• PACS- There is life in the old dog yet
  • Jef Williams
  • Herman Osterwijk
  • PACS- There is life in the old dog yet
  • Jef Williams
  • Herman Osterwijk

PACS – Alive and kicking

RSNA 2015 in Chicago felt like the funeral of the good old PACS as we know it with the entire market abuzz with new concepts such as reconstructed/deconstructed PACS or vendor-neutral archives. Picture Archiving and Communication Systems suddenly looked old-fashioned and irrelevant. Radiologists neither mourned nor cheered, they didn’t quite know what to make of all this: What’s happening here and how will it affect me and my work? A little over one year later, the answer is straightforward: Not that much. In fact, PACS is anything but dead, and indeed its future is looking bright as the PACS experts Herman Oosterwijk and Jef Williams predict.

There is life in the old dog yet

”Obituaries for PACS were definitely premature,” says Jef Williams, partner at Paragon Consulting Partners and a seasoned PACS insider. But why? Very simple: Because PACS is much more than an archive for digital images; it is the main tool for workflow optimization. ”Ninety percent of what we do in imaging is help on the departmental level to improve the workflows in terms of  working conditions, quality of care and modern medical processes,” he explains. Herman Oosterwijk couldn’t agree more. For the President of OTech Inc. and another old PACS hand, PACS is “the tool to make images available at the right place, at the right time and in the right quality. Therefore it is a crucial part of healthcare IT today – and will be so tomorrow.”

Re- and deconstructed PACS: nothing but a storm in the teacup?

If experts and users agree on the importance of PACS in modern healthcare scenarios, what was the hype of de- and reconstructed PACS all about? As is often the case in supposedly saturated markets the hype was driven by marketing strategists of huge IT companies. Or as Jef Williams puts it: Those terms are a “vendor narrative”. A reconstructed PACS is nothing but the common concept of having an enterprise system comprising multiple vendors. “We have always had that. For instance in the US your PACS vendor and your reporting vendor are in most cases different companies,” the expert underlines. For Herman Oosterwijk as well, the idea of reconstructed PACS is old news. Take the IT infrastructures of huge hospital with special requirements for managing and handling data, for example in terms of research, he says, “The idea to build a software solution from different components is the domain of huge hospitals because you need a lot of experts and knowledge to run such a system. When today people talk about deconstructed PACS, they often mean something different, namely that the PACS becomes more open, with open interfaces allowing systems to be more standardized. Such solutions are still difficult to handle and not recommended for the faint-hearted IT department. That’s why companies came up with the term ‘reconstructed PACS’ since it implies the advantages of an open solution in combination with the full service of the company’s support,” Herman Oosterwijk explains. 

The rising demand for so-called deconstructed solutions was triggered inter alia by the healthcare institutions’ endeavors to centralize medical data in only a few systems. And a PACS is the perfect place for storing and handling images institution-wide. Today, many clinical disciplines other than radiology have gone digital – from cardiology to organ-specific fields such as ophthalmology. For a long time, medical data could only be stored and managed within the device which had acquired them. This of course is a disadvantage when it comes to an integrated diagnostic approach drawing on all medical data that are available for a patient. 

The PACS as institution-wide imaging center?

Starting from the idea that the PACS can function as an institution-wide place for images, the term ‘vendor-neutral archive’ (VNA) was coined. ”Apart from the fact that a PACS does more than just archiving data, two challenges we are facing when we work with data of different departments and from different sources are file format and workflow. Outside radiology there is a lack of standardization in formats, and images are rarely accompanied by meaningful metadata. Moreover, outside the radiology department you leave orders-based workflows where for example attaching an image to the patient record takes on an entirely different dynamics. It is quite hard for one system to overcome those barriers,” Jef Williams says. Having said that it might not be necessary to store all images physically in one system. The crucial issue is the possibility to access the information via one system. This may well happen via intelligent connections and image exchanges. “As long as you can register the information, distribution of images is a good option to provide centralized access for decentralized data,” Herman Oosterwijk adds.

A look into the future of PACS

If PACS is anything but dead then where is the development heading for? Oosterwijk and Williams see two main trends: optimization of workflow and integration. For the latter it is important to have more open systems, i.e. the systems need to be easily interoperable and should “speak” standards. This openness will be crucial to fulfill the need to centralize medical data and to share medical information internally and with external institutions or persons. Another important aspect of centralization and sharing is the fact that data must carry the same name across several systems. In short: semantics must be improved. “And of course one workflow aspect when it comes to PACS is the continued improvement of hanging protocols so that data are presented intelligently in order to be able to obtain quick and clear information,” Herman Oosterwijk emphasizes. For Jef Williams there is especially one trend that will shape the PACS debate over the next few years: “The most compelling technologies that will influence the PACS are machine learning and the deeper technology that is being developed to strengthen the intelligence of analytic data. This will be fundamental for the data analyzing workflow in radiology. Machine learning will be a perfect complement to the daily routine and it is going to improve diagnostic results.” Last but not least there is one important aspect far beyond technological wizardry: the PACS market is by no means saturated, says Herman Oosterwijk: “We keep on focusing on the US, the European and the Middle Eastern markets. But we are overlooking those countries in the world that have just begun to implement modern healthcare and digitalization. They are a huge market for basic PACS solutions that are reliable and stable. So there really is no need to worry about PACS and its future.”

Herman Osterwijk President of OTech Inc.

Herman is trainer/consultant based in Dallas, TX who has authored several textbooks on PACS and healthcare IT standards and has been participating in the DICOM, HL7 and IHE standards committees for many years. He has trained healthcare imaging and IT professionals for the past 20 years in over 20 different countries through seminar, webcasts and many publications and lectures.

Jef Williams Managing Partner Paragon Consulting Partners

Jef is a well-known and frequently asked PACS Expert in the US and beyond. His background as a leader at GE, COO at Ascendian Consulting, combined with 15 years of Healthcare IT experience provides him a diverse and creative approach to problem-solving and solution design. He specializes in assisting organizations with organizational strategy, operational improvement, software design and selection, and enterprise deployment initiatives. Moreover, the is author of several articles about imaging and archiving solutions and member of organisations like the Society for Imaging Informatics in Medicine (SIIM) or HIMSS.