PACS showdown proves a winner without having one

The first-ever PACS showdown had many highlights, not the least of which was the sheer technical accomplishments needed to pull it off. What it won't have is the public announcement of an official winner.

The showdown at the Society of Computed Body Tomography and Magnetic Resonance meeting in April involved six vendors: Agfa Healthcare, Amicas, Fuji, GE Healthcare, McKesson Provider Technologies, and Philips Medical Systems. Some vendors expressed apprehension about publicizing the outcome; others welcomed it.

"The society asked us if we wanted the results released and we said yes," said Barry Gutwillig, executive director of marketing and business development for Amicas. "We wouldn't be here if we didn't feel we could rank. It's a testament to the six vendors who are here, and maybe more so to the ones who are not here."

The vendors with more sensitive concerns, however, won this debate. To ensure a healthy participation at the next showdown, the SCBT/MR will not publish how the audience ranked each vendor.

The vendors may have a valid concern. In one demonstration, for example, the range of "excellent" rankings for each vendor went from 13% to 53%. This variable pattern remained consistent with all three tests. Workflow function, like beauty, is in the eye of the beholder.

While no clear winner emerged for Dr. Richard Hallett, a cardiovascular radiologist at Riverview Hospital in Indiana, when pressed he selected McKesson, Agfa, and Fuji as his first-, second-, and third-place favorites, respectively.

"I realize this showdown is a small fraction of everything PACS entails, but just by the demo cases and radiologist interaction, I got a good feel for how user-friendly and robust the interfaces are," Hallett said.

Dr. Dennis Foley, chief of digital imaging at the Medical College of Wisconsin, said that Philips, McKesson, and Fuji performed reasonably well in handling large data sets and managing relatively routine daily work. None of these companies, however, had well-integrated 3D solutions in their packages, he said. His nod went to GE for its hanging protocols, exam comparison, access to prior reports, and recovery time from interruption.

An electronic survey of the audience of about 150 attendees revealed that two-thirds have a PACS. Slightly more than half of these respondents own one system, while the remainder own two or three. Surprisingly, 64% of the PACS owners are dissatisfied with their systems, and 32% will be shopping for a new one within the next year. Two-thirds of all respondents read CT studies on PACS, while 22% use stand-alone workstations capable of advanced 3D reconstructions. Another 42% are shopping for stand-alone advanced workstations to interpret CT.

"How PACS integrates advanced imaging is a hot and rapidly changing process," said Dr. Eliot Siegel, chief of radiology and nuclear medicine at the VA Maryland Health Care System and comoderator of the event. "It's fascinating that the PACS vendors are embedding multiplanar capabilities into their products in addition to integrating with stand-alone 3D and advanced workstations."

Whether PACS or stand-alone workstations will eventually do the bulk of advanced imaging is not yet clear, Siegel said, calling it an interesting tug of war.

More than a few attendees, while happy with their PACS, were surprised to find their system was capable of performing at a much higher level. Attendees also seemed to cherry-pick certain functions in the different scenarios. One liked the way the mouse moved for GE in a certain exercise; someone commented on the Philips' color scheme for a particular window; another was partial to the seemingly infinite number of allowable open windows on the Amicas system. The personalities of the demonstrators also influenced opinions, as a radiologist described one as very efficient and another as too humorous.

As radiology increasingly depends on PACS, however, the focus of the competition should move away from counting clicks and toward assessing workflow efficiency, Gutwillig said. Variability among vendors is decreasing. All showdown participants could perform each of the tests.

"The question now is about the 'C' in PACS - the communication. It's not the people or the pictures. It's about how workflow is distributed," Gutwillig said. "We talked about all the tools, but how do those tools translate into productivity? How does productivity across your entire department or practice come into play as well? It can't be answered in this kind of scenario, but they are very interesting questions to ask."