Maybe you shouldn't buy a PACS

July 18, 2002

First, a confession. I love PACS. I believe that implemented correctly, PACS can be a panacea to radiology. PACS is an enabler of great change to improve the delivery of services by radiology. At the same time, it is no guarantee. PACS represents change,

First, a confession. I love PACS. I believe that implemented correctly, PACS can be a panacea to radiology. PACS is an enabler of great change to improve the delivery of services by radiology. At the same time, it is no guarantee. PACS represents change, and any change involves risk. Perhaps for that very reason, I can't stand to see a poor PACS implementation due to a misunderstanding of that risk.

I have compiled a list of conditions that should give you pause before you purchase a PACS. I hope the list will stimulate thought into what expectations and assumptions you have before jumping in. I think vendors should feel the same way I do. If you don't know what you are getting into and don't have the right expectations, you are setting up the vendors to look bad.

If you think PACS is just another modality, please don't buy a PACS. PACS has tentacles that reach out to every modality as well as the radiology information system, the dictation system, and the hospital information system. PACS is an information system, not a modality, and it requires the planning and forethought of one. PACS is a foundation technology that all your modalities will build on.

If IS and radiology aren't on speaking terms, don't buy a PACS. PACS breaks through the organizational boundaries of IS and radiology, and both have a legitimate right to be owners of the technology, but neither can be the dictator. An overly radiology-centric PACS will likely be an island that serves only the needs of radiology. An IS-centric PACS might not listen carefully to the voice of the customer and understand the ramifications of PACS on workflow. It's not a question of which, you simply need both teams at the table vested in the success of the PACS.

If you are a traditionalist, don't buy a PACS. The diffusion of technology in an industry typically follows phases: First innovators jump into an unproven technology. Then as it matures, early adopters and, finally, the majority get involved. The last person to the party is the traditionalist. A traditionalist is someone who is completely risk averse and will not try anything newfangled until everyone else on the block has proven it to be successful. PACS is somewhere in the 10% to 15% penetration range in the U.S. healthcare market and is in the early majority phase. Only a handful of the hospitals that have gone digital have been able to get rid of most of the film throughout the enterprise.

If you don't think PACS takes a team to support and implement it, don't buy a PACS. The common denominator for the successful PACS sites that I have witnessed has been a team that championed it, a strong leadership team with good influencing skills and an understanding of workflow in and outside of radiology. A team that can work with physicians and understand what it takes to get their acceptance makes the difference. Vendors and consultants simply cannot replace a good team in providing the necessary leadership to get people to let go of film.

You might have noticed that I didn't cite cost as a reason not to get into PACS. Not only can PACS be cost-effective, but it should be. My only caveat is that you should look beyond the outright costs of film and also account for the productivity gains in radiology.

The bottom line is that if you want to get into PACS and feel the pressure to modernize your service, you need to do your homework and be an educated consumer. For those who are willing to implement PACS right and enter the information age with both feet, welcome to the party.

Dr. Nagy operates Club PACS - http://radtutor.mcw.edu/clubpacs/ , a Web-based source of PACS information.