Impact of PACS on patient outcomes remains unknown

The well-known benefits of PACS have been documented: increased radiologist productivity, no lost films, and reduced material and labor costs.

While productivity and economic advantages are easily measured, pinpointing the impact of PACS on patient outcomes remains an elusive target.

"It's not clear how PACS improves patient care at this point," said Douglas Orr, president of J&M Group, a healthcare consulting firm in Connecticut. "It's nice you have PACS, but what does that mean to me as a patient? Other than physicians or radiologists being more efficient in getting access to information, where has it improved outcomes?"

In a standard course of patient diagnosis, it may take from two weeks to a month to go through the series of necessary tests, Orr said. First, you have to get an appointment at the modality, which may take several days, then it's a day later before the results are available so your physician can decide what to do next.

"If you have to schedule another test, that's another two-day wait," Orr said. "You go through three or four iterations of this, and you're already two or three weeks into a disease. PACS isn't the solution for speeding up time to diagnose and time to treat."

Some radiologists agree.

"There have not been good studies to show PACS improves patient outcomes or that length of stay is reduced," said Dr. Steven Horii, associate director of the medical informatics group at the University of Pennsylvania Medical Center. "It may eventually be possible to show an improvement in outcomes, but it may be moot -- the shift to PACS seems to be happening whether or not there is conclusive evidence these systems are cost-effective."

Designing a convincing study would be very difficult and possibly unethical, said Dr. Paul Chang, director of the division of radiology informatics at the University of Pittsburgh Medical Center.

Horii cited two reasons for believing patient outcomes (time to definitive diagnosis and treatment) can be improved:

• Time from an examination request until results are available has been reduced. "We, and other PACS research groups, have shown this rather conclusively," Horii said. "Whether that has an effect on patient care is still debated. We found, for example, that faster availability of images and reports did not shorten the time between requesting the study and the requesting physician reviewing the results."

• Radiologists have reliable, fast access to prior examinations. "Most of us believe we do a better job if we can see the prior studies when we interpret new ones," Horii said. "With film, this was often skipped (the infamous 'films not available for comparison at this time' phrase in reports) if the films were not readily found."

Positive effects of PACS on patient outcomes can already be seen in emergency departments, intensive care units, and operating rooms, Horii said, but PACS is just part of the picture, according to Chang.

"If we are to truly improve patient outcomes, radiologists have to be willing to reengineer ourselves to fully embrace and exploit this technology to provide added (and more timely) value," he said.

So far, according to Orr, PACS is merely a mail system, a means of delivering images from one site to another. And in order to change that, radiologists need to make patient outcomes an objective.

"PACS still has a step to go before becoming a force to reshape diagnostic and patient care protocol," he said. "It won't happen by itself."