In health IT, a bona fide religious war appears to have broken out, with all-rounders and specialists entrenched on opposing sides, each claiming the IT landscape in hospitals and clinics as their own. The victims here are IT managers and users, who, when it comes to the question of which system is the right one, are getting caught in the crossfire. And yet the differences – at least with regard to image and diagnostics management – are not at all as stark as certain providers would have us believe. Modern PACS solutions are distinguished by a depth of functionality, clinic-wide implementation options, and by an open architecture, and do not require anybody to compromise ‒ as long as medical facilities know what to look out for during invitations to tender.
A fully open system – as standard
The number of interfaces in image management has always been considerable, and with the integration in PACS systems of non-radiological imaging modalities, this number is increasing unabated. A crucial feature of modern PACS systems and the basic prerequisite for optimum process support in clinic-wide image and diagnostics management is therefore a fully open system. In concrete terms, this means that the interfaces to information systems such as KIS, RIS or CIS should be just as platform-independent as those linking to infrastructure, i.e. to SAN, NAS or long-term archiving systems. This requires a high level of interoperability – again, independent of the manufacturer of the system to be integrated.
Particular emphasis should be placed on the seamless connection of modalities: only a flexible, expandable and vendor-neutral PACS system will allow custom expansion of image and diagnostics management, not only to include new equipment but also other departments or locations. However, the connection in itself is not the only issue at hand – a deep level of integration is also required that allows the configuration of intelligent hanging and reading protocols, in turn creating the real-added value.
This degree of openness in a system is ensured by implementing standards, which thanks to IHE and formats such as DICOM, HL7 and XML, are truly flourishing in the PACS domain and are also internationally recognized. The PACS system should also be able to "include" modalities that in themselves are not yet able to support established standards. In order to facilitate a comprehensive approach to image management, it must also be possible to migrate data from legacy ultrasound or ECG equipment into the PACS system and to convert it to the DICOM format. If the PACS system is not able to perform intelligent data conversion, medical facilities must either accept the fact that their documentation will include significant gaps, or they must upgrade all of their equipment.
PACS-II and special systems: a contradiction in terms?
Open systems are not bucking the trend of consolidating the IT landscape across all departments and establishing a standardized approach to image and diagnostics management. In fact, the opposite is true: the possibility of deep modality integration and strong incorporation into information systems are prerequisite in this regard. This is because the implementation of standards and the option of conversion to them – primarily DICOM – is what makes the establishment of a consistent, patient-oriented archive for images and diagnostics possible across all departments. As part of this process, a wide variety of options in terms of data administration, presentation and archiving are consolidated, which were previously often completely self-contained. The goal is to have a KIS structure that allows all data to be called up and imported to it at the touch of a button.
The corresponding motto is "integrate, don't replace; connect, don't separate". In this respect, tasks are in fact moved away from specialized, decentralized workstations to a central, web-based system. However, this all takes place with an efficient workflow in mind, as all data can be called up in standardized fashion using a viewer from any location. Nevertheless, this does not rule out the fact that the compilation of specific diagnoses, for example using support systems, can be carried out as before using dedicated workstations. The important thing is that this data lands in exactly the same system and is available for everybody.
Using the radiology toolbox
In additional to centralized data storage, using a PACS system clinic-wide as an image and diagnostics system (PACS-II) offers an additional benefit: radiological PACS features have considerable potential in terms of improving processes in other clinical domains. Accordingly, the measurement tools are ideally suited for use in the quantification of wounds, 3D volume views support trauma surgeons in surgical planning, and cardiologists benefit from options for editing ECG curves as well as from the simultaneous display of moving images, for example in order to compare the latest left heart catheterization examination with a preliminary examination.
Thanks to the consistent implementation of the DICOM strategy and the open nature of PACS systems, additional scenarios are conceivable for the future, for example the integration into the system of bio-signaling from intensive care medicine.
Understanding, mapping and optimizing processes
Crucial in the successful implementation of a PACS system is that it offers maximum process support. This may appear to be obvious – but only at first glance. The demands placed on an intelligent image and diagnostics management system require a high level of specialization, which only dedicated PACS providers can really achieve. And as regards specialization: the popular phrase "stick to what you know" also rings true when it comes to the functions of PACS systems. It doesn't always make sense for a PACS manufacturer to develop every function from scratch. Particularly when it comes to CAD systems, cooperation with established specialist software providers is often the preferred approach. Core competencies with regard to imaging, viewing options, distribution and archiving – for example such as image registration, integration of tomosynthesis, visualization of blood vessels, and screenshots / screen capturing – should, on the other hand, be the product of the PACS manufacturer's own development laboratories. A successful mix of in-house development and the integration of specialist systems is the basis for strongly process-oriented support.
Furthermore, when choosing a PACS system, hospitals should not only pay attention to isolated functions, but instead ensure that the workflow as a whole is supported by intelligent hanging and reading protocols. The key here is that the PACS manufacturer understands and can map the "data flows", as well as the significance of the data within the treatment framework as a whole, including deep integration in the KIS system, regardless of the manufacturer. Also conducive to process support is the improvement of interdisciplinary collaboration as part of case conferences using PACS: calendar functions and screenshot / screen capturing, i.e. the freezing of diagnostic settings, make the presentation of patient data easier, and should be provided by the system.
To summarize: a PACS system must adapt to the existing structures in a facility – and not the other way around.