9 Must-See Picture Archiving/Communication Systems

Industry experts report that the picture archiving/communication systems market is 95% saturated. So what's new in the PACS industry?

Well, for starters, the replacement of older systems constitutes at least 80% of new sales. Most hospitals and standalone radiology centers are now purchasing their second-generation PACS systems. In addition, cloud-based imaging that appeared on the scene about three years ago is now a "must-have" feature.

A recent report by KLAS revealed that health care organizations no longer rely on a single vendor and are seeking out companies that can provide an enterprise-wide imaging strategy that can store and archive images.

Depending on the size of a facility and the volume and types of radiological procedures, choosing the right PACS vendor can be an arduous task. What features and tools does the system provide? What about the reputation and stability of the vendor? Does it offer open standards? Does the PACS easily integrate with other hospital systems such as HL7 and the electronic medical records (EMR)? Is it DICOM (Digital Imaging and Communications in Medicine)-compliant?

"In 2012, what I'm looking for in a PAC system is not just a digitization of the film-based workflow, but bringing intelligence into the workflow, making it a lot more about the patient than just a series of images," said Rasu Shrestha, MD, vice president, medical information technology at the University of Pittsburgh Medical Center. "What I really want today is a system that is able to treat the patient as a whole, as opposed to me treating a series of images."

Shrestha said the interoperability and technology radiologists have at their disposal today--particularly systems that can talk to each other--can help clinicians know a lot more about the patient. "It will be beneficial not just for the radiologist, but also for the surgeon and other clinicians," Shrestha said.

What other key features should providers look for when shopping for a PAC system? Industry experts suggest advanced visualization, teleradiology, a customized work list, voice recognition, and cloud-based imaging.

Some experts question whether or not cloud-based imaging is right for everyone. In the current environment, some hospitals are choosing to build their own cloud, while others opt to work with a cloud provider to remotely host cloud-related services. According to Shrestha, cloud-based imaging has been a game changer in many different areas, especially in clinical workflow. He asserted that these days it's very easy for patients to get access to their own images through the cloud if the institution also has capabilities such as personal health records.

What Should CIOs Look For?

What questions are CIOs and IT managers asking when they're getting ready to purchase a new PAC system?

Christine Kao, global marketing manager for PACS vendor Carestream, said that CIO and IT administrators often ask how a PACS will fit into the larger enterprise--and not just from a software perspective. She said that hospitals seek out vendors that have commercial off-the-shelf products that are hardware-agnostic and that offer open-standard integration with what the institution already has in its environment, including its EMR.

For Adam Fuhriman, IT director at Intermountain Medical Imaging in Utah, the number-one issue is interoperability. "With that, we are looking at stuff with a mature application programming interface (API) that we can link into. That's our top item because we have so many different systems in our environment."

Fuhriman added that he's always looking for better ways to link systems together to enable single log-in, or ways to share patient data between systems.

Fuhriman, who oversees five outpatient imaging centers that are associated with Trinity Health, said that voice recognition and reporting are also important components of a PAC system. "Reporting is more important from my perspective than voice recognition--the voice recognition just drives the reporting. We're looking for ways that we can make the reporting part more efficient for the radiologist to get more accurate reports, [and to] deliver that report faster, especially in the case where we have a lot of ERs that we support."

Some industry insiders contend that the best way to think of conventional PAC systems these days is in three parts: visualization, workflow, and the ability to archive images.

"Archiving is being extracted outside of departments because it's the same effort, whether you're doing it for cardiology or radiology or ultrasound in the OR. So those are typically now using vendor-neutral archives," said Keith Dreyer, MD, vice chairman of radiology at Massachusetts General Hospital in Boston.

Dreyer, who is also chairman of the informatics committee at the American College of Radiology, said that when purchasing a new PAC system, it's important to choose a vendor that can demonstrate that it has up-to-date technology so that it can perform things like advanced visualization or cloud visualization.

"I would want to make sure that I can see a migration path off that system--so that the data is removed in a way that I can migrate to other visualization tools," Dreyer said. He noted that in the past, purchasers would buy one visualization tool, one workflow engine, and one archive, all from the same company. Today, however, there are a dozen visualization tools, a dozen workflow tools, and a dozen archives. "So if I didn't want to purchase those three [tools], I'd want at least a prime contractor that could outsource those other solutions. But when I buy now, I look for those components, [and] structured architecture so I can replace components that don't work."

Finally, Dreyer said that he would look for layered architecture and a layered system. "I think that's the big thing. The days are gone where you would buy everything from one vendor."

Take a look at the following PACS vendors and see which ones best match your current needs.