It doesn't seem right to call PACS old because the technology is still in its youth. But the PACS of today is definitely a more mature sibling of the PACS of a decade ago.
Today, hospitals want their digital images to travel outside the confines of radiology and reach the entire radius of their healthcare enterprise: fast, on demand from anywhere, all the while maintaining excellent image quality. Vendors are doing just that by serving up PACS (picture archiving and communications systems) dependent on a Web-based architecture. The systems are more organized and efficient in design, relying on sophisticated storage techniques, advanced software and increased bandwidth.
It may be more appropriate these days that PACS are maturing, and the World Wide Web is now its companion down this long and winding road of information technology.
It was only natural that Boston Children's Hospital would implement a PACS that allowed doctors to read images online, seeing that the 350-bed pediatric facility had already been using the Internet to access clinical information for more than five years.
"We adopted Web technology inside the hospital to develop a Web-based Results Reporting application [to access the electronic medical record] that contained many pieces of electronic medical information that could be viewed using networked PCs," says Ted Treves, M.D., vice chairman of Radiology Information Systems. The only images that could be accessed during that time were nuclear medicine, since the department had a mini-PACS of its own, explains Treves.
By the time the hospital installed Fujifilm's Synapse PACS in 2003, the physicians were more than ready for its arrival. "The results reporting application was built purposely so that when PACS arrived, we would have enterprise access to all diagnostic images," explains Treves.
Synapse uses a compression scheme that stores three versions of an image - making it less network intensive and saves storage expenditure - thus satisfying both the imaging experts within the department and at the same time providing enterprise image access to all Children's Hospital clinicians.
Film has not been eliminated, rather it is gradually being reduced, says Treves. "We recognize that some [clinicians] cannot get the job done without printing film. The key is not just to cut the film, but also to have broader and timely access to the images when and where needed. With our PACS we no longer lose film, so we feel good that images are available all the time. And the more people who have access to the PACS, the more they are secure that they don't need to ask for the film," says Treves.
A DIFFERENT ROUTE
It is not a one-way street hospitals travel down when making the Web a part of daily workflow. Web-based models are flexible so healthcare facilities can start with enterprise distribution or teleradiology, and then build upon that investment to move to full PACS. University of Chicago Health Systems (UCH) first used Amicas Inc.'s enterprise wide distribution system for referring physicians and clinics because their initial PACS focus was enterprise clinicians, not primary interpretation by radiologists.
"Two and a half years ago, there was a push to get our clinics - such as hematology, oncology, rheumatology, ER, thoracic surgery - filmless," says Sanju Abraham, director of Radiology Informatics at UCH. What was their objective? "To not print films in these areas, giving clinicians access to the images immediately and making the most out of UCH's archive investment," says Abraham.
While the Web granted clinicians immediate access to the images, film use did not stop altogether. The operating room (OR) still uses film, says Abraham. It's not a software challenge impeding the OR's filmless transition, rather challenges are posed in configuring a filmless OR. "There are 25 ORs and each one presents a unique challenge. There are going to be two, dual-head monitor configurations on carts tethered to the wall with a network cable. Where do you position them? Where do you keep them in such a way that it is not going to be in the way?" poses Abraham.
In June, the 603-bed system then decided to employ Amicas' Vision Series PACS for primary interpretations by their radiologists and deployed diagnostic workstations. Backed by years of on-line priors, helpful training, a physician champion and workstation-replaced-alternators, radiologists had little reason not to use it.
"The first thing we accomplished