The big question: Where is deconstructed PACS going?

February 06, 2017
From the January 2017 issue of HealthCare Business News magazine
There are some powerful arguments for the deconstructed PACS model. The true vendor-neutral archive is a far better data management solution than the “archive” component of the turnkey PACS. The VNA can assure data compatibility between disparate PACS. It can support a very sophisticated user-defined information life cycle management strategy. Its cost can be amortized over multiple imaging departments. Most importantly, the better VNA packages included access to the file structure and database schema, making it possible for the customer to basically eliminate an expensive migration from one VNA to another by simply migrating the database directory to the new VNA and pointing it to the image data on the existing storage solutions.

The deconstructed PACS strategy allows for the integration of specialized diagnostic applications with the VNA. This flexibility to choose the most appropriate diagnostic display applications presents a better solution for sophisticated radiology departments that might want one diagnostic application for general radiology, another specific to mammography, another special application for nuclear medicine, and perhaps a fourth for advanced ultrasound. The deconstructed PACS strategy provides more choices for optimizing the clinical display application, the one that will image-enable the EMR. Rather than being strictly radiology-centric, the clinical viewer could support radiology, cardiology and DICOM as well as non-DICOM native data object formats.

The deconstructed PACS strategy also allows for a greater choice for the workflow/ worklist component of the PACS. In addition to a richer set of features and functions, an enterprise workflow application could support inpatient-context access to relevant clinical data known to the EMR, like the structured data being managed by the enterprise content management solution, DICOM studies from other PACS or image data repositories, and non-DICOM images captured by mobile devices and outside images forwarded through image sharing solutions.

There are several negatives to the deconstructed PACS model. First and foremost, the deconstructed PACS “system” is composed of multiple pieces of technology (software applications) developed by and supported by different vendors. These independent pieces require sophisticated and optimized interfaces to support their integration into a functional and highly performant system. The independent components each have their own remote system monitoring dashboards, making it difficult to troubleshoot. For these reasons, a deconstructed PACS model requires a sophisticated IT department with deep experience in project management, help desk and system monitoring. Lastly, the deconstructed PACS model almost always requires a significantly larger investment than a comparably configured turnkey PACS solution.

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