Understanding PACS System Life Cycle and Upgrade Considerations

Embarking upon a PACS system implementation requires a commitment of your time, energy, and finances. For both your current and future needs, it’s important that you get the absolute most from the PACS system you choose. 

No Fork Lift Upgrades
In the world of PACS Systems, a “forklift upgrade” is referred to as the complete removal of the existing system and a replacement of that PACS system with an entirely new one. When evaluating systems, ask if the vendor has separate charges for upgrades and what their estimate is for costs over time. In particular, inquire about customers who have purchased their system six years ago or more and what their costs are today to upgrade.

It’s not uncommon for practices who initially opt for a less expensive PACS System to find that the savings they experienced at the onset, later came back to cost them even more money when it was time for an upgrade. So, to avoid this costly experience of being forced into a forklift upgrade in the future, find a vendor that provides continuous upgrades throughout the time you own your PACS system; find a vendor that offers this ongoing upgrade at a predetermined, agreed-upon cost.

What is the Life Cycle of the PACS System?
A three-year update, refresher, or replacement cycle has become the norm for many onsite PACS Systems. At that stage the hardware could start to fail, reach its “end of life” termination of support, become incompatible with past upgrades, or become incompatible with new IT added since you first configured your local PACS and DICOM server.

The thought of planning, budgeting and spending the time and money to install, configure, update, and upgrade your PACS system every three years may seem overwhelming. There are ways to avoid this. You can choose a vendor that leverages the cloud and puts all of your PACS storage online. You can also purchase only the storage you need for the upcoming year and encapsulate your storage from the PACS server by employing a network attached storage technique.

In addition, cloud-based computing offers a different architecture that can meet today’s PACS system needs. While many current image transfer mechanisms require opening DICOM ports or CD imports and exports, cloud-based-systems provide a standards-based, secure, bi-directional image and communication sharing at the patient, provider, or organizational level.

While eventually some hardware and devices will need to be replaced and/or updated over time, the life cycle of the PACS system can be extended and last for many years beyond this 3-year norm if the software is regularly updated and maintained.

System Compatibility and Modalities?
The PACS system you purchase should be able to interface with current hospital information systems (HIS) and radiology information system (RIS). X-ray plain film (PF), computed tomography (CT), magnetic resonance imagining (MRI), and images from other modalities must be able to be easily stored and accessed in your PACS. So, if you don’t want a completely separate PACS for each of these modalities, then it is important you choose one a system that can handle multiple modalities. Choosing a PACS that supports a wide number of modalities in the healthcare environment enables all the critical reports and information to be obtained instantly.

The ability of smart PACS products to handle a broad range of diverse images from various modalities in an accurate, efficient, and sophisticated way is fast becoming the industry norm. A vendor neutral PACS System will enable diagnostic images and reports from multiple modalities to be stored, managed, updated, and shared. Unlike first-generation PACS that were radiologist-centric, today’s PACS systems are versatile across the various departments and modalities of the healthcare enterprise.

By having a single PACS System that handles all the modalities of your practice you can eliminate the need, and expense, of multiple PACS. This greatly simplifies EMR integration and ease of use for your staff.

Unified Reports and Workflows
Unified reports will streamline your workflow. Creating an organized, efficient, and easy-to-access PACS system complete with unified reports at your fingertips should be the goal. Being able to access the “entire person” from the PACS workstation (and not just the image) is integral to the overall care and well being of the patient. Further, the ability for the system to provide a patient’s reports, data, and images with a single click enables your team to provide better care.

How to Get More from Your PACS System

Embarking upon a PACS system implementation requires a commitment of your time, energy, and finances. For both your current and future needs, it’s important that you get the absolute most from the PACS system you choose.

The key to getting more from your PACS system is finding and selecting the vendor that offers a scalable, user-friendly, compatible, and upgradable solution. You need a partner who can orchestrate the equipment, software, and devices into a useable solution designed for your practice.

Upgrade Considerations
For many years, PACS systems have continued to evolve, change, and improve. These improvements mean that the system you invest in will, over time, become more and more obsolete. Understanding the upgrade path and life span of the PACS System you are reviewing is critical. Some systems include free lifetime upgrades while others require you to purchase an entirely new system. These factors can save or cost you a lot of money over time. Also, regardless of the upgrade costs, you’ll want a system that demand as little maintenance from you personally as possible.

Where PACS Systems Have Been
To understand the future of PACS Systems, it’s good to take a quick look back. The first-generation of PACS Systems were a radiology-centered, thick-client model that exclusively emphasized translating film to digital in a healthcare environment. These systems lacked many of today’s integral components, including: networks, technology, and archives. Individuals who purchased this thick model handled all their advanced imagine processing on a single workstation (essentially a $50,000 desktop computer with expensive and fast computer chips, a lot of memory, and loads of hard disk space). This first-generation PACS was expensive for many reasons, including high hardware costs, a T1 line to run the workstations, and distribution costs for CD’s, messengers, and delivery services. The second-generation PACS system was focused on improving workflow and solved the film-to-digital transition. Instead of being radiology-centric, it became enterprise-centric. Hallmarks of the second-generation PACS were Web-based systems, thin clients, and EMR integration.

Minimize Obsolescence
For the first two generations of PACS systems, the focus was maximizing its investments through maximum efficiency and throughput. Today’s new third-generation PACS systems should require an archive neutral approach that leverages the cloud and emphasizes interoperability among multiple vendor neutral archives. While it’s easy for a PACS system to send current and archived images, clinical context is also needed. Choosing a PACS system that has an unprecedented level of integration with the EMR and other information systems to provide lab values, pathology results, and other critical data is essential. Another element integral to the longevity and functionality of today’s PACS system is a robust business intelligence and analytics.

To keep these latest PACS Systems from becoming obsolete, it is important for you to avoid becoming locked into an obsolete storage strategy, especially since data storage systems can be one of the single greatest expenses for many PACS systems. One emerging solution for this need is online storage. By putting your PACS system storage online, it is both economical and a good protection from obsolescence.

PACS System Reporting – Workflow, Distribution and EMR Integration

In Part 1 of this post we covered report customization, accreditation standards and auto-population of measurements. Here are some additional tips on what to look for from a PACS Reporting System. 

How simple is the workflow?
A PACS System should enhance and improve your ability to diagnose, treat, and manage your patients’ health. The simplicity or complexity of the PACS System you choose should be looked at before purchase to determine how usable the system is. The depth of features should be balanced with how the system helps you streamline and expedite your ability to deliver patient care.

Everything from how many mouse clicks are needed to generate a report to how easy your distribution options are should be weighed when making a decision. As a physician, you want to spend the least amount of time possible clicking through data to get to the specific patient info you need.

What are the distribution options for finalized reports?
There are a variety of options and methods for distributing diagnostic reports on your PACS System. Full-text reports can be sent to referring physicians and other specialists via the appropriate HIPAA-compliant web links or by emailing the full-text report. To protect patient health information, finalized reports that are sent via encrypted email are also in compliance with HIPAA regulations. Typically, a report can be reviewed online by simply logging on to the patient’s file or by going to the URL link. Patient reports can also be viewed and saved in a Portable Document Format (PDF) or a Word processor-compatible format. In addition, finalized reports can be integrated into electronic medical record (EMR) systems and electronic health record (EHR) systems.

How easy is the EMR integration?
The integration and deployment of both PACS and EMR systems into your patient care delivery process provide significant clinical benefits. The higher the integration into your care delivery process, the higher the Return On Investment (ROI) for these systems. Integrating your EMR and PACS System supports interconnected images from patient tests and the report.

It’s important to ask how easy or difficult the integration of your EMR system will be with the PACS Systems you are considering. Some PACS Systems require that patient identification and initial record creation must be accurate at the very onset – with minimal (if any) rework. As a result, this ability to enter the patient data correctly the first time around requires an attention to detail and an exact thoroughness on the part of your staff. Other PACS System providers can do the integration for you to minimize the workload for your staff. It helps to know the level of difficulty and cost when making a decision.

Some common errors when the integration is poorly handled include:

1) If a duplicate patient record is mistakenly created, it can affect your clinical decisions since you may be reviewing only the new (and second) EMR patient record. Without knowing you are actually looking at a duplicate record creation, you could easily miss pre-existing patient records or prior image reviews in your PACS system. It is critical to have all the clinical actions generated for a patient entered in a single visit.

2) A new encounter is added to the wrong patient’s record. This error creates the potential for completely corrupting the clinical decision support process by entering some other patient’s info into the wrong file.

EMR integration can provide tremendous benefits but the method used to link the two, and the level of difficulty to achieve the connection, should factor into your decision on which EMR or PACS System to choose.

How to Create Great Reports with your PACS System

From treatment planning to patient outcomes, accurate reporting is at the center of patient care. Being able to easily create, access, review, and share custom reports in a streamlined manner enables you to spend less time at the computer and more time focused on patient care. Here are the top reporting considerations when looking for a PACS System. 

Are the reports customizable?
The ability to produce high-quality reports, that are completely customizable, is a necessity for any PACS System user. It’s essential for the reports to be accreditation-compliant, comprehensive, and customizable.

The reporting tools within your PACS System should be able to generate custom forms, route them through printers or email, and then systematically log the integral details that will enable you to interpret the data. Reports can be customized for different uses, including identifying discrepancies, test results, and quality control. Having a reporting tool with a file where all your customization takes place makes a potentially time-consuming and frustrating process easy. With the right reporting tools, creating customized, accurate, and user-friendly reports can be easy.

Do the reports meet accreditation standards?
Regardless of PACS System you select, you’ll want to be sure the reports you create and distribute meet accreditation requirements, including: Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) and Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) compliance.

Whether it’s through a single-vendor integrated solution provider or a vendor offering several information-technology-enabled clinical workflow and diagnostic imagining solutions, you’ll want your PACS system to have the functionality of critical results reporting that comply with recent changes in accreditation and billing requirements.

Auto-population of measurements
When selecting your PACS system, you’ll want to inquire if the vendor provides a truly comprehensive approach to data analysis and auto-population of measurements. Some systems only capture and populate DICOM measurements without also providing a complete suite of user-friendly data analysis tools. Reports that are available in a highly-structured report format typically offer data fields that enable you to make various queries.

Reading & Reviewing Images with a PACS System

Considering how you plan to use the images you will be reading and reviewing is a key factor in deciding which PACS System is best for your practice. Is your goal to transform your practice into a filmless environment? Are you seeking to access the highest image quality possible? Are you interested in the most cost effective way to transfer images from a remote setting? By factoring in your intended clinical use of the PACS System and all the possible inherent image quality requirements you require for reading and reviewing patient files, you will be well-equipped to make the best decision.

The right PACS System should provide flexibility and convenience, not only by moving to a completely digital environment, but also by providing software that makes your team more productive.

DICOM Imaging vs. Non-DICOM
A PACS System that utilizes the Digital Imaging and Communication in Medicine, or DICOM, format will provide the highest image quality and the greatest level of flexibility. By acquiring images through this method, you are reading, reviewing, and using the original data that is created at the device level. Ideally, images in the PACS System you choose will be stored in this standard DICOM format. Different PACS Systems have different levels of DICOM support, so do your homework. A PACS provider stating they support DICOM does not guarantee that the vendor operates in strict adherence to this communications standard. With a DICOM standard verified system, the medical images you read and review will be displayable at both the spatial and contrast revolution values with which they were first acquired.

Image Compression Considerations
With so much data entering and stored in the system, certain PACS Systems compress the images to save space and increase speed. This doesn’t necessarily mean that images are compromised, but it should be a consideration. Image compression can be acceptable as long as the diagnostic assessment made as a result of viewing the images is not affected in any way. To ensure this, any compression used must be applied before the radiologist has reviewed the images and data; then, he/she is able to use the native resolutions when reading. Heavy compression should not be applied after the radiology review.

Image Modalities
To avoid the cost and hassle of multiple PACS Systems, you’ll want a PACS System that supports various modalities. The rights PACS System can handle imaging modalities such as nuclear medicine, nuclear cardiology, multi-slice CT, vascular ultrasound, and ECG. Ensuring that you have the connectivity, data encoding/decoding, and clinical protocols in place when making your initial investment will save time, energy, and money in the future.

How a PACS System Helps Your Practice

In Part 1 of this topic we focused on how a PACS System can improve your practice workflow. Here are four additional ways that a PACS System can help your practice.

Provides a central repository for all patient records
The right PACS System will bring all your patient records into a single, searchable and secure repository. Having easy access to all your records is a significant benefit but, you also need to consider how the system you select will connect to other PACS Systems. The right system will allow you to share your records with members of your healthcare group and outside hospital systems as well. To have a truly central repository for all the medical records and images for all your patients, you want a PACS System that will enable access to any image from any system. Additionally, your PACS System can best help your practice if it supports all digital modalities (and their associated data), versus a single modality.

Delivers a standardized method of imaging and reporting
Medical images can be obtained from a wide range of instruments (ultrasound, magnetic resonance, digital radiography, etc.), and from number of different providers (radiology, cardiology, gastroenterology, etc.) Your PACS System should be able to provide a standardized method of imaging and reporting. An easy-to-access method of retrieving, reviewing, and reporting diverse images will significantly increase efficiency throughout your practice and enable you to spend more time with your patients. The time spent trying to access and connect to a variety of image formats is a waste for your practice.

Ensures secure archiving
Diagnostic images and medical data stored in your PACS System should be secure and accessed only by providers that you authorize. Unlike paper folders, which are potentially visible to anyone within reach of the front desk, a digital system should provide password-protected access to 256 bit encrypted data. Strict security safeguards should be in place to protect patient information from unauthorized access, use, error, or loss. The privacy safeguards presented in the Health Information Portability and Accountability Act (HIPAA) should be strictly adhered to in the PACS System you choose. Further, access to HIPAA compliant data can be tracked and recorded for audit purposes. Incorporating a PACS into your practice clearly demonstrates to both your patients and your personnel that you are running a professional and organized practice where patient confidentiality is respected.

Assists with gaining accreditation
It’s no secret that major insurers are starting to require accreditation. With reimbursement being closely linked to those accreditation standards, choosing a PACS System that can maintain and generate reports and assist with gaining proper accreditation will help keep your practice flowing financially.

How a PACS System Can Improve Workflow Efficiency

When making any major purchase, the benefits should outweigh the drawbacks. With more and more medical offices and healthcare facilities across the nation implementing PACS Systems, the question is no longer, “Should I invest in a PACS System for my practice?” but rather, “How can a PACS System best help my particular practice?” 

Improving your workflow should be one of the most pronounced ways that a PACS System will help your practice. Implementing the right PACS System for your practice can help you create a gap-free, service-oriented, and highly efficient medical office environment. Your patients expect an individualized and organized office visit, and the PACS System should help your team guide patients through their experience at your office.

A PACS System should increase workflow efficiency in a number of specific ways:

  • Minimize the amount of time spent searching for all of your patients’ medical records
  • Increasing the expediency and accuracy of your diagnoses
  • Enhance your office’s internal communications capabilities
  • Speed up outside communications with colleagues and specialists.

What to look for in a PACS System

Looking for a PACS System can be a confusing process. There are countless features and benefits that different systems offer and it’s hard to know which one is the right fit for your practice. Below is a list of the top five things to look for in a PACS System when evaluating your options. 

1. Is it user-friendly?
There’s no sense investing time and money in a state-of-the-art system if users are hesitant to embrace it because it seems too complicated or overwhelming. While the whole philosophy behind implementing a PACS is to streamline and expedite obtaining critical patient information, the process involved must be easy to learn and simple to use for practitioners and their team.

2. Is it customizable?
Being able to customize reports to meet your office’s particular needs is a necessary component of your PACS solution. The default report settings that come installed with a PACS System may not always fit each doctor’s particular needs. Choosing software for your PACS that is completely customizable enables you to read and review studies and medical reports the way you want. With customizable software, you are able to choose whichever advanced searching and display modes that are appropriate and convenient for your daily use and access.

3. Is it scalable?
Scalability refers to the ability of the PACS to continue to function well after more patient files are added to it and additional features are utilized to meet your needs. You want a PACS that is readily able to be expanded as time goes on, as internet speed and access increase even further, and your specific medical office needs change and expand. With the continuous advancement of technology, there will always be new options and features of PACS offered as the system continues to become streamlined, affordable, and ever-present in the healthcare field.

4. Is it compatible?
If you don’t want a completely separate, stand-alone PACS for each modality, then it is important you choose one a system that can handle multiple modalities. Choosing a PACS that supports a wide number of modalities in the healthcare environment enables all the critical reports and information to be obtained instantly. Further, the PACS should be able to interface with current hospital information systems (HIS) and radiology information system (RIS). X-ray plain film (PF), computed tomography (CT), magnetic resonance imagining (MRI), and images from other modalities must be able to be easily stored and accessed in your PACS.

5. Is it easily accessible?
Accessibility is a critical factor when evaluating a PACS System. Some PACS are limited to single workstations that are provided by the manufacturer while others are web based and only require a browser. These considerations affect how easy it is for team members to access data within the PACS and how easy the information is to share. Choosing a PACS that supports all modalities in a scalable, web-based application is ideal for many practitioners. Whether you are seeing and caring for your patients in your office or while making rounds in the hospital, having the ability to instantly access their individualized information (digital images, clinical photographs, reports, findings, blood work, test results, colleagues’ notes, and any/all other pertinent information on file) with just a few clicks of a keyboard helps streamline and improve the whole healthcare process for all involved parties, including (and most importantly) the individual patient. Choosing software that gives you access to each of your patients in their own electronic portfolios empowers you to remain on top of their healthcare plan of action and provide the best, individualized care and attention to each of them.