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PACS and opinions: What to consider when upgrading a PACS

by Lisa Chamoff, Contributing Reporter | February 11, 2019
Health IT PACS / Enterprise Imaging
From the January/February 2019 issue of HealthCare Business News magazine


It is important for healthcare organizations to consider the big picture of image sharing and viewing, according to Michael Gray, a consultant specializing in the digital management and distribution of medical image data, and decide whether or not they are ready to migrate to an enterprise viewing and archiving system.

For Gray, the challenge is analogous to being able to see the “forest from the trees” in the sense that if you don’t see the big picture it’s hard to invest in the right components.

If deploying an enterprise imaging system, facilities also must assess whether or not the components that will be supplied by the EHR are acceptable, according to Dennison.

“What if the reading worklist is incapable of providing advanced features?” Dennison said. “It’s not so much a technical incompatibility. It’s more about the parts that radiology users will be using – does it work and does it work well? If not, how are we going to mitigate it? Are we going to use third-party software?”

For example, a community hospital may have more general radiologists, while a larger health organization will often employ more subspecialty radiologists that require a specialized workflow.

“Some organizations take a lot of time to define their worklists very specifically,” Dennison said. “Often, two or more rads will share a worklist. If the reading worklist logic isn’t very sophisticated, it requires a person, like a radiology coordinator, to manually assign cases. Radiology needs to be engaged in the decision about the reading worklist application that will be used, or risk getting whatever IT thinks is best.”

Dr. Eliot Siegel, chief of radiology and nuclear medicine for the Veterans Affairs Maryland Healthcare System, said that while it’s critical that IT is part of the team that makes the decision on the PACS and archive system, it’s equally important that radiologists, who have important training, be involved in decisions regarding medical imaging.

Radiologists need to consider computer monitors and brightness, and also how peer review – in which radiologists judge each other’s interpretations – is done.

“It’s imperative that a new PACS system be able to do that,” Siegel said.

This means that while radiology departments may take a back seat to IT, they still need to help navigate the decision.

“For many years, radiology would buy their own systems,” Dennison said. “Now, when components are supplied by the EHR, they’re not going to the vendor. I’ve seen radiologists who are a little too trusting that the right thing will happen, and it doesn’t. You’re relying on other groups for your success.”

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