As healthcare continues to evolve and grow, so does the need to make the large number of disparate technologies fit together and function seamlessly. In some cases, this means first taking apart or reconstructing these information systems. There has been a long-standing need in healthcare to put all components of the patient record with images and all support diagnostic documentation into a single solution rather than a multitude of partial solutions. It has been suggested that the deconstructing of picture archiving and communication systems (PACS) has the potential to achieve this goal. However, deconstructing PACS is not a universal term, and before we can understand its potential benefit, we must understand what it means.
Defining the Deconstruction of PACS
The concept of deconstructing PACS focuses on eliminating the virtual walls that separate many different areas of patient diagnosis and care as they relate to images. This means expanding the ability to access and view images and diagnostic findings to all clinical departments and specialties, well beyond the traditional reports and information that are already stored in electronic medical records (EMR). Achieving this goal means overcoming many challenges and obstacles, but the potential advantages, quality outcomes and efficiencies that may evolve is worth considering.
Significant technological advancements in recent years, such as the vendor neutral archive (VNA), have laid the foundations necessary to achieve the deconstruction of PACS. In some ways, this was the initial step in deconstructing PACS as the history of PACS reflects a landscape of many disparate cardiology and radiology X-ray based PACS, as well as specialized ultrasound PACS. VNA offers a solution that takes advantage of the economies of scale, allowing images and reports from different systems to be centrally archived in an enterprise storage solution.
The development of a universal viewer established a standard access, allowing physicians to retrieve and view results from different sources and origins without having to use multiple workstations. Currently, the universal viewer is not readily available from all vendors nor is it yet fully realized. In concept, it allows images to be viewed anywhere (home or office) and on many generic workstations, as well as many types of hand held devices (smartphones and tablets) with access to diagnostic-quality images and supporting data and reports.
The Benefit of Deconstructing PACS
As hospitals add more facilities to their networks, integration is key to getting the right information to the right clinician at the point of care or point of decision at the critical time. The VNA and deconstruction process may offer a more efficient way to integrate new facilities into large hospital networks. The process would make not only the storage but also the access to the full images, tools and diagnostic information truly vendor independent and accessible via a single point of access, viewer and system.
“The chief information officer (CIO) is looking for a reliable, unified solution that is similar to the movement already underway in the EMR applications. Improvements would come with a single point of access, which is most likely going to be via the EMR,” said Henri “Rik” Primo, strategic relations, digital health services of Siemens Healthineers. Primo also thinks the deconstruction of PACS will “likely improve the hospital’s ability to implement and maintain a higher level of cyber-security as a centralized function.” This is important, as the protection of patient data remains a huge area of concern for providers and the number of breaches increase.
Deconstructing PACS could also drive collaboration among all PACS and image capture reporting vendors, as well as EMR vendors. Industry collaboration has always been challenging, but the future success of this and similar industry initiatives requires a much more open approach. This in and of itself can result in positive changes.
According to Louis Lannum, director of enterprise imaging, Cleveland Clinic, Cleveland, Ohio, “Having a common workflow engine that allows a consistent process from orders (if needed) to imaging acquisition, information management, diagnostic review, reporting, storage, archive, retrieval and review (non-diagnostic and diagnostic) would improve consistency and establish an enterprise-wide standard that would simplify the process across the enterprise’s healthcare spectrum. This would streamline the healthcare IT process, consolidate resources and reduce cost and space for redundant storage that currently exists in most healthcare settings.”
Primo echoed this same sentiment, saying, “It provides the capability to bring information into a more centralized governance, which can bring enhanced consistency. It also can be instrumental to drive interoperability between different PACS, image capture devices, reporting and the EMR.”
Quality Outcomes
At its core, a deconstructed PACS solution would allow all physicians involved in direct patient management to access all available information compiled across the continuum of care. Currently, clinicians must deal with multiple sign-on functions and different workstations, often spread out across the hospital, that have diverse graphic user interfaces (GUIs). This makes trying to holistically manage patient care and efficiently gather, review and implement a treatment strategy feel like a herculean task.
“As a primary care internist, having a system that is easy and simple with all the information is what I would like,” said Troy Martin, M.D., chief medical officer of QuestCare Hospitalist Group. “Direct patient interaction is down to 10 to 20 percent a day with 80 to 90 percent of my day being spent on information gathering, documentation, etc. This solution could move the physician back to what they love, what they became a physician to do and that is direct patient interaction, care and management.”
A deconstructed environment could offer improved patient outcomes as a result of clinicians having access to the patient’s full information, findings and diagnoses in an efficient manner. “It could reduce or eliminate mistakes in reports and images from different patients ending up being represented as the same patient. The more eyes you have looking at data the more likely you will catch any mistakes,” Martin said.
Primo provided industry perspective, stating, “From a big-picture perspective it has the theoretical benefit to enable improvements of the overall quality of care while reducing costs long-term.” This statement speaks to the current climate in healthcare — providers are being asked to provide superior care at a lower cost.
The Deconstructed Future
There are and will be many challenges to the deconstruction of PACS. As with any innovative technology trend, there are concerns. A few such concerns are the training necessary to use the technology correctly, scaling the solution as volumes and size of healthcare enterprises change, connectivity to other systems, analytics support and appropriate security. Technological advances, such as solid-state drives, cloud storage and virtual networking, are helping offset some of the costs. Do these challenges outweigh the all-encompassing need for a new solution to the imaging needs of today’s clinicians? We believe the answer is yes.
In a deconstructed PACS world, there is potential for better workflow, best-of-breed vendor component selection, increased interoperability between healthcare institutions and EMR, and lower cost of ownership over the traditional PACS paradigm. This emerging concept may be a great opportunity to create a forward-looking strategy with a solution that is customizable and will work within the parameters of the facility’s needs.
However, at the heart of this concept is the desire to bring more efficient, accurate, quality patient care that will result in improved patient outcomes. One of the most poignant sentiments that we believe embodies the feeling of a majority of physicians, nurses and clinicians who choose to pursue medicine to help others comes from Martin.
“Anything that can be done anywhere, but specifically for information gathering that can minimize the time that the physician does clerical work and enables them to do what I call ‘doctor work,’ which we seem to have less and less time for, is an improvement and a huge positive result,” said Martin. “To me that is the goal, that is where we all win. In the last 5 to 10 years, I have seen lots of things push us away from doctor work and almost nothing go back toward focusing on giving the physician time to use our skills learned and knowledge to take care of people. To me that would be the ideal focus and a positive outcome for healthcare and ultimately for the patient.”
Editor's note: You can read Michael J. Cannavo's Counterpoint argument here.
Tom Watson, RCVT, is a clinical analyst at MD Buyline with over 40 years of experience in the field of cardiovascular medicine. Matt Adams, MBA, joined MD Buyline as a healthcare IT analyst after spending more than 25 years in healthcare information technology, business development and consulting. Cris Bennett, R.T. (R)(MR), is a clinical analyst at MD Buyline with over 19 years of experience in medical imaging including general radiography, CT, MRI and radiology IT.
April 22, 2024 
