Picture Archiving Communications Systems (PACS) will probably be the crowning achievement for any administrator. Installing a PACS is the most important system process in Radiology, but there are some key items and issues left unresolved by most if not all vendors. These portions consist of a RIS to Archive integration, a RIS to Modality interface and an inexpensive means of Networking Images to the end users. The last issue to consider is the Communications Network.
Most solutions are less than half solutions because they only account for image capture, storage and communications to the most common areas, mainly because of cost. Most do not have an inexpensive solution to network the images to other 1,001 locations that will spring up. They do not account for capturing the information from the point of patient registration let alone from scheduling.
Scenarios most likely to arise soon after implementation are:
RIS the heart of any PACS
All of the above, except hard copy film integration, can be handled with the integration of the RIS. This is argument enough to have a RIS. Choosing your RIS is just as important as choosing the PACS vendor. Both must communicate and both must have an upgrade path. Do not fall for the sale of one system doing it all. Assuredly the system will wind up doing both poorly.
Let each do what they do best. A RIS is built to handle massive amounts of information and handle it in very short period of time. Utilize the RIS to eliminate spelling mistakes, setting schedules for the modalities, routing and pre-fetching the co-ordinated exams, keeping track of images, integrating to the HIS for physician communication, produce imaging and modality reports, and to set maintenance schedules that are incorporated into the exam load.
A PACS is not made to dynamically track images, it will tell you once they are archived but not as the exam is done IE images are located in the Radiologist station and the archive, this image is number 1 of 65 or the beginning and end of a study as it is performed. Neither is it made to create and maintain rule sets for what images/exams are related to each other by category IE an IVP is a relative study to a CT of the abdomen etc. These are important issues in networking images.
A RIS/Modality interface is a must. The interface must be bidirectional. A bidirectional interface offers the means for the modality to accept information from the RIS for patient demographics etc and allows the modality the path to send information back to the RIS for validation. The information provided would consist of exam start and completion along with total images and where the images are located. Exam location is critical to retrieval speed. When an exam is requested from a workstation other than the original destination, why retrieve from the archive when retrieving from a local station is faster, a RIS is built to handle this logic function with great speed and resource efficiency.
The bi-directional interface of the RIS to modality will work wonders for scheduling and image retrieval. It will eliminate common spelling errors that can occur with printed patient requests, this feature alone can prevent costly time of editing patient files because the data is validated without any manual typing. Without this feature think of the time it will take to correct normal errors in typing patient names for image capture. Without a validation feature exams performed on the same patient have a high risk of winding up in separate files.
The RIS, if instituted properly, can provide an interface to the HIS allowing image access utilizing low cost terminals. The common HIS terminals will need upgraded monitors specifications. They would allow image viewing on the nursing units at a cost lower than the conventional clinical review unit sold by most PACS vendors. Additionally these same terminals can be used for normal patient record retrieval.
COMMUNICATIONS
In most cases the Local Area Network (LAN) will not be of any concern. The only word of caution is not to let anyone tell you the images can be sent over the same network as the Hospital IS. This is not saying that there is no inter-communication because there must be a bridge between the two. The radiology imaging network must function independently of all other networks. The image network can't afford to compete for space on any other information network that will not only slow down but could shut down. There is no such animal as a network that never goes down.
The largest area of concern will be for those hospitals that are part
of a system or have affiliations. In this realm of operations the Wide
Area Network (WAN) is going to be the most problematic. The problems arise
not only from technology but also area availability. The technology is
there, in most cases, but for those facilities in remote areas service
will become a problem. Communications
technology can be segregated into distinct areas of availability, Rural,
Suburban and City. All technology has a price; speed costs money.
ARCHIVING
Archiving is another issue that should be examined closely. The archive must have the functional ability to store all images for a predetermined length of time, most likely the full file retention statute. There are many solutions to image storage. The trick is to have the forethought to choose which technology is best for you now and for the future.
As with most technologies archive
structure and formats change with time.
Last Updated January 24, 1997 by Peter C. Veader