Does PACS replacement have you seeing red? With the right partner, the process can help keep you in the black. Today’s vendors ease the transition with everything from all-in-one solutions to ways to leverage existing hardware.

PACS replacement. Just the thought of this task is enough to inspire dread and anxiety among radiologists and administrators. The goals are relatively simple: Radiologists want to make their PACS work better. They want mechanisms that increase efficiency throughout the organization. They want enhanced productivity and a means for radiologists to give their best diagnoses with confidence and speed. That’s what PACS is designed for, but the older jumble of existing technology doesn’t provide it. So replacement becomes the feared next step.

But it doesn’t have to be this way. Today, companies are forging a new role in the marketplace by offering streamlined replacement services and even innovative new products that transition sites to efficient enterprises. With a few lessons learned from vets in the field, and a look at the technological options available, radiologists and administrators can eliminate the frustration and create something incredible.

Why is PACS replacement such a challenge? Consider the intimidating trials of implementing any new technology or process. Expenses and costs can seem steep. Taking inventory of goals and needs can be tough. Staff will need to take time away from busy schedules to help implement the change and go through training. But add the challenges of migrating existing data to new PACS systems, recouping existing hardware investments, and understanding the current system’s complexity, and frustration and confusion reign.

The way in which PACS technology evolved over the last decades gives us a more focused look at why replacement is a burden. Initially, radiologists looking for an archival system purchased various components from different vendors and put together a solution for their practice’s needs and issues. The result was a hodgepodge, a mix of diverse pieces of machinery put together in an ad hoc fix.

There’s more, of course. The PACS systems built over time by radiology centers and health networks were necessarily made from a general radiology perspective, or from a cardiology, nuclear medicine, or other specialty perspective, depending on the site. Each specialty wanted and needed different technological add-ons as they became available, as well as different specialized applications and dedicated workstations. More haphazard additions and a system unfriendly to other types of applications ensued. As another result of this hodgepodge, the actual archives of pictures became overly complex. Imaging centers had islands of archives without easy mechanisms to access, manipulate, or move them.

Taken together, existing PACS systems are a mess. Radiologists look at what they have and see inefficiencies, wasted capital, and a source for increasing process problems throughout their organizations. Replacing the systems is increasingly necessary, but the idea of replacing the messy mixture of tools and technology is absolutely overwhelming.

That’s the beauty of several new offerings by innovators in radiology information technology. Taking on these challenges are companies like Philips, Andover, Mass; NovaRad, American Fork, Utah; and Carestream Health, Rochester, NY, which offer specific services geared toward easing the replacement process. And some radiologists have, as a result, come to view their PACS replacement not as a nightmare but as a genuine business booster.

Survival Stories

Tim Moore, BS, RT(R)(MR), diagnostic services manager at Maui Medical Group in Maui, Hawaii, oversaw his group’s PACS replacement in 2006. With its previous vendor, the group’s existing PACS system was the epitome of the mishmash, with continuing modifications, rising expenses to maintain, and lack of support. It needed a fix.

Maui Medical Group had a laundry list of goals and challenges but needed to keep its budget in check. It looked at 15 different companies seeking the best of the breed within its price range. What it found was value beyond its expectations.

“We chose NovaRad for their value but also because they offered something other companies didn’t,” Moore said. “They offered specific and simple data-migration guidance and service. We had 4 years of studies in our existing PACS and needed to bring them on to the new system. As part of our contract, and not a separate add-on like other vendors, they provided a plan to do that. Plus, NovaRad promised a quick transition, something others couldn’t.”

The process was speedy. The company came in on a Saturday with its equipment and made the transition within 2 hours, eliminating the potential horrors of a lengthy and drawn-out procedure. The migration of existing images to NovaRad’s servers occurred at off hours over an additional week, and the subsequent data validation was also swift.

NovaRad is a relatively small company that specializes entirely in PACS/RIS, a size and focus that meant Maui Medical Group can easily receive support when needed. The group also appreciates the continuing commitment; within the contracts are included contingencies for when hardware and software become obsolete, machinery fails, storage capacity needs grow, and/or other expansion is needed.

“We found the vendor that made sense from a cost perspective and could deliver us a modern platform and plan,” Moore said. “It’s easy for doctors and radiologists to use, and it has enhanced communication between our facilities and remote locations. We’ve gained some major efficiencies, which speeds up report turnaround to referring physicians and results in patients getting treatment sooner.”

Bob Garrett, administrative director of radiology at Christiana Care Health System in Newark, Del, found the PACS-replacement solution he was looking for through Philips. Christiana replaced its existing PACS system in January 2006 and added capabilities and refinements throughout the summer. One of the group’s biggest initial challenges? Simply figuring out what needed to be done.

“Understanding the current processes we had in place, and what needed to change, was a tremendous challenge,” Garrett said. “We had to understand our processes and workflow, and realize which departments and clinicians were affected. We couldn’t just make a transition in CT and MR without impacting general radiology as well.”

Garrett and Christiana had an existing working relationship with Philips for its PACS tools, and when they learned that Philips was going to offer a new tool that allowed easy replacement, simpler expansion, and more business benefit, they jumped at the opportunity to convert. The iSite PACS system from Philips integrates into pre-existing HIS/RIS systems and provides cohesion across the enterprise, including workflow lists and constant access to radiologists, technologists, referring physicians, and critical care departments.

The results for Christiana were dramatic and simple to obtain.

“Our ability to communicate with other departments is much better, as is our ability to distribute cases and images,” Garrett said. “For the patient that comes in through the emergency department, we don’t have to chase down their films anymore. No matter where they are, physicians can access images when they need them to immediately see exactly what’s going on. It has actually made a big impact on education as well. Before, we had to carry stacks of films around to conference rooms, drop them off, pick them up, sign them out to residents, and hope we got them back. Now, residents can just pull cases up for conference and view them at any time.”

“It’s 180 degrees better,” Garrett continued. “Our whole workflow and organization is improved.”

Best Practices and New Innovations

From these experiences and others, radiologists have learned what works best for PACS replacement. They say the best vendors provide firm processes and procedures for transitions, but also remain flexible and customized to that center’s specific needs. These best vendors offer cost efficiency but also innovation. The best vendors offer support when needed and involvement in the process.

With the advent of the Aspire Breast Imaging Workstation, Fujifilm offers a Web-based PACS with the tools and performance required to meet the needs of today’s busy mammographers.

“Philips was involved early on with us to help determine the best solution,” Garrett said. “They helped us define workflow and the demands for the number of cases we did, examine our storage needs, and figure out what would work best to move things forward. It was a great undertaking, but the results have been terrific, and we wish we had done it a lot sooner. We continue today to get comments from radiologists and other departments. Physicians will tell us how great the system is and how thankful and appreciative they are for access.”

As PACS becomes more routine and instrumental in radiology departments, the essential differentiation—especially when it comes to replacement—comes from the other things the company offers.

“Looking at the products out there, most companies offer pretty decent PACS systems,” Moore said. “But it’s the other things, like interfacing and all-in-one solutions, that make a vendor. Everyone is looking for a way to minimize time to review images, to have all the information at hand and make diagnoses easier. But you have to look at workflow and think about what you can gain. We went from a manual system to streamlined, a very slow system to something highly advanced.”

As the need for PACS replacement grows, the need for vendors to innovate and create new solutions is profound. Carestream Health is one company that is taking that idea to heart. At this year’s RSNA it introduced the CARESTREAM SuperPACS? Architecture, which adds a layer on top of existing PACS systems to automate workflow while utilizing existing equipment investments, streamlining processes, and connecting radiologists in an efficient way.

The new SuperPACS architecture automatically dives into a legacy PACS system, determines previously existing studies, and extracts the associated metadata to make these studies available throughout the new system. The setup and process promises to remove the time normally required for data migration. But it also tackles a major issue that centers face: how to leverage existing hardware investments, all of which still have life and value left. Carestream Health’s system takes advantage of current archives and the associated capital investments.

“We’ve seen a number of customers that have multiple facilities, multiple PACS vendors, and multiple specialty workstations, and they want to provide a more efficient reading service over the entire workflow,” said Joseph P. Maune, director of product management, Healthcare Information Solutions, at Carestream Health. “With today’s technology, it’s impossible. SuperPACS is unique because it forgoes replacement and preserves existing infrastructures by simply placing a layer on top, a tool that provides a unified worklist and utilizes a common workstation.”

The SuperPACS promises greater productivity and efficiency through a global worklist. Throughout multiple facilities, radiologists and specialists can access existing and new images and share information securely. The goal is to save costs, time, and energy while allowing radiologists to do what they do best.

“We continue to invest in ways to make radiology and radiologists as productive as possible so they can diagnose with confidence and speed,” Maune said. “We’re trying to get to that sweet spot where radiologists spend less time navigating through images and more of their time on the actual diagnoses. That’s the power we bring to radiology.”

With the right partner, even PACS replacement can be a simpler and deeply beneficial process. Through continued creative thinking and solutions, today’s PACS vendors are looking to boost their profile by offering smoother PACS replacement, and are making the jobs of radiologists and administrators a little easier.

Amy Lillard is a contributing writer for Medical Imaging. For more information, contact .