The Fate of PACS

Since May, there’s been ongoing debate about one of your most significant, frequently-used tools – your PACS. Has it, in fact, outlived its original purpose only to be replaced by a sleeker, more versatile system?

At this year’s SIIM conference, Donald Dennison, director-at-large of the SIIM Board of Directors and chair of the ACR Connect Committee, rocked the industry by suggesting just that. He predicted that by 2018, the radiology world would be PACS-less, and there are some in the community who agree.

But, not all. Many of you – practitioners, vendors, and customers – still believe there’s life-blood in PACS. Just not in its current iteration. The system has to change to fulfill a new role within a rapidly-morphing health care environment. If it can do that, radiology’s diagnostic workhorse will still be able to meet your needs and those of the industry’s other stakeholders.

“This isn’t a death – it’s a maturation. It’s overly hyperbolic and misleading to discuss the death of PACS,” said Paul Chang, MD, radiology professor, vice chair of radiology informatics, pathology informatics, and enterprise imaging medical director at the University of Chicago. “This is us saying today’s radiology department isn’t the file room. Our value is in interpretation of imaging studies and contributing to patient management.”

But, to meet that goal, you must be aware of the many factors affecting the direction in which your PACS will likely go.

The Drivers
The reasons pushing this need for change are multi-factorial.

Expansion: PACS functionality no longer belongs only to radiology. Operational control has been taken out of radiology departments and given to information technology (IT) departments for management and maintenance. Many non-radiology departments, such as cardiology, dermatology, and neurology, can easily access archived images, as well.

Electronic Medical Record: Most hospitals and between 70% and 80% of office-based physicians use an electronic medical record (EMR) for managing, organizing, and storing patient records. An EMR-compatible PACS goes beyond being a radiologist’s diagnostic tool to being able to improve data mining, trend analysis, outlier identification, and strategy implementation, said Nadim Daher, principal healthcare analyst with research analysis firm Frost & Sullivan.[[{"type":"media","view_mode":"media_crop","fid":"41037","attributes":{"alt":"PACS","class":"media-image media-image-right","id":"media_crop_466602101608","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4265","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 133px; width: 199px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©sfam photo/Shutterstock.com","typeof":"foaf:Image"}}]]

Mergers & Acquisitions: An increasing number of practices and hospitals are coming together, necessitating smooth communication between disparate electronic medical records (EMR). Free-flowing communication between these patient record systems is critical, so referring physicians and emergency department doctors have unfettered access to imagines and your diagnoses, said Cristine Kao, global health care information solutions marketing director for Carestream.

Accountable Care Organization: This new health care model is rooted in providing better quality care for patients. According to Brad Levin, general manager and global head of marketing for enterprise imaging and advanced visualization vendor Visage Imaging, leveraging an enterprise solution – rather than a legacy PACS – makes it easier for you to not only read studies more quickly, but to also make them seamlessly available to other providers who might need them in order to meet patient needs in a timely fashion.

Modular Approach: Instead of purchasing a PACS system from a single vendor, Daher said, many customers are looking for diagnostic and storage systems that are easier to manage and manipulate. Consequently, they’re piecing together systems from multiple vendors. This tactic makes it easier to meet the disparate needs of various departments, as well as change out parts that might need an upgrade sooner than others.

Payment: Shifts toward bundled reimbursement and value-based purchasing has turned radiology from a revenue-maker to a cost-center. A PACS that plays a larger role with multiple departments can highlight the value of radiology’s services, such as early detection and preventive care strategies that are made possible only through imaging services.

One Health System’s Experience
With all industry forces pushing PACS away from its original legacy design, an increasing number of practices and health systems are gravitating toward a more vendor neutral archive (VNA) option – one that frees them from being tied to a single vendor, Daher said.

“The definition of PACS as we know it is dead – the big, monolithic, end-to-end, everything-to-everyone, single vendor system isn’t very flexible,” he said. “People are more interested in making independent decisions and working with someone other than their PACS vendor.”

And, Florida’s Broward Health System recently did that in May. The move – a pivot to a modular approach from vendor Mach7 Technologies – greases the wheels for greater collaboration between different specialties.

“The VNA solution has been a cost-effective solution for Broward. We’ve done a study on the cost of storing DICOM and non-DICOM images, and the value proposition is there,” said Ronaldo Möntmann, Broward’s vice president of information technology. “The VNA gives us the ability to control and enforce compliance, HIPAA regulations, and store all the domains in one centralized location. We have better control of the data at a lower cost and high availability to leverage solutions that aren’t proprietary.”

The Mach7 Technologies’ Enterprise Imaging Platform offers Broward a physician and patient portal to share images and diagnoses. It backs up and encrypts data, and it also provides redundancy as an extra measure to safeguard images in case of any network failure. In addition, the system maintains and provides ability to read data in any format. For example, data saved as PDFs are read as PDFs or JPGs as JPGs.

According to Boris Kalitenko, Broward’s senior PACS administrator, the health system is in the second phase of getting a universal or enterprise viewer. Clinicians use a variety of different platforms and devices, so any viewer must be compatible with them all. That’s a feature legacy PACS systems can’t offer, he said.

Considering viewers and how you can access images in any system you choose is critical, he said. Not only can the right system enhance your ability to provide the highest level of care at minimal cost, but it can also augment how you impact patient well-being and quality of life.

“One of the things that I think is critically important is self-assessment. Anyone should start by looking at how much it costs to run a PACS as it is and how much it will cost if they don’t do anything,” Kalitenko said. “When you look at it from that standpoint, it’s eye-opening. There isn’t just a need to move forward – there’s a need to move forward now. If you postpone to the end of a contract, the cost of any action would be more expensive.”

A PACS by Any Other Name
Despite the greater migration from legacy PACS to more VNA solutions, PACS isn’t going anywhere anytime soon, said Eric Reinholt, PACS administrator for Pennsylvania’s Mercy Health System. Any new software, VNA, or RIS that allows radiologists to read images is only a PACS by a different name.

PACS won’t evaporate from the industry, he added, until computer-aided detection tools are sensitive and accurate enough to effectively diagnose without human involvement.

“A physician or patient portal or a RIS that has image-display capacity fine enough for a radiologist or referring physician is a de facto PACS,” he said. “PACS isn’t going away. It’s simply being incorporated into another system. It will never be obsolete because radiologists require a special tool to read images.”