NovaRad Corporation doesn't charge per click either. "If [customers] don't want to purchase [NovaPACS] up front because they are small hospitals and can't come up with the money, we will give them a subscription-based model where they pay for the software on a monthly basis based on their image load but [the cost] doesn't change," says Vice President Paul Shumway.

Some trends to watch in the PACS markets include ongoing mergers of RIS and health IT vendors with PACS companies so that they can offer integrated solutions. The key here is that the promise of PACS to improve productivity depends on how well it works with other databases to truly speed workflow. Other hot technologies include 3-D visualization platforms and virtual reading environments in which radiology groups read for multiple facilities, supported by the teleradiology capability of PACS.


"When people think of PACS, the first thing they think about is the image on a monitor but any company can do that-you can download a free viewer off the internet. That's the easy part," says Lenny Reznick, Director of Enterprise Image and Information Systems, Agfa HealthCare. "It's really the integration and how you fit into the workflow of the surroundings which makes it difficult and that's what separates Agfa from some of the other companies." Agfa's IMPAX integrates advanced 3-D visualization software from third parties such as TeraRecon for high-end university hospitals. Agfa also offers its own visualization products to smaller hospitals. "One of the biggest differentiations we have in our PACS product line is integration flexibility. We know we need to integrate with RIS, HIS and EMR but it doesn't stop there. It's advanced 3D visualization, desktop integration, dictation and voice recognition systems, and critical test results management systems."

Words to the Wise

To navigate the intricate PACS market isn't easy. Last year's meeting of the Radiological Society of North America included 138 PACS exhibitors.

"It's a jungle out there and you have to be careful. There are a lot of products, some are good, some not so good," says Mike Bushior, Owner, Advanced Medical XRay, Somers, CT. He suggests going with a company with local representatives who will be there when you need support. And don't forget training. "Everybody talks about the IT person and that's important, but you really need a good applications person that knows the imaging side not just the IT side," Bushior says.

At the risk of oversimplifying, industry experts have told DOTmed that many of the technical aspects of PACS are similar from one high-tech product to another. As a result, important distinctions that affect the buying decision include the level of integration with current RIS and HIS systems, the vendor's ability to map and migrate old images to the new system, and after-sales support, among other finer points.

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