Next-generation PACS: Out With the Old & In With the New

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Perhaps a little like planning a house renovation or even a second marriage, the second time around can be more complex when it comes to PACS. Implementing a next-generation PACS can bring the same angina, but with calculated planning, the benefits are quite predictable. With concerns ranging from moving data from the old system to the new and avoiding system down time, replacing a PACS needs extensive planning and careful execution—and a team approach to assure success.

What can institutions looking to move to a next-generation PACS expect to find in the way of differences between new and old? Terence Matalon, MD, chairman of the department of radiology at the Albert Einstein Medical Center in Philadelphia, believes that one of the things that distinguishes a next-generation PACS is an ability to “accommodate different, multiple other applications. The openness of a system to work well and interface with other applications is being viewed as an essential necessity,” says Matalon. “Particularly since no single [PACS] vendor has been able to meet all the needs of the various institutions.”

Some of the applications, Matalon says, are related to things like Joint Commission requirements from the standpoint of critical test results reporting, while others might be related to issues surrounding peer review, or how well a voice product interacts with a radiology information system. What is critical is the system’s ability to interface with other systems across the enterprise, he says, “and a lot of companies that previously took more of a proprietary approach, now recognize that there are a lot of niche products that people may want that aren’t necessarily within [the vendors’] repertoires.”

Matalon adds that the incorporation of a robust web product also is the mark of a next-generation PACS.

For Mark Watts, corporate imaging system manager at IASIS Healthcare Corporation in Franklin, Tenn., the question isn’t only about what a next-generation PACS can offer, but what a first generation PACS can’t. “Our [previous] PACS product just never developed along with the changes in healthcare, and interoperability became an issue,” he says. “It was like driving an older car, the PACS didn’t seem to be able to grow with the needs of our organization.”

System reliability and stability

In early 2009, Iowa Health System was rapidly approaching the breaking point with its first-generation PACS. The health system, which comprises 34 hospitals and clinics and is divided into seven regions within the state, was experiencing some severe “reliability” issues, according to Joy Grosser, Iowa Health’s chief information officer. “Our system was growing and the PACS itself was becoming unstable,” says Grosser. “It wasn’t giving us enough uptime.”

“The system was often down, and that obviously impacts patient care,” says Tony Langenstein, IT directory of technology for Iowa Health. “We had asked for—and worked with the vendor on—enhancements, but those efforts just came to naught.” An example of a problem the system faced, he says, was an effort to improve the old PACS web product “that was just horrendous.” Iowa Health worked with the vendor to upgrade the product, but right in the middle of the process, Langenstein says, the vendor purchased an entirely different web product that negated all of the upgrade efforts.

While Iowa Health had identified the problems, and knew what it wanted to accomplish with the new generation PACS, it faced one major impediment—time. The old PACS had basically reached the end of its effective life and needed to be replaced immediately. “We had kind of painted ourselves into a corner,” Langenstein says. “We had waited so long that we were forced to do something”

According to Grosser, the system had been having internal discussions—involving physicians, administrative staff and IT personnel—to identify ongoing problems with the old PACS and to determine what a new PACS needed to provide. In the spring of 2009, the system decided to move—fast. And a selection process that began in May had, by the beginning of August, resulted in the selection of a product and the beginning of a system-wide installation.

“We wanted reliability, and a partnership that would allow us to see enhancements throughout the PACS product, something that was fast and would provide good web access right out of the box,” Langenstein says.

The expedited process—from sending out RFPs to the final PACS installation—took about six months,