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Deploying a PACS: Issues to consider

Application Service Provider PACS: Analyzing Costs of Service

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Towards A New World of Communications in Medicine

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St Paul Radiology Goes Filmless

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Deploying a Picture Archiving and Communications System

Part 3

Radiology Information Issues

A PACS is not going to provide the benefits expected of it, such as operational efficiencies and automated image distribution, without a radiology information system (RIS). This is not subject to debate. In most cases, it is possible to make do with the currently installed RIS or radiology module of a hospital information system (HIS) vendor (depending on the revision level) once PACS implementation begins. Some of the functional features that the PACS is capable of may be unavailable, but through the use of a gateway, which is sometimes called a broker, the integration of the RIS and PACS can make the whole system functional.

A case can easily be made for the deployment of a RIS made by one of the freestanding RIS vendors if the institution is also going to deploy PACS. Most radiology modules marketed by HIS vendors are not easy to integrate, and they provide minimal functionality for PACS environments. Much of this is due to the fact that they were developed with the thought that radiology was an additional function that they could handle. RIS vendors, in contrast, consider radiology to be their area of expertise and understand its functions and its performance requirements very well. This enables the RIS vendors to meet the integration demands of a PACS environment adequately. Being heard more often from executive committees today is the idea that spending money on a PACS might as well be accompanied by the acquisition of a RIS.

Moving forward without a RIS minimizes the benefit of the PACS investment. An intensive care unit (ICU) or emergency department (ED) can go filmless while the radiology department continues to print images for interpretation. There is still a benefit to be achieved, in both cases. The ICU will benefit from having images available almost immediately, the films are less likely to be lost, and it will be possible to integrate the reports with the images. In the ED, a similar situation will be experienced. The films will be available immediately, and the ED physician can discuss the case by telephone with a radiologist who is in the radiology department or at home on call.

Going much further without a RIS is almost pointless. The recent introduction of the modality worklist management feature of the DICOM 3.0 standard has had a significant impact on productivity. With the even more recent performed procedure step and archive commitment, PACS has taken a much larger step in cost justification and in expected increases in productivity.