Multisite PACS raises new issues

The difference in planning a simple, single-site PACS and a complex, multisite, wide area PACS is more than just one of scale.

"There is a major difference between a vertical (single-site) PACS and a horizontal (multisite) PACS implementation," said Gary Reed, president of Integration Resources in Lebanon, NJ.

In a multisite PACS, resources are spread out and not necessarily centralized in one hospital. Because more detail in planning and training is therefore necessary, the formation of a well-organized PACS committee is essential.

Reed cites several factors to consider when planning a multisite PACS:

• Network infrastructure. A fully redundant, fault tolerance network capable of supporting a functional PACS is by definition complex and expensive.
  
• Archives. Archives must be in separate buildings, and the network should be redundant with separate points of entry at each location. It might be best to have different network providers in case of carrier failure.
  
• RIS interface. Questions to answer include, Is there one RIS operating on the enterprise network supporting all locations? Is there a single patient identifier for all locations? Does the entity have the network and software support to maintain the system over a wide area?
  
• Film digitizers. Most multisite imaging centers use a central film archive and courier film around daily. When PACS is introduced, getting film images on the PACS may require additional film digitizers and workstations at the archive.
  
• Vendors. Not every PACS vendor has implemented a wide area PACS. Most PACS offerings will not support wide area workflow. Vendors must demonstrate where they have successfully implemented a wide area PACS and where they have interfaced to the specific RIS.
  

In-house support capabilities must also be assessed.

"If the technical support is not sufficient, then either hire additional personal or outsource services," Reed said.

It is also important to devise a well-defined set of functional specifications. The vendor must guarantee attaining these specifications.

"One of the key benefits to a multicenter PACS is the ability to perform workload balancing and subspecialty reading," Reed said. "This requires some very specific workflow capabilities not found in a vertical hospital system."

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