Enterprise PACS: Where Do the Opportunities and Challenges Lie?

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 Deploying PACS capabilities beyond a radiology department or facility provides the opportunity of extending the reach of diagnostic imaging to the entire spectrum of clinical medicine. The benefits to healthcare practitioners are immense—increased diagnostic certainty and the capability to provide efficient and effective treatment.

Radiology services in the United States are typically provided in three venues: academic medical facilities; private practice diagnostic imaging centers; and community hospitals. A multi-site facility that covers thousands of lives will face different challenges to extending a PACS throughout its enterprise than will a diagnostic imaging center or community hospital practice. However, each of these types of operations must meet the demands of multiple specialties to have access to radiological images and information.

Academic practice meets challenges

Jeff Schaefer, director of diagnostic and therapeutic services at University Medical Center (UMC) in Tucson, Ariz., has slogged his way through the PACS trenches for a number of years. The 355-bed non-profit, acute-care hospital is part of the Arizona Health Sciences Center and is adjacent to the University of Arizona Colleges of Medicine, Nursing, Pharmacy, and Public Health. Although spun off as a private organization, the facility maintains a strong relationship with the university.

Besides the hospital, UMC operates two hospital-based physician offices, a cancer center, and is affiliated with an orthopedic practice in Tucson; one hospital-based physician office in Green Valley, Ariz.; a medical transplant physician office in Phoenix (for pre- and post-transplant patients); and is opening a diagnostic imaging center in its home city. In addition, the UMC radiology department is part of the Arizona Telemedicine Program, which provides consultative healthcare services to the state’s rural and Native American reservation residents.

The facility performs approximately 190,000 imaging procedures on an annual basis, with a modality mix of digital x-ray, mammography, CT, MRI, ultrasound, fluoroscopy, and nuclear medicine studies. This results in about 4 terabytes (TB) per year of digital image storage for the institution, according to Schaefer. UMC has 26 attending radiologists and 24 radiology residents.

PACS capabilities are deployed throughout the UMC enterprise, Schaefer says, with diagnostic-level workstations and monitors in the operating rooms and emergency department as well as the radiology reading area. Off-site access is controlled through secure network connections.

When UMC first began widespread implementation of PACS access, there was some initial adoption reluctance on the part of clinicians who had grown comfortable with a film-based culture.

“Over time, they’ve grown to recognize how much faster it is to retrieve image studies via the PACS,” Schaefer noted.

The facility is in the midst of a transition to a new PACS product to meet increased demands by its users for diagnostic images and information. Along the way, Schaefer has acquired some hard-won knowledge of the issues facing an enterprise-wide PACS deployment.

“One of the biggest challenges we’ve had over the past few years has been the issue of storage management,” he says. “With the changes in diagnostic modalities to higher volumes of images as well as bringing onboard new digital modalities, I was faced with asking for more and more money each year just to maintain the archive.”

To address this situation, UMC has elected to transfer its archive management to an application service provider (ASP) model. According to Schaefer, this frees the facility from having to construct and deploy an archive disaster management solution, provide archive maintenance, or hire personnel to manage and service the system.

“With an ASP-based archive, we’re better able to focus on providing service at the point of clinical care, which is our primary goal as a healthcare system,” he noted.

For those facilities seeking to expand their current PACS beyond radiology, or an institution looking to bring an enterprise PACS on board, Schaefer recommends that they pay close attention to security and access beyond the walls of the hospital.

“One of the challenges we faced is that we wanted to be as secure as possible, but we didn’t want to hinder patient care,” he says. “You have to walk a fine line between securing your PACS network and providing as much access as possible to physicians. You should