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PACS - HPN ONLINE EXCLUSIVE |
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Is PACS dead? Technology rebranding, redefinition effort draws mixed signals When picture archiving and communications system (PACS) technology debuted more than two decades ago with much fanfare at the Radiological Society of North America’s annual conference and exhibition in Chicago, its name and clever acronym seemed creative and futuristic enough to withstand obsolescence. PACS even weathered the minor push to upgrade “picture” to “image” to better reflect the dignity of the output as the purists and ambivalent united in opinion that it was more of a cosmetic updating that would destroy a perfectly good brand identity. That was then. No longer. Now there’s a passionate grassroots movement to throw out the name and acronym altogether for something completely fresh that represents the industry’s expansion and the technology’s need to keep apace with the changes. But does the radiology industry really need to change the name of PACS, incorporating a new buzzword – enterprise – that has yet to spawn an easy-to-recall acronym? Here’s what 20 leading PACS manufacturers had to say. HPN: There’s a simmering-below-the-surface movement to rename PACS ‘enterprise image management solutions,’ whose acronym is not quite as catchy. What makes ‘enterprise’ such a buzzword in this area? When you hear the term, how do you define it to replace that eyeball-rolling moment with a light-bulb-in-a-thought-bubble realization?
Bill Culton,
product manager, diagnostic solutions, Enterprise defines the designs of solutions that can scale beyond a single department or facility while maintain synchronization of users and data. There have been many attempts to come up with a new and improved acronym for PACS – like CIMS for Clinical Images Management System and others. With the trend of RIS/PACS combined systems perhaps both acronyms will be replaced with one.
Hossein Pourmand, vice president, business development, PACS is already permeating the enterprise without a name change. The digitization of medical imaging has allowed imaging to move beyond the domain of the radiology department and PACS is evolving to acknowledge this reality. However, this should not be viewed as boxing the enterprise into a single image management solution. An image management solution using Grid architecture will provide enterprise-wide image management and archiving capabilities in a more efficient and cost effective manner. Healthcare providers need to think on an enterprise level in order to succeed in an era of rapidly increasing costs and decreasing reimbursements. Self-contained clinical solutions that duplicate viewing, storage, management, distribution and reporting capabilities are expensive and inefficient. CIOs and other administrators want to create shared resources that also offer specialized software and other components to meet the needs of each clinician. In the end, this approach will help integrate information about the patient and present it to clinicians in a way that allows for better diagnosis and decision making. So cost pressures — while negative in the short term — may be an asset to the industry in the long-term by enabling more efficient workflows and better patient care. Troy Oliphant, PACS strategic analyst, Cerner Corp., Kansas City, MO While PACS does have a much better ring to it than EIMS, PACS also brings to mind a radiology-centric focus rather than today’s reality of an enterprise-wide solution. Providing access across the enterprise to all image types, including radiology imaging, wound care, lab slides, anything that has an image associated with the exam. This is why ‘enterprise’ has become such a buzz word. The dawning realization that clients should be able to leverage the existing ‘imaging’ archives to view images of all types across the entire enterprise. With Cerner’s MultiMedia Foundation archive and Enterprise distribution viewer, we have achieved ‘enterprise image management solution’ and can do so in context with the patient’s EMR.
Ed Heere, president
& CEO, CoActiv Medical Division, Call it what you like. PACS is already is an ‘enterprise image management solution,’ at least some PACS products are. Those that will survive the cost reductions and feature enhancements necessary to cope with DRA, national healthcare and the rapidly growing price competitive marketplace that PACS has become. I have been in the medical imaging space 15 years. This concept has been discussed since 1998. I even contracted a marketing firm to determine some novel approach. At my previous company [Emageon] we consistently used the term ‘enterprise image management systems,’ but lo and behold, customers always referenced our systems as a PACS or Enterprise PACS. There are more interesting challenges to enhance the system to provide greater value for hospitals, physicians and patients, than to invest energy in changing the name. Notwithstanding, the reason that enterprise is relevant is that customers want leverage from their investment. If they have to buy five independent, department PACS system, their management costs multiply exponentially to provide support, maintenance and training. Paul Shumway, vice president, NovaRad Corp., Salt Lake City Enterprise is such a buzzword in this area because facilities realize that to effectively improve workflow and performance at their facility or group of facilities their imaging system needs to be easily accessible and usable by the entire enterprise – radiologists, referring physicians, techs, schedulers, etc. PACS and RIS – whether known by these names or by a new name – need to provide access to images and information anytime, anyplace and in the correct and usable format.
Eric
Mahler, director of marketing, Radiology Informatics, There have been several attempts to rename PACS with no great success. In the healthcare industry, PACS is as commonly recognized as Kleenex and Scotch Tape. Although, the acronym is clearly known in the medical community, deployments of ‘enterprise system’ solutions are not as understood. Due to the fact that not all PACS are created equal, it is the responsibility of the vendors to clearly articulate how they address enterprise deployment relative to scalability and performance. Philips defines the enterprise by guaranteeing diagnostic quality image access to ‘all’ studies in three seconds or less to an unlimited number of users deployed over a 10baseT (min) network.
Lenny Reznik,
director, image and information solutions, Healthcare providers today realize that PACS is a lot more than a radiology application that displays images. It is strategic part of the IT strategy that serves the radiology and other image-generating departments as well as the clinician community. Over the past several years PACS has evolved from a simple way for radiologists to view images to a key component of a patient’s medical record, accessed and counted on by numerous clinicians during a patient’s care episode. This re-thinking or re-evaluation of PACS is driving organizations to re-examine their systems and strategic goals. There is the realization that their current PACS may not be meeting their clinical and strategic goals, leading to a growing PACS replacement market. CIOs, CMOs and other executives understand the need for an imaging IT solution that meets the needs of multiple departments. Over time, the term PACS may go away and the EIMS may take its place. Agfa HealthCare’s EIMS is a highly integrated infrastructure that allows each professional within the healthcare enterprise to work according to his or her own requirements, simultaneously sharing information and maintaining a seamless workflow between clinical departments. The clinical foundation of Agfa HealthCare’s EIMS is its IMPAX Data Center, which provides multi-media storage and distribution to clinicians, supporting the continuity of patient care. IMPAX RIS (Radiology Information System), PACS (Picture Archiving and Communications System) and reporting solutions – covering radiology, cardiology, mammography and orthopedic clinical departments – are all part of this system.
Allen
Scales, senior vice president, product management, We don’t see this as ‘below-the-surface movement.’ PACS generally referred to a radiology department-centered solution. ‘Enterprise image management’ is a more accurate and descriptive term than PACS because it refers to a solution that securely manages patient data, workflow, and medical content in addition to ‘pictures;’ unifies the portion of the patient record that is of highest interest to the physician; provides specialty tools customized to the user – instantaneously on-demand – at the point-of-care; and easily enables collaboration across multiple specialties. Although there are enterprise aspects of PACS available today, there remain many opportunities to optimize the experience of diagnosticians and clinicians that will lead to enhanced and more cost-effective care.
Adam
Earwicker, business marketing manager, Reducing or even eliminating the duplication of capital investments, the desire for improved accessibility throughout the patient relationship management process and the inevitable convergence of the electronic medical record with the image management system are all possible contributing factors. The emphasis on retaining a structured approach to data management especially in the context of maintaining the viability of the future data-mining exercises and the portability of health information – especially in light of recent declarations by major industry players – serve as other possible motivating factors. Finally, the term ‘picture’ and ‘archiving’ are anachronisms that diminish the relevance of the myriad of sophisticated tasks and processes perform by today’s systems. Certainly a new acronym is not the answer. PACS as it is today is a clinical system. As a clinical system the goal must be to improve the quality of care. To achieve this goal the physician using the PACS must integrate with the enterprise. This integration comes in the form of increased access to clinical information from the various care settings and also increased participation in the care cycle through better communication. The system at the point of care should also capture data associated with the workflow that can be used to evaluate and improve the overall efficiency of the imaging environment. The provider will have a need to maintain imaging data as a vital part of the medical record, physicians will have an increased need to integrate with the enterprise. This integration will be based on the need for imaging to participate in the entire care cycle, as well as to utilize information from the entire care cycle in their decision process. Much the same way a news anchor can navigate a variety of different statistical, images, and maps interactively with the wave of a hand, physicians may soon have a similar opportunity as new PACS technology emerges. Richard Taylor, national sales director, ScImage, Los Altos, CA In fact, ‘Enterprise Image Management’ is a description that we have used to describe our product offering. Enterprise-wide solutions are exciting to many in the healthcare arena because siloed solutions have been so prevalent over the years. As care regimens have become more complicated, the need for access to more information to build those regimens has become of utmost importance. Today, PACS must be viewed as a subset of what is now known as ‘enterprise imaging informatics.’ PACS is no longer a radiology-specific departmental solution. PACS needs to address the imaging needs of all users in the enterprise – wherever they are. This includes the ER, the OR the ICU, the oncology department, the general surgery department and many others. With many hospitals belonging to a integrated delivery network (IDN) there is a need to access imaging data of patients that may have been diagnosed in facility A but who are being treated at facility B within the IDN. Users across the IDN [the enterprise] need to have seamless access to the patient data. Ten years ago PACS was mainly a replacement for film that enhanced the productivity in a radiology department. PACS is now the engine to access imaging data across all departments, leading to improved enterprise efficiency and to improved quality of care that is enabled through real-time access to vital imaging data.
Tim Kulbago,
senior vice president, strategic business initiatives, The term ‘enterprise’ means many things to many different people. Many think of an ‘enterprise’ as a large organization with many people at many facilities doing many things – for example, a multi-hospital health system. Even smaller entities, a two-facility outpatient imaging center, for example, is an ‘enterprise.’ Thus, a RIS/PACS that may be perceived by someone as not an ‘enterprise’ solution, in fact, is one in this environment because it allows facilitates the smooth flow of the patient through the system. In other cases I have heard the word ‘enterprise’" to mean multi-disciplinary. In this context, organizations face a different set of challenges. Gary Reed, president, Integration Resources, Inc., Lebanon, NJ The name PACS has endured since 1982 when the concept of an electronic imaging solution was first introduced. The term PACS is universally understood in the medical community. To change the name will take the cooperation of the different medical imaging societies and the medical community in general. The term ‘Enterprise Image Management Solutions’ (EIMS) is a better term defining the enterprise-wide access and distribution of medical images; however, it has a long way to go to replace the established term PACS. In our opinion, a change of name is not warranted. There are many buzz words in our industry, ‘enterprise’ being one of them. For Intelerad, PACS has always been about the enterprise, and it has taken so long to raise the profile of this acronym to recognizable levels even just within the healthcare industry that changing it would be like starting over. Shelly Fisher, president, BRIT Systems Inc., Dallas The enterprise has always had two different meanings in the PACS environment. 1. The ability to store image data from different areas (cardiology, pathology, etc.) 2. A centralized area that stores all the data. In either case, a central system can be used to decrease the cost of meeting the multiple storage requirements of HIPAA and of connectivity to multiple systems, such as a RHIO server. Centralizing information to a large, highly available, well managed system can improve care and cut down on the costs of having multiple systems doing the same work. However, the various groups involved need to figure out how to share the costs. If everyone wins, this should not be insurmountable, but it does often require leadership and compromises. (2,035) Mike Dolan, vice president, sales, Acuo Technologies LLC, St. Paul, MN Acuo Technologies believes the term ‘enterprise’ has been used inappropriately too often and has lost its relevance. The key to current and future value is functionality, interoperability and controlled access to data. First and foremost, the applications need to provide the usefulness they are purchased for. Once the applications are found to be useful they need to be able to interact with other applications or data sources in order to increase their utility. With all this interoperability, controlling access to data becomes the key logistical and political challenge that, at times, dwarfs the technical issues. Acuo supports and enables interoperability between disparate systems and the conversion of proprietary data archives into an ‘enterprise’ data repository that can be accessed via applications and portals that authenticate and control access. The term PACS will die on its own. Many attempts have been launched to kill it. PACS will disappear when it loses its relevance due to changes caused by deploying a standards-based strategy that focuses on ensuring the sanctity of the source data and the functional availability to the users who have the need and rights to access it. Stephen N. Kahane, M.D., chairman, CEO and president, AMICAS Inc., Boston We see the term ‘enterprise’ used in a couple of different forms. The first use of the word enterprise is to acknowledge that the images and reports commonplace in PACS need to be distributed beyond the walls of radiology to the ‘enterprise’ (e.g., other departments, offices, clinicians, etc.). This is being addressed in many different ways, but is most readily accomplished with a modern, Web-based architecture. This is relatively straightforward, provided the architecture of the PACS solution is not overly antiquated. Related to this, we sense a real need in radiology for new technologies that do not cause installation headaches for referring physicians – specifically in relation to sharing images outside radiology, and indeed outside the four walls of hospitals and imaging centers. Imaging centers and radiology groups that can provide referring physicians with real time access to their patients’ images and results – without forcing those physicians to spend time with complicated software downloads – will build stronger, more durable relationships with their referring physicians. The second use of this word refers to the inclusion of imaging beyond radiology. PACS is most readily associated with radiology, but is increasingly commonplace in cardiology, pathology, ophthalmology, etc. For various reasons, in this context, there is an industry-wide perception that ‘enterprise’ implies economies of scale in the cost, maintenance, and functionality of a system. Many people are hoping to realize a superior discount in their purchase while getting a ‘better’ solution that spans multiple departments. Specifically, if a customer chooses to buy a radiology and cardiology PACS solution from ‘Vendor B,’ they believe they can get a better discount for buying better products and realize superior clinical value from an ‘integrated system.’ While buyers might realize a superior discount percentage from a price negotiation point of view, the ‘under the covers’ integration of imaging beyond radiology often tends to be very disappointing (beyond simple IT efficiencies like sharing a storage array, which should not depend on the vendor anyway). For example, ordering studies in radiology is vastly different than ordering studies in cardiology. Cardiology tends to be a ‘data-centric’ specialty, whereas radiology is far more ‘image-centric.’
The differences in workflow and the patchwork integration
between systems typically mean that the economics of scale in functionality
do not materialize. Until that changes, the use of the word ‘enterprise’
will likely continue to be abused in this context.
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