier, maintenance management is less complex, and the cost of service contracts may be lower. Interoperability and data flow glitches become the responsibility of a single vendor to resolve.

The impact of and problems relating to software upgrades can be diminished. Multiphase implementation is more feasible, providing a realistic solution.

Hospitals with installed radiology PACS are not the predominant purchasers of cardiology PACS, nor do they necessarily opt for a single vendor solution. Vendors stress that no assumptions can be made and that generalizations are dangerous because every hospital is different.