After years of talking about starting and/or planning to begin a PACS project for the radiology department, many facilities are now?finally?moving forward with it. Doing so often raises other questions for a hospital. One question I’ve often seen raised is: If a hospital proceeds with a radiology PACS, what, when, and how should it plan for a cardiology PACS?
It seems that if radiology is prepared to begin moving its project forward, invariably, the cardiology question is asked. (Interestingly, I find that if a facility is moving forward with a cardiology PACS first, the question about radiology seems to be left for another day.) Here, I would like to share some thoughts about the dynamics of these two departments and the decision-making considerations when looking at implementing PACS.
The most important thing to remember is that the cardiology department never should decide who the radiology vendor should be; by the same token, the radiology department never should decide who the cardiology vendor should be. This concept is especially true if you want your project(s) to be successful at the implementation and clinical levels. Certainly, there are benefits to buying both PACS offerings from the same vendor. However, if either user population is not pleased with the vendor application and/or user interface, using the same vendor for both PACS offerings is probably not a legitimate solution for your facility. You will be reminded constantly that the PACS does not perform as desired, and/or that the department did not select or prefer that vendor.
Both of these factors compromise the buy-in from the committee, whose commitment is essential to make the project a success. Because I detailed the politics of various decision-making committees in a previous “Informatics Report” (January 2005), I will not rehash my opinion here of which department might, should a single decision be made or forced, have the stronger political influence between radiology and cardiology. You probably already know what would happen at your hospital.
Suppose your facility already has created a strategic plan for radiology PACS and cardiology PACS, or is in the process of planning or preparing a recommended plan. You and your team are the experts in the internal workings of your facility, so you’ll know the best way to proceed; however, you might want to consider a few things that will help support your decision. I have drawn my recommendations from the success of my clients’ projects, which is always my sole focus. We at the Thomas Group Ltd (Anaheim, Calif) have helped implement radiology PACS at more than 50 facilities and have worked with a handful of facilities on their cardiology PACS projects. Our clients’ success is what keeps our business successful.
What might not be obvious is that you need to form two different project committees. Functionally, each committee will want representation from the department, physicians, information technology (IT), and possibly executive/administration. Therein lies one of the challenges of doing both projects at the same time. The one constant is IT representation. Departmentally, many times two different sets of management need to be involved and, certainly, a radiologist could never represent a cardiologist?and vice versa. Executive/administration representation might or might not be the same or required for both departments.
In addition to forming two committees, you will want to write two separate requests for information, your on-site presentations must be different (maybe a radiology presentation followed by a cardiology presentation), and, of course, the workstation demonstration must be dedicated to the end-user specialty.
On a functional level, depending on how your exams are ordered, you will need to know if separate information systems manage patient data and order detail. Knowing how the exams are ordered is important to PACS database management. Remember, your RIS or CIS is the quarterback that provides the PACS with the data and information on how to manage that data. Radiology has the DICOM standard (admittedly with deviations); however, the standards for cardiology with such areas as catheterization, stress, echo, EKG, hemodynamics, and nuclear medicine are not quite as defined across each modality source. Also, do not forget that today’s specifications might not be standard or even available to systems installed over the past 5, 10, or 20 years. Replacing your modalities probably isn’t a cost you will want to add to your cardiology project. Understanding exactly what can be connected and how that connection works for each cardiology PACS solution is essential to purchasing a solution that meets your expectations.
Radiology’s user interface and clinical tool set will be different than that of cardiology’s. For this reason, the PACS should only be evaluated by the specialty end-user responsible for primary exam interpretation. I cannot overstate that their buy-in and support of the technology is crucial to the project’s success. Many times, the specialty end-user will identify their preferred vendor or a couple of preferred systems. At this point, the other committee members have weigh-in with what criteria are most important to them, and you will need to know if the vendors have a differentiation in those criteria.
Many facilities prefer to use all the same hardware. Certainly, they will want to have an enterprise archive strategy that also encompasses the data needs of both radiology and cardiology. Sharing the archive is advised, whether your process has led to the same vendor for both applications or not. The vendors must be able to effectively query each other’s databases, even in the same archive. It is at this archive level where the project can become an enterprise PACS regardless of the chosen PACS offerings.
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In closing, when it comes to PACS for the radiology and cardiology departments, you should prepare yourself for two separate projects, two separate processes, and a single archive. If the end result is the same vendor, there are benefits; however, if the end result is not the same vendor, you can still make two successful investments that optimize both the cardiology and radiology offerings of your facility. The ultimate success of your investment, though, is contingent on being comprehensive, thorough, and diligent in the entire process.
Michael Mack is VP of business development at the Thomas Group Ltd (Anaheim, Calif). Having more than 20 years of experience in the medical imaging industry, Mack now specializes in PACS planning and implementation.
