AR: PACS implementation can be a roller coaster ride
The benefits to productivity and efficiency provided by PACS are widely publicized, but a PACS implementation isn’t without its challenges. In the February issue of Academic Radiology, radiologists and PACS managers from University Hospitals Case Medical Center (UHCMC) in Cleveland offered their experiences implementing PACS to illustrate potential gains and problem areas.

Jeffrey L. Sunshine, MD, PhD, of the department of radiology at UHCMC, and colleagues wrote that their implementation began in November 2002, with expansion to physician offices and other departments in 2004, standardization of protocols in 2007 and enterprise expansion across the entire system occurring in 2009. Currently, UHCMC has approximately 90 dedicated technologist stations, approximately 60 clinical workstations for high-resolution review and more than 65 operating room stations. More than 700,000 radiology exams are performed annually.

The authors broke down the operational improvements of PACS into four main areas:
  • Physician productivity: Electronic transmission of images between the main campus and outpatient satellite facilities improved workflow and spurred an increase in exam volume from 269,750 exams in 2003 to 722,661 exams in 2010.
  • Turn-around time for report dictation: Turn-around time decreased from longer than 80 hours in 2002 to less than 20 hours in 2010.
  • Film-related costs: Film purchases and related costs were slashed after PACS implementation. Reduction in film over five years cut costs by $3.2 million, reduced courier-related expenses by 60 percent and resulted in a 90 percent reduction in costs for supplies such as film jackets, labels and custom negative preservers.
  • Labor expenses: Forty-five percent of the film room clerks were no longer needed after implementation, and speech recognition cut transcription staff from 24 to three in the first year.
However, the PACS implementation at UHCMC faced several challenges, according to Sunshine et al, including:
  • Networking: Despite certifying the network through a third party, the authors reported high latency issues at three sites necessitating bandwidth upgrades.
  • User acceptance and communication: Sunshine et al wrote that acceptance was a predictable issue, but despite emails and training courses designed to move users to the new system, some remained unaware of changes.
  • Vendor compliance: “We faced an initial near-constant need to upgrade hardware and application software components of the system to achieve the promised functionality, which, of course, made the install much more complex to manage,” wrote the authors. “That said, the vendor did in the end provide the necessary components.”

This is not the end of the story for UHCMC or PACS. The authors noted several expected developments on the horizon.

“As institutions strive to upgrade or migrate to new systems, the archive and database architecture need to become more independent of vendor proprietary system requirements,” wrote the authors. “For example, vendor-neutral enterprise image storage has the advantage of storing all images regardless of specialty origin in a single source site and enables the completion of the transition to digital imaging across all image sources.”

Outcome tracking after imaging and structured reporting are two other issues that will affect the future of PACS, according to Sunshine et al.