Overflow crowds of radiology administrators crowded the session rooms, gambling on picking up the inside scoop. It wasn’t blackjack or roulette, but an interest in making serious investments in picture archiving and communications systems, attracting both high rollers and quarter slots players alike. While the annual meeting of the AHRA (American Healthcare Radiology Administrators in Las Vegas, from July 30 to August 3 provided many educational choices, PACS was for sure the overwhelming winner.
The PACS experts were clearly in demand, as Stuart Gardner, Michael Cannavo and Gary Reed were all in attendance, providing tips, tricks and seasoned advice. With recent research reports and market forecasts predicting strong growth in PACS over the next few years, it seemed a good use of time to talk with administrators and then review the tradeshow floor, looking for trends and opportunities.
Everyone’s doing it
Radiology administrators everywhere are looking to do PACS this year, and almost everyone has a budget. It may be a first time system, do-over, expansion or upgrade, but it didn’t take more than 30 seconds of conversation to elicit the current status of any radiology department’s plan. The acquisition cycles are quite varied, but the thrust of the effort and the money behind it are real. The driver that set off this feeding frenzy? Technology and user maturity. Critical mass has finally arrived for this market, and you don’t need to be a technical expert to buy, install and use these systems. However, you need to change many practices within the radiology workgroup, and this is why everyone is encouraged to build and use a PACS planning TEAM. PACS administrators are the next addition to many department staffs (or at least this title is added to someone’s current job description) as someone will need to own the problems that are expected to arise from the daily use of these computer networks.
Trends
The image explosion in medical imaging has hit — it’s been widely discussed, but seldom appreciated until archiving systems began to capture much of the work of radiology departments. The average growth in procedures for CT and MRI has been well over 10 percent, and in well-managed facilities, more on the order of 15 to 20 percent per year. This implies that procedure volumes double every 4 to 5 years. Compounding this growth is the increased number of images per procedure, especially resulting from multi-detector CT and fast MRI systems. And don’t forget those volume-intensive 3D images. Net result — you need an archiving system bigger than you think, and the same holds true for your network bandwidth.
DVD is the current hot archive technology. Gigabit networks are up there too. Current wisdom suggests buying just one or two years worth of archive capacity, as technologies continue to evolve (note: become obsolete), and archive prices continue to drop (how rare in radiology!).
In all of this, X-ray is the exception flanked by an asterik. It’s a mixed modality for most users, with both digital and analog acquisition technologies in use, depending on the procedure and the radiologist. CR has helped much of the work go digital, but DR remains a work in progress for the average department.
Film has not disappeared — it’s still maintained, and there are radiologists who require selected medical imaging procedures be read from film. So don’t throw it out, just plan for a substantial decrease in the use and maintenance for this image media.
Technospeak
DICOM is the backbone of modern PACS, but reading a DICOM conformance statement is not encouraged. These vendor documents describe the technical interfaces in specific detail to enable radiology departments to build multi-vendor systems. If you are considering a PACS from a single vendor — which makes you the clear exception these days — you still need to provide access to images to outsiders. DICOM is your password to successful image exchange.
Multi-vendor systems are extremely popular approaches, as everyone likes choices, and this holds true in PACS as well. Living with a buffet of choices sometimes requires heartburn medicine — in this case, it comes in the form of a consultant. Use a good one to keep your PACS selections looking more like a healthy diet than a junk food binge.
Service and Training
An earlier mention of PACS administrators is just the tip of the iceberg, with respect to the need for training and support for these systems. The status of the PACS (up, down, fast, slow) will soon determine the relative happiness of both radiologists and other physicians who will be depending on this network to provide “any image, any time, anywhere.” DON’T let this become an albatross — invest in people and training to manage the inevitable problems that will occur. Nobody wants to hear: “The network is down, but someone will be out tomorrow to take a look at it.” Invest in service (at least for the first few years) — you want all hands on deck when the network is down.
Finally, the wisdom garnered from this seasoned group of AHRA members — take your time and work as a team. PACS represents a substantial investment, but the benefits are real, especially in the management of patient decisions where time makes a difference.
Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].
