Paper cites pros and cons of multidepartmental PACS

The advent of large-scale PACS and Web-based image distribution has spawned an interest in extending the classical radiology PACS into multidepartmental PACS (MD-PACS).

Radiologists may be confronted with questions from clinical colleagues on whether their modalities can be linked to the radiology PACS. An August paper (Eur Radiol. 2006 Aug 16; [Epub ahead of print]) catalogs the advantages and disadvantages of an MD-PACS.

"With PACS continually evolving, it is very likely that MD-PACS will become an important IT trend in the near future in the delivery of optimal patient care," said Björn Bergh, director of information technology and medical engineering at the Universitätsklinikum Heidelberg in Germany.

Bergh's paper describes four types of modality integration approaches:

• direct modality integration (Type I)

• integration via DICOM acquisition software (Type II)

• integration via specialized systems with PACS connection(Type III)

• integration via specialized systems without PACS connection (Type IV)

Bergh said an MD-PACS would be particularly beneficial for those hospital units that mainly produce still images and do not already have a specialized information system, such as dermatology, ophthalmology, and ENT.

Aside from what Bergh calls a cost-effective capital and maintenance solution, an MD-PACS would provide universal accessibility for all multimedia objects and link all clinical information in the HIS-electronic patient record.

An MD-PACS would also offer standardization and homogeneity of IT architecture, allow optimal deployment of IT staff resources, and provide a means by which the costs of redundant departmental PACS implementations and continuing support can be avoided.

An MD-PACS solution will be more difficult for departments that already have their own specialized information systems, however, because often those systems lack DICOM capabilities or dedicated Web distribution systems, according to Bergh.

"In order to include such departments in the MD-PACS, a replacement of the specialized system by HIS-EPR with Type I or Type II integration appears to be the only reasonable approach," he said.

Whether this is possible will depend on both the functionality of the HIS-EPR and the MD-PACS. Bergh cited other disadvantages, including lack of departmental flexibility and hospital reliance on a single vendor compared with best-of-breed departmental PACS.

"Any performance or stability problems could potentially affect the entire hospital," he said.

Still, Bergh said that since PACS has become a core component of hospital IT landscapes, substantial advantages can be demonstrated if an MD-PACS were implemented across clinical departments.