Cutting Edge Issues
Internet-Enhanced Physician Practices

Deploying a PACS: Issues to consider

Application Service Provider PACS: Analyzing Costs of Service

eHealth:
Towards A New World of Communications in Medicine

Case Study Zone
St Paul Radiology Goes Filmless

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Mission Statement
Customer Base
Partnerships
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Support Services

Application Service Provider PACS: Analyzing Costs of Service

Part 4

The display subsystem is the second component; it includes all the required display stations, diagnostic reading stations, high-capacity and low-capacity clinical review stations, and technologist stations. The third (reporting) subsystem includes all of the hardware and software components required to convert the transcription-based reporting system into a voice-recognition reporting system. The network, or fourth, subsystem includes all of the hardware, software, and services required to design and deploy the WANs and local area networks. The fifth subsystem is a miscellaneous one that includes such necessities as film scanners, hospital information system (HIS)/radiology information system (RIS) gateways, HIS/RIS software interfaces, and DICOM modality licenses. A summary of the component count and average list prices associated with each of first five subsystems is presented in Table 2.

The sixth and most important subsystem in this model is the server subsystem. The typical ASP focuses on the server applications; therefore, this subsystem is the key to understanding the business worthiness of the program. It is possible to include virtually any PACS component in a fee-for-study finance program, and many of the ASP programs can include all of the on-site components in the per-study fee. The purpose of this modeling exercise, however, is to focus on the ASP components that provide PACS applications from a remote service center. Most ASP programs have not yet proposed remote hosting of display functions (other than web viewing), nor have they proposed replacing components from the acquisition, network, and miscellaneous subsystems. If it is also assumed that remotely hosted transcription services are not included, the only components of the traditional PACS that the ASP program is supposedly replacing are those in the server subsystem. The important question then becomes which components of the server subsystem will stay in the imaging department and which will be removed to the remote service center.

The PACS server subsystem includes a number of components or applications: the database server, the image data server, the archive server, the archival media server, the work flow server, and the web server. While almost every PACS provides these individual applications, there is considerable variation among vendors as to how and where these applications are supported in hardware.