PACS has transformed radiology. But as more imaging-based specialties jump on the bandwagon and adopt or customize their own versions of PACS, many in radiology are reporting more problems with PACS. Health Imaging & IT spoke with radiologists and administrators to compile and address the 10 most vexing challenges.
With the government-supported rush to EHRs and radiology's links to multiple providers and specialties, integration with hospital information systems (HIS) seems a never-ending struggle. Sharing images between specialties or loading patient information to other providers' EHRs are common problems. Integrating PACS with RIS, voice recognition and billing are too often a struggle.
Although a lack of inter-vendor device and IT integration can often make the problem worse, the market is improving as providers and meaningful use demand greater integration. Still, many radiologists and PACS administrators prefer to make full use of hospital IT to configure their own systems and achieve a bit more autonomy.
"Don't customize when you can configure," recommends Richard L. Kennedy, MSc, technical director of imaging informatics for Kaiser Permanente Medical Group in Sacramento, Calif. Additionally, integration engines enable practices to forge ahead with individual best-of-breed hardware and software that can be integrated with almost any platform. Experts unanimously recommend sorting out proprietary rules before inking any contracts, which allows clinicians and executives to establish reasonable expectations and plans.
It happens: deal with it by planning for it. "Every system has downtime," Kennedy points out. "You need to establish alternate workflows." Both scheduled and unscheduled outages are inevitable, but they need not have too serious an effect on patient care. Business continuity systems are essential and can be as simple as a small public domain mini-PACS or as sophisticated as a fully redundant primary PACS.
3. Hanging protocols
Non-standardized hanging protocol display is a common and pesky challenge for PACS users. Because images from different modalities are not organized by default, each study takes a little longer to read—which can add up to a lot of wasted time for radiologists, notes Nicole Fennell, PACS administrator for Scottsdale Medical Imaging in Scottsdale Ariz. As the number of scanners increases and the sample of vendors expands, the problem grows worse.
Some success can be found in renaming or normalizing the image series descriptors on each scanner, say Fennell. Joseph Johnston, PACS administrator at Bethesda North Hospital in Cincinnati, agrees. Both Fennel and Johnston report that normalizing the series names has standardized the hanging protocols in 85 percent of cases.
Integration problems concern hardware, from digitizing pre-DICOM modalities to integrating systems for advanced image reconstruction. Add-ons like a DICOM converter can help squeeze out additional value from older CT, angiography and fluoroscopy systems
Eliot L. Siegel, MD, professor of diagnostic radiology and nuclear medicine and associate vice chairman for informatics at the University of Maryland School of Medicine in Baltimore, would like to see much better integration between PACS and advanced visualization systems including a shared image archive and for PACS workstations to be able to display thicker CT sections using thin section data to avoid the need to save both the thin and thick slices.
A robust IT staff provides a strong palliative to interfacing various vendor systems. "My No. 1 challenge right now is managing the hardware between different vendors," explains Paul Leonhardt, RIS/PACS administrator for Caldwell Memorial Hospital in Lenoir, N.C. He notes, "Meaningful use is basically expanding the 'bolt-on revolution.'" If opting for in-house configuration or individual best-of-breed systems, additional software for integration is often the next-best solution to new devices with pre-negotiated vendor contracts.
As with downtime, failures are unavoidable, and selecting a PACS vendor with strong experience and demonstrated support is key. Leonhardt notes that as systems within radiology and between radiology and other specialties become increasingly interdependent, yet tied to disparate vendors, "there is a domino effect when errors occur." Moreover, as service switches increasingly to remote support, quality has declined even as prices