'Plug-and-play' PACS may be just the ticket for Latin America

Last month I attended the CancunRad radiology conference in Cancun, Mexico (not a bad place to have such an event) and gained some insights into the status of imaging technology in Latin America.

Based on scientific posters and presentations at the conference, it seems as if the practice of medical specialties and availability of technology is up to par with that in the U.S. This is especially true of the private institutions, where the same equipment from the same vendors is being used. In fact, several of the posters at this conference could just as well have been at the RSNA meeting, and the show floor was filled with familiar vendors one finds at conferences in the U.S. and Europe.

The one exception was PACS, which is far from achieving widespread implementation in Latin America. Unfortunately, many hospitals and providers in this region have had some bad experiences, which has hurt expectations and made potential customers very cautious.

The technology is the same, so there can be only three other reasons for the perceived failure: support, support, and support. I have always wondered why medical imaging companies based in Texas or California hesitate to send a support person to Mexico City but don't have a problem sending one to New York City, which is actually farther away.

Absent this support, true plug and play is an absolute requirement for PACS, especially in countries where engineers and technicians lack proper training. At the same time, labor power in many of these locations is relatively inexpensive, and some hospitals are capable of doing their own system integration.

This is where standards come in: If there were no DICOM or HL7 to facilitate the integration of these systems, there would be no connectivity and no solution. Therefore, in countries such as those in Latin America, standards are an absolute must, and plug and play is an imperative.

Fortunately, many PACS components are available "off the shelf" and even in the public domain. One hospital in Mexico City spent less than $10,000 for a server and public domain viewers and is able to do what a commercially available PACS can do but at much lower upfront cost. Of course, this system needs more hand-holding and more people to support it, but in this instance people are more readily available than dollars for capital investment. The system does not have all the features and functionality of a commercial product, but as soon they become just bells and whistles, nobody will miss them anyway.

The thing we can learn in the U.S. from such examples is that it might not always take a sophisticated piece of software to do the job. Maybe that inexpensive Web browser (or, even better, free viewer) is the only thing a physician needs to look at an image. Pragmatic solutions, such as the University of California, Los Angeles giving patients their images on a CD that also contains a freeware viewer, make a lot of sense. These inexpensive components continue to gain functionality and support. Who knows, maybe we'll see the Linux equivalent for PACS competing with the big Unix and NT guys one day.

Comments or questions should be directed to Herman Oosterwijk at

herman@otechimg.com

From Health Networking News, a biweekly business newsletter covering the medical information technology industry published by Diagnostic Imaging.