The big question: Where is deconstructed PACS going?

February 06, 2017
From the January 2017 issue of HealthCare Business News magazine

PACS vendors’ reactions
The vendors that were still offering the traditional, turnkey PACS solutions that notably featured decade-old infrastructure and fat client diagnostic displays were understandably “cool” to the concept of deconstructed PACS. Their initial counter strategy was negative selling, focusing on one or more of the negatives listed above. During the past two years, while that negative selling strategy was failing with some of the large IDNs that chose the deconstructed PACS route, many of the turnkey PACS vendors were executing their technology catch-up programs.

Their first step was the seemingly overnight conversion of their PACS archive into a VNA. The second step was replacing their fat client clinical viewer with either an in-house or OEM-supplied version of the zero-client universal viewer. Several spent the time to develop an improved workflow/worklist application. As of RSNA 2016, at least one of these vendors has replaced the old fat client diagnostic display application with a zero-client, server-side rendering, pixel-streaming diagnostic display application.

In addition to these upgrades to their software application stack, many of the turnkey PACS vendors have made the effort to optimize the interfaces that would allow more efficient connectivity to both their own individual applications and those offered by other display and VNA vendors. In two-plus years, many of the turnkey PACS vendors were back to being competitive with upgraded applications that fit nicely in a deconstructed PACS model, or a mostly new and improved turnkey PACS (if the customer didn’t mind waiting another year for the complete system upgrade to be completed).

Best-of-breed component vendor reactions
The vendors promoting the deconstructed PACS strategy had to foresee the difficulties they would soon face in selling a (relatively) expensive, multi-piece, multi-vendor solution to health care systems that did not have the requisite IT staff or financial resources. As indicated in Geoffrey Moore’s Technology Adoption curve, there are significant differences between the innovators/early adopters and the early majority/late majority.

The former groups are more inclined to take reasonable risk and are willing to pay a premium for the technology they feel they need. The latter groups are much less likely to take any significant risk, and they generally do not want to pay for technology they know they do not really need. Faced with this potentially gloomy forecast, the deconstructed PACS vendors went to work expanding their offerings. The vendors that offered universal clinical display applications went about adding features and functions that one would expect to find in a diagnostic display application, including hanging protocols, 3-D rendering and fusion capabilities and the ability to handle digital breast tomosynthesis image studies.

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