Schooler also points to the additional challenge of storing and retrieving images. Each PACS has its own short-term storage capacity, and in order for the EMR to retrieve archived images, it has been necessary to install a long-term, common-platform storage solution on the back-end. On top of that, Schooler notes that Orlando Health is working with Symantic to ultimately roll out a cloud-based PACS image storage solution. “You're going to see a lot of imaging going to the cloud,” he says.
And while Schooler acknowledges that Orlando Health has been able to build bridges between different PACS platforms, he states: “As people like me find options that are integrated, you'll see us buying that integrated solution.”
NECESSITY: THE MOTHER OF INVENTION
Sometimes, specific needs lead to innovation around integration and interoperability. The University of Pittsburgh Medical Center (UPMC) health system, for example, needed to accommodate multiple, diverse PACS solutions, leading the organization to develop a unique solution. With 20 hospitals, 30 imaging centers and a total of about two million imaging exams per year, UPMC uses PACS from FUJIFILM, Siemens, and GE Healthcare. But it relies mainly on Philips, says Rasu Shrestha, M.D., vice president of medical information technology and a member of the KLAS advisory board. “The PACS solution we have here is different from the vanilla iSite solution.”
As a recognized innovator in healthcare IT, UPMC had already developed its own PACS, called Stentor, which was subsequently acquired by Philips and rolled into its iSite product.
What was still needed was a way to bridge different PACS platforms, to make all images available across the entire enterprise, and eliminate duplicate tests. Two years ago, UPMC developed a solution called SingleView to address that need.
In explaining the philosophy behind SingleView, Shrestha says, “A lot of PACS vendors are still focused on a silo approach. But they're missing the point. It should not be about PACS or RIS. It's not about an application. It's about the clinical workspace. SingleView is our imaging interoperability platform that bridges the silos.” One of the unique features of SingleView is that it provides instantaneous access to a patient's previous imaging studies and reports, regardless of the department or origin, he says.
As a radiologist, Shrestha knows the importance of having access to previous images and reports, but his emphasis on the clinical workspace goes beyond PACS. “What we're trying to achieve is treating the patient as a whole-a more holistic approach. I want relevant, actionable and contextual information at the point-of-care. SingleView creates a more patient-centric view of imaging. It gives us, at the point-of-care, all the imaging history of that patient,” he says.
DECISION-MAKING OPTIONS
The decision to purchase or upgrade a clinical system like PACS requires buy-in from a number of stakeholders, not least the physicians who demand a system that works best for them. “This is not a CIO decision,” says Schooler of Orlando Health. “It's a collaborative process.” For those contemplating purchasing their first PACS, or replacing an existing system, Schooler's advice is simple: “You have to get ready to operate on multiple platforms. But if you can buy an integrated platform, why would you buy multiple platforms?”
Adds Shrestha: First-time or replacement purchasers need to spend a lot of time reviewing PACS solutions in their entirety and speak with other customers of the vendors they are considering. “Look under the sheets,” he said. “How future-proof is the vendor? Look for vendors that aren't afraid to embrace industry standards-not just develop a proprietary system.
“And analyze your workflow,” he says. “Make sure the PACS you choose will fit your workflow.”
Richard R. Rogoski is a freelance writer based in Durham, N.C. Healthcare Informatics 2011 September;28(9):28-30
