The Paradox of PACS: Panacea or Pandora's Box?

PACS can be a many splendored thing. It has the potential to increase the productivity of your radiologists and technologists, as well as referring physicians. It can help reduce your inefficiencies such as lost films and retakes. A well-implemented PACS can bring your practice up to the next level of performance and has become a pre-requisite to a competitive radiology practice. The vendors are certainly selling PACS as the next best thing to sliced bread, but are they glossing over some warning signs that are whispering caveat emptor. With PACS, not only will you lose the infrastructure for film, alternators, processors, and film room personnel, but you also will lose your patience for film and the delays associated with film-based methodologies.


The first warning you should heed is that once you have begun your first steps down the road to PACS, you don't want to idle long in a mixed environment. Living in a dual environment of film for the enterprise while your department goes through its metamorphosis is a painful period without much payback. It takes more planning and leadership to deploy to the enterprise than it does the department, which may be why many hospitals get stuck in this situation far longer than they intended. Make sure you have the leadership buy-in, staff, and momentum to enact the change throughout the enterprise.


A second fundamental change comes with your clinicians, who now gain instant access to images as soon as they are generated by the modalities. They might not be as willing to wait as long for the report. Gone are the days of the radiologist as the gatekeeper and the first to see the films. This will put pressure on the department to speed up reporting in its effort to retain its value on the physician care team. This will compel you to re-evaluate the transcription process and to examine technology such as speech recognition and template reporting.


A third warning about embracing PACS is recognizing that you are now on a path where all your equipment to manage images needs to be replaced every three to four years. Really. It is not a one-time capital purchase by any means. Much like our personal computers, medical monitors, workstations, networks, storage, and servers all will be obsolete within a few years. Support for obsolete equipment goes up dramatically as does the probability of failure. Obsolete equipment also usually impedes continued software upgrades from the PACS vendor. So once on the road of PACS, you will need to recognize that change is constant and computer hardware has a short half-life.

PACS is arguably the biggest change in the way radiology does business in the past 100 years (since film). The transition to filmless is similar to the way businesses in the '90s embraced electronic communication systems and tried to get rid of paper. For a period there was more paper than ever, as businesses could print multiple copies with ease. Over time though, businesses came to rely on electronic systems, especially for communications like email. To do this, businesses re-engineered their workflow to best utilize these systems. Today, few businesses could survive by communicating solely through the post office. So will it be for radiology. Digital modalities have allowed us to print more film than ever before. Yet the restrictions associated with managing film have become a boat anchor at a time when we need to make our time as productive as possible. Not only do we need PACS, but also we need to redesign our workflow and remove non-value added steps.

My recommendation is to jump into PACS with both feet. Make sure none of your key stakeholders are halfhearted about the project. Commit to metrics associated with film reduction as well as physician acceptance. Film reduction will ensure continued financial support from administration, and monitoring the physician reaction is important to minimize any surprises from users across the enterprise.

I hope you realize that PACS is both a panacea and a Pandora's box. No doubt it is a game changer and your department will never look the same again. So if there is one project that you decide to do right, please let it be your PACS. The amount of pain you endure is inversely related to the amount of planning that goes into the project. Give it the extra time and staff it takes to understand exactly what you are getting into.

Nagy also is the founder of Clubpacs, a free online community for PACS administrators (