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Goldilocks and the three PACS

February 17, 2020
Health IT PACS / Enterprise Imaging
From the January/February 2020 issue of HealthCare Business News magazine

By Mike Cannavo

With better than 95 percent of all facilities in the U.S. having PACS, navigating the vendor pitches can be a challenge.
The PACS market today almost exclusively deals with either a hardware and software upgrade of an existing vendor or an outright replacement or consolidation, where multiple PACS from different vendors are bundled into a single solution. These can be from either one of the incumbent PACS or an outside vendor. This excludes the inclusion of third party applications like AI (artificial intelligence), digital tomography, 3D reconstruction, and other areas.

Features and value propositions that make certain solutions a better fit than others are often determined by whose system the group is used to reading from and what other PACS they are familiar with. With the possible integration of artificial intelligence (AI) aside, most PACS simply try and emulate features that are found on other PACS that have been very well accepted. This makes the decision of a replacement PACS even more challenging. When you put several PACS side-by-side one system seems to morph into another. One vendor may provide a few extra features but often end users forget to ask how important these are in the day-to-day readying process and how they impact workflow. Three-dimensional (3D) reconstruction is used by many but how this is implemented impacts the individuals doing the reconstruction. Does the radiologist want to do the 3D themselves or have it sent over to them already processed? If they do it themselves they need to understand that it may slow down their reading process, costing them time and money. If the tech has to do the reconstruction it may lead to fewer studies being done over the course of a day and negatively impact both tech productivity and hospital profitability. The same can be said with just about any software application used. It’s all about finding the right balance.

A radiologist using a PACS needs to be like a carpenter. The tools you use most frequently should be on your tool belt and available within reach at all times. Others need to be available in the truck and easily accessible. The last group, the ones used sporadically if at all, should be back at the shop where they can be selected as/when needed.

A PACS end-of-life is typically six to seven years after it is first put in service, although many systems are used longer. This is up from years past where five years was the norm when a PACS would be replaced. PACS need to last longer and provide more years of service because there often isn’t money in the budget to replace an existing PACS. Sometimes a simple upgrade to the existing system will buy an extra year or two before a PACS can be fit into the budget. Additionally buying a new PACS isn’t like buying a new car. Data and databases need to be migrated, networks may need to be upgraded, hardware and software may need to be replaced, and other areas need to be considered. This impacts not just the baseline PACS but also ancillary and third party applications that may be running concurrently on the workstation. We are seeing this now as Windows 7 hits its end-of-life (EOL) early next year, and the migration to Windows 10 requires upgrades for many of the other applications running on the workstations. Some of these simply require software updates and upgrades that may be done for free, while others have unanticipated costs attached to upgrading them. Using the car analogy, it’s like budgeting $X for the car then finding out you need different tires and suspension and an options package that has options you probably will never use but it’s the only way you can get the one application you had before and both liked and used extensively. Welcome to the world of PACS. Upgrades are the same way. For every one new feature you get, the chance that you will lose a feature you enjoyed is actually quite good. That is why few sites implement every software upgrade when it becomes available. Not only is the software often not completely stable despite all the testing it goes through before it is released, but you tend to lose things you really liked.

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