Imaging integration plays essential role in PACS success

Imaging must be integrated into the enterprise information infrastructure if the process improvements possible with PACS are to be realized, according to a speaker at HIMSS Wednesday.

Many of the benefits of PACS extend well beyond the radiology department and can only be realized when imaging is incorporated throughout the enterprise, said Fred Behlen, Ph.D., an assistant professor of radiology at the University of Illinois, Chicago (UIC).

"PACS, as we've all learned by now, can't justify the cost solely by the elimination of film and film handling," Behlen said. "The process of justifying a digital image management system is not just a matter of satisfying a bunch of bean counters hopelessly obsessed with hospital solvency."

Savings on film and related expenses can be expected, of course, but PACS ultimately has to earn its keep by process improvements throughout the patient-care enterprise and not just within the radiology department, Behlen said.

"Radiologists are trying to reach for money outside the radiology department because we don't have enough of our own," he said.

Integration of imaging throughout the enterprise is important, according to Behlen, because radiology is only directly involved in three of the eight steps in the patient care process:

1. patient arrives;
2. physician sees patient and writes an order;
3. patient goes to the imaging department;
4. patient is imaged;
5. radiologist interprets the image;
6. physician looks at the report and image;
7. physician treats patient; and
8. patient is discharged.

Only steps 3, 4, and 5 directly involve the radiology department.

"True start and end points in the process are outside the radiology department," Behlen said. "Reports can be served through computer-based patient records (CPR) or direct through Web servers. Web servers can be feasibly integrated with CPR systems and inherent CPR security models."

To make PACS investments pay off, institutions must implement enterprise integration. In a clinical context, physician Order Entry is needed to realize full PACS benefit, although document imaging of orders can be an effective interim measure.

Behlen cited several other recommendations. Correctly linking image data to RIS reports is crucial to achieving process improvements and avoiding fishing for data. UIC found that validation of patient demographics is best accomplished at examination time. The university also found that upgrading all scanners and imaging devices to use Modality Worklist is extremely costly. Behlen suggested the use of Quality Control workstations as an alternative.

Web-based viewing of images is satisfactory for all imaging review outside the radiology department, according to Behlen.

"Clinicians would love it if it was faster, but image quality is not an issue. It works," he said.

In terms of security, integration of the Web viewer with the client for the CPR causes the Web viewer to inherit the CPR system's security model. This can be an important consideration when planning ways to comply with pending HIPAA regulations.