Top 10 Problems and Solutions of PACS

PACS has changed traditional radiology. More and more clinical departments have begun to deploy or customize dedicated PACS versions. However, many reports point out that PACS currently has many problems. The following are the 10 most difficult challenges of PACS currently recognized by medical imaging experts and information technology personnel.

1. Integration

As the government increases its support for electronic health records (EHR), many medical institutions are eager to connect multiple suppliers. The integration of PACS and hospital information systems (HIS) seems to be an endless debate. Poor compatibility of professional image sharing software with other vendors' EHR is a common problem. Integration of PACS with RIS, voice recognition and billing are often difficult points.

The problem is often exacerbated by poor compatibility between devices and IT systems from different manufacturers, but the market is moving towards greater integration between devices by standardizing usage requirements. Despite this, many radiology departments and PACS administrators prefer to configure the hospital's own systems to achieve more autonomy and full utilization.

"You should try to avoid compatibility issues between systems due to customized systems," Richard L. Kennedy, director of imaging information technology at Kaiser Permanente Medical Group in Sacramento, California, suggested. In addition, good compatibility of hardware and software can ensure integration with almost any platform. Experts unanimously recommend that clinicians and equipment managers establish a reasonable equipment procurement plan based on this principle.

2. Work stoppage

Plan for downtime. "Every system has downtime," Kennedy points out, "and that's when you need to build an alternative workflow." Scheduled and unscheduled system outages are inevitable, but healthcare organizations shouldn't dwell on the negative impact on quality of care. A business continuity system is necessary, and it can be as simple as a public mini-PACS or as complex as a completely redundant PACS system.

3. Suspension Agreement

Nicole Fennell, PACS administrator at Scottsdale Medical Imaging in Arizona, believes that non-standardized hanging protocols are a challenge faced by PACS and users. Because different image modes require a certain amount of time to decode, once these times are added up, it will greatly reduce the efficiency of the radiology department. With the increase in different brand specifications of scanners and the expansion of the supplier product chain, the situation is getting worse.

Fennell and Joseph Johnston, PACS administrator at Bethesda North Hospital in Cincinnati, both agree that renaming or standardizing the image series descriptions for each scan can alleviate the problem. They both report that standardized series names have resulted in 85% of hanging protocols being standardized.

4. Synergy

Integration issues involve hardware, from preprocessing digital DICOM models to integrating systems for further image reconstruction. Add-ons such as DICOM converters can help doctors get more information from old CT, angiogram and fluoroscopy images. Eliot L. Siegel, MD, professor of diagnostic radiology and nuclear medicine and acting chairman of informatics at the University of Maryland School of Medicine in Baltimore, said he would like better integration between PACS systems and advanced visualization systems, including sharing image archive files and enabling PACS workstations to display thick-slice images using thin-slice data to avoid the need to store both thin-slice and thick-slice data.

No matter how well-versed an IT staff is, there is no way to deal with the complex interfaces of different vendors' systems. "My first job is to manage hardware from different vendors," said Paul Leonhardt, RIS/PACS administrator at Caldwell Memorial Hospital in Lenoir, North Carolina. "Rationalization is basically an expansion of the 'bolt-on revolution.'" If the company chooses an in-house configuration or a single-best system, additional software integration is a second-best option for the vendor compared to new equipment.

5. Customer Support

Downtime and failures are inevitable, and these can show whether the PACS vendor has strong customer support capabilities. Leonhardt pointed out that although the systems between radiology and other specialties are becoming increasingly interdependent, there is still a "domino effect" of errors between different suppliers. In addition, more and more businesses involve remote support, but as prices rise, the quality of service continues to decline. This shows the importance of vendor selection. Not only can choosing the right PACS reduce the possibility of errors, but the right vendor can also greatly reduce the risks that may occur in the future.

6. Training

Effective training is designed to solve a specific problem, rather than preparing administrators to solve many problems. Training can be a cost-effective way to expose administrators and physicians to the many underutilized or underappreciated features of PACS systems. "Training helps staff understand the functions of the system and makes their jobs easier and more efficient," explains Howard Epstein, M.S. in medical administration and PACS administrator at the University of Southern Nevada Medical Center in Las Vegas. The university medical center's education department has launched a collaborative program involving radiology, information technology, etc., and all new education and medical administration staff will receive training in this course, which helps to keep a large number of employees aware of the relevant workflow.

7. Elimination and renewal

Replacing an old PACS can bring many advantages to clinical and administrative workflows, but there is no denying that there are often many problems in the short term after the replacement is completed. "It's a painful process," said Steven C. Horri, MD, Department of Radiology, University of Pennsylvania, Philadelphia, at the 2010 Radiological Society of North America. Johnston said: "Often, IT departments don't really understand the difference between radiology workstations and general computers, and they treat them as ordinary computers, which is a major problem."

Migrating to a new PACS is often the most challenging part of the process, especially when it comes to handling old protocols. From the data that has been published so far, all data items have accumulated errors over the life of the system. (This is not a problem, but it is another matter if the site uses old archives.) Finding common problems and solutions goes a long way. Horri's advice is to "sign a new agreement with your new vendor." Since costs always exceed budgets, the cost of data migration is actually determined by the vendor according to the contract.

8. To which department does PACS belong?

As specialists slowly begin to see the value of PACS, the system is slowly moving away from radiologists. "PACS has become an enterprise-level tool used by nearly every specialty, and as this changes, the purchasing, upgrade and configuration decisions related to PACS are bound to change. In some cases, hospitals will shift the focus of deployments from radiology to a framework that is more core to the hospital structure. In this case, deployment decisions may favor departments with higher patient volume, and hospitals may even want one company to provide all solutions," said David L. Weiss, MD, associate professor of medicine at Virginia Tech Carilion School of Medicine and medical imaging information coordinator at Carilion Clinic in Roanoke.

The equipment that hospitals ultimately choose may not be optimized for the radiology department's workflow alone, Weiss said. Since radiologists spend more time on PACS workstations than any other department, this means that radiologists need to maintain strong professional communication with the IT department to avoid having to make PACS deployment decisions for IT reasons.

9. Ergonomics

Hospitals can hire ergonomics experts to evaluate PACS workstations and make corresponding improvements, which can alleviate the symptoms of "repetitive stress" caused by radiologists and greatly promote productivity. Despite the accelerated technological progress, the interface tools of many PACS workstations have not changed much. Weiss pointed out that "although two-button mice and traditional keyboards are still the main means of computer user interaction, they are not conducive to PACS workflow." He personally likes a 17-button mouse. Many manufacturers are improving the ergonomic design of PACS by adding configurable user interfaces.

10. Disaster Recovery

Like business continuity, disaster recovery can prevent disasters from becoming a painful experience for management. Many hospitals choose redundant servers, cloud storage, or both. Being prepared for downtime can save doctors and patients from significant losses.