Start Planning the Funeral for PACS

NATIONAL HARBOR, MD-If you fast-forward three years, you’re likely to see a world without PACS, at least this is what Donald Dennison, director-at-large on the Board of Directors for SIIM and chair of the ACR Connect Committee, told attendees at the opening session for SIIM 2015.

His talk piggybacked on his February 2014 article in the Journal of Digital Imaging, provocatively titled, “PACS in 2018: An Autopsy.” In keeping with this year’s SIIM theme of “the image enabled enterprise,” Dennison predicted that the future holds enterprise viewers.

He described three external market forces that are trickling down into the imaging informatics world and leading to the demise of PACS.

Money: There is no debate that payment reform is coming, whether it is containing the cost of health care, shifting from volume to value-based payments, or looking at bundled payments, Dennison said. What isn’t under debate is that something needs to be done, he said. A major concern is the idea of waste in health care, initiatives like appropriateness criteria are targeted to minimize unnecessary care.

EMR Adoption: Statistical trends show that EMR adoption, just a few years ago, applied to 15%–20% of office-based physicians, today that number is up to 70%–80%. What happened with the EMR adoption is that a lot of separate departmental information systems had to migrate over to one larger system, Dennison said. The systems had to be decommissioned to have fewer interfaces. With more eyeballs on one system, you can expect more consistency. The adoption of EMR provides an opportunity for access and enriching imaging records. Enterprise viewers can now be embedded in the EMR, Dennison said. In addition, using one large system that’s managing the patient and the results allows for aggregation of data besides the medical record and DICOM diagnostic imaging. Enterprise images, including images from scopes, photographs, and videos can also be integrated, he said.

Consolidation: Hospital systems are combining with other systems or buying up smaller practices, Dennison said. He noted that the integration of these systems means that organizations that used to look for a centralized PACS are now looking at a VNA. “The greater value proposition will be the fact that we have a system that is paired with our EMR that acts as our electronic medical record imaging repository,” Dennison said. “So that we now have a single system that contains all of the consolidated imaging records from all of our facilities from all imaging-generating departments.”

The creation of an enterprise imaging plan requires strong governance, defining how the strategy will be presented and how it will be used. It’s not just the radiology department that owns these systems now. Dennison urged that imaging informatics professionals get involved from the beginning. A misunderstanding of what a complete EMR looks like runs the risk of putting data into the wrong system or capturing the wrong metadata, so a seat at the table by an imaging informatics professional is essential.