Making PACS Work

The deployment of picture archiving and communication systems (PACS) today is no longer as simple as a hardware deployment with the appropriate clinical (read end-user) training along with an understanding of the support requirements. PACS today compels an organization to revisit its entire infrastructure and storage strategy and clinical support requirements, in addition to a review of its electronic medical record (EMR) strategy to boot.

Mission critical

Many institutions today are moving forward with either their initial foray into PACS or seeking the replacement of an earlier-generation system. Both scenarios require separate and unique approaches to a successful deployment. As the application of PACS continues to mature, the industry is continuing to discover just how critical it is.

We, as an industry, have been experiencing for many years the increasing impact of diagnostic imaging as a clinical tool. This has become apparent throughout the continuum of care.

Now, with the accepted application of PACS by many disciplines, our vulnerabilities are becoming more apparent, as well as our increased understanding of how critical this application is. For example, what impact will the crashing of the network have on the emergency room? Our ever-curious minds can take over from here and generate many scenarios that would have a CIO up all night with worry.

As we know, crashes are only one area that needs to be addressed. How about the many other areas that push the envelope on both performance and functionality? This brings to mind the need to consider the integration to the EMR and the physicians' portal, doesn't it? And oh, by the way, where are we regarding our cost-effective approach to storage such as the enterprise-wide storage strategy, and what effect will it have on our existing infrastructure strategy?

And, interestingly enough, the PACS vendors don't really care about your priorities or strategies. So, when shopping for a PACS or considering the deployment or replacement of an existing PACS, now it's imperative to address these integration issues as well as the Accept Testing Criteria with your strategies. More often than not, it's in your best interest to have the PACS vendor integrate to your storage solution — whatever that may be.

Impact on EMR or physicians' portal

Having an understanding of your EMR strategy or your use of a physicians' portal is critical when deciding or negotiating with a PACS vendor. At issue here are both parameters of functionality and performance. Will your EMR or physicians' portal integrate well with your chosen PACS? These parameters apply equally well if you are not purchasing a PACS but are purchasing the EMR or portal.

Impact on infrastructure and/or storage

Given the many considerations involving the "right" storage solution for each entity, it is important to at least have a thorough understanding of the impact of the application of PACS. The data generation is huge and getting larger, i.e. 64-, 128-, and 256-slice CTs are around the corner. The time requirements to move the data is fast.

HIPAA now requires that we have a disaster recovery (DR) application place. Our survey showed that only 50 percent of the hospitals surveyed at the Society for Imaging Informatics in Medicine's annual meeting in Austin (SIIM, formerly known as SCAR) did not have a DR application in place.

Given our growing dependence on our diagnostic imaging networks (PACS) today, business continuance is now becoming a required application. This is not a cheap investment. Going back to my earlier comments of what would the impact be on your emergency department if the network crashed, this now has a more significant meaning.

Initial PACS deployment

For those institutions that are deploying PACS for the first time, it is critical to understand your vulnerabilities to a favored vendor's approach to your deployment.

The PACS vendors can provide a lot of assistance, however oftentimes, just like any institution, they do not have an excess of skill sets available to adequately address your issues, such as deployment strategies and unique training requirements.

If there is one area that is overlooked, it is the area of training and support for not just the deployment but also the day-to-day ongoing maintenance and escalation processes. The initial installation for any institution is always a learning curve. The length of that curve is all too often longer than need be, due to the lack of proper training and education. It is advisable for any institution to purchase additional application and support training to minimize that curve.

Replacing an existing PACS

Depending on the age of the existing PACS, there can be a variety of issues to address. These issues range from the vendor selection (why are we changing vendors?), to data migration from the current archive, to integrating the new PACS into the long-term enterprise strategies of the infrastructure, storage and the EMR. These issues will undoubtedly evolve into the paperless department issues. And what about voice recognition?

These issues can make for a great project plan that requires diligence in both development and execution, something that many institutions have a tendency to rush through to meet deadlines. It's these kinds of mistakes that cost us millions of dollars in unmet expectations.

All too often, our IT departments have dismissed a PACS deployment as trivial based on their experience of having deployed clinical projects successfully in the past. This attitude is also what gets them in trouble. What we seem to be experiencing within the industry is a growing smugness of our IT staff and their increasing influence of "what the real requirements" of a clinical application ought to be, combined with a seemingly diminishing understanding that their role is to support the clinical mission of our business. That, however, is a story for another day.

It's important that, as we mature as an industry in this age of informatics, we develop a complete understanding and respect for the roles of each other — no matter what that role may be.