"Those that are web based are more successful in the market. Those that are not are trying to morph their product to be web-based because of the benefit it gives users, or they are acquiring companies [that have a web product]," suggests Morgan.

Some say that the internet is slower and raises concerns over possible service interruption, along with higher costs. The degree to which you'll need to share images with referring physicians and other radiologists will dictate configuration. The internet affords easy access by radiologists reading remotely with privacy compliance and encryption fully secured. Referring physicians are readily put in the loop, too. "That's a very big business benefit," stresses Mahler. "Referring physicians will send more patients if they get results quickly."





Of course pricing is the other critical consideration. It's not possible to estimate how much a PACS system will cost without factoring in the provider's scale in terms of number of clinicians, administrators, workstations, modalities, imaging studies, etc. Simple "PACS in a box" solutions can cost in the $10,000 to $200,000 range and are available and affordable for small healthcare providers.

For example, ADDIS Systems (Associated Direct Digital Imaging Systems), Natick, MA, makes a standalone mini DR/PACS combo. It's a software and hardware acquisition and storage package perfect for individual practitioners. The product, priced up to $35,000, can go "anyplace where they can put an upright bucky or mounted detector," according to President Edward Small.

Inclusive turnkey RIS/PACS solutions with hardware including servers, and software including dictation can run from $200,000 into the millions. However, the pricing structure is typically quite simple since many PACS systems are priced by the study, known as "price per click."

One company that has bucked the price-per-click trend is NCS DataCom, Inc., an online PACS solution provider focused on small- to medium-sized imaging centers, small hospitals and radiology practice groups. Their offering is called perfectPACS. "This is priced at a flat rate per system access, facility, modality and reading physician. So it's not a per-click solution. It's doesn't get more expensive if the client gets more successful," says Jeff McConocha, Chief Technology Officer for the Cleveland, OH company. "Most of the other [PACS providers] charge per study. That's considered a 'per click' because every time you do work, you pay for it. We have discovered that a lot of people in this marketplace would like to have more budgetable cost control." Merely increasing the number of studies does not add cost in the NCS plan, which was designed by a radiologist. The costs would increase only if a customer added a facility or access point that the company would need to manage.

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