Today’s digital picture archiving and communication systems (PACS) is highlighted with several choice words around the industry: accessible, flexible, Web-based, thin client versus thick client and vendor-neutral. Whatever term is used to describe the PACS of today and the future, one thing is clear: the aim now is to be able to store medical images, sourced from any modality, in a secure location on a network and retrieve them for review from any platform or any device.
With many of today’s healthcare reforms requiring providers to do “more with less” and to operate more efficiently, the ability to easily access medical images and share those images with the appropriate parties — from the referring physician to the patient — is increasingly important. One such avenue for that is the Web, where medical images and reports can be stored and retrieved by appropriate users without a direct cabled connection to the system.
“The future for PACS is in the cloud,” said Steven Tolle, chief product officer for Merge Healthcare, at the 2013 annual meeting of the Radiological Society of North America (RSNA). Whether it is the whole PACS, from the viewer to the archive, that is stored off-site or simply pieces of the system, PACS solutions are more likely to involve the cloud now than ever before.
Need for Interoperability
When hospital systems and radiology practices are growing rapidly, they need information technologies (IT) to keep up and accommodate the increasing number of users, patients and pieces of data that load the PACS. Adding to this is the number of physicians outside the enterprise who may also need to call up medical images from that PACS but are not connected.
Legacy PACS currently in place in some hospitals are often vestiges from an earlier era, when systems required proprietary software and/or hardware to be installed on-site and continuously maintained. As infrastructure ages and study sizes expand — particularly with dataset-heavy modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) — these PACS can become overwhelmed, and users are left waiting a certain amount of time for an image to load, time that is inefficiently used and could be repurposed elsewhere.
Interoperability can be key. With radiology practices servicing a number of hospitals and clinics, it is important for different PACS to be able to communicate with each other. Triad Radiology Associates (TRA), a practice based in Winston-Salem, N.C., performs readings for hospitals and outpatient imaging centers within a 50-mile radius. The practice also performs specialized reads for subspecialties such as musculoskeletal, neuro and vascular. At one point it was having to accommodate images coming from a variety of PACS, including McKesson, Merge Healthcare and Novarad, since they were all in use by those sites that TRA serves, said Tom Smith, chief information officer for Triad Radiology Associates. Centers were even using multiple versions of
McKesson’s PACS while a separate center was on
Philips Healthcare’s iSite PACS.
Currently TRA employs a PACS system from Merge to read images for several of its hospitals and physicians’ offices, while utilizing Novant Health’s McKesson PACS for the remaining hospitals and the five imaging centers. The current system allows TRA’s radiologists to view worklists for the entire practice and not just the individual hospital where they are located. Radiologists’ worklist could include studies specifically assigned to them as well as images requiring a specialized reading. The remaining items would include images across the practice that still needed to be read, even if they were from a separate hospital down the street, according to Smith. With these interoperable and flexible worklists, efficiency has improved significantly at TRA, he said.
Moving Toward Anywhere, Anytime Access
A thick client PACS requires the use of certain workstations that are set up with the program, and consequently workstations that are updated with the latest version of that PACS. Today’s PACS can cut down on these inefficiencies and also help hospitals meet requirements for Meaningful Use certification by facilitating the movement of images throughout an enterprise. And with the use of the cloud, users can access their PACS from the Internet in any computer in a hospital or outside of it, without needing to upgrade hardware or install software applications.
Successful technologies in the consumer space, such as smartphones and mobile tablet computers, are also affecting the healthcare industry. Radiologists and clinicians armed with personal iPhones or Androids are now expecting a more intuitive level to the systems they use. Having these devices on hand has paved the way for increasing mobile access to PACS, with many doctors now able to access the system on their tablets and subsequently pull up medical images from a specialized viewer. Users at TRA, for example, are using a zero-footprint viewer to pull up diagnostic images on an iPhone, said Smith. Untethered from a desktop workstation, radiologists can access images and records from anywhere, saving time and money and allowing clinicians to attend to a patient faster.
Medical images comprise huge amounts of data, and it is important for hospitals and clinics to be able to store, move and retrieve them through secure and reliable networks. With many striving toward Stage 2 Meaningful Use requirements, using the right PACS can help improve workflow efficiencies and mobile “anytime, anywhere” access, trends that will continue to drive the development of future PACS.