PACS is at the center of the patient information challenge. Accessing patient information and managing images from across the many silos of data held by the different “ologies” within the healthcare enterprise is a daunting task. Once accessed, matching the right viewer with the right user further challenges the situation. The viewing needs of clinicians vary based on their specialty—more advanced for diagnosticians and more straightforward for others.

Managing patient information must meet legal and regulatory retention requirements and these rules can change over time. Lifecycle management of data is coming of age as patient information is being stored on systems never scaled or designed for the volumes generated and managed today. As the healthcare enterprise grows, it becomes distributed and more complex with multi‐sites and multi‐PACS and multi‐vendor PACS.

As patient information is dispersed across multiple departmental PACS, each individual department’s workflow contains patient information unique to that department. Awareness of the need outside the department is not fully appreciated resulting in image knowledge remaining within the department. Specific problems with PACS archives include: 

• PACS own the data
• PACS utilize proprietary formats and DICOM header tags and values
• PACS are marginally DICOM-compliant:
  • Collaboration is difficult
  • Presentation states and notes are not compatible among systems
• It is difficult and expensive to share storage with PACS:
  • Media choice is limited
  • PACS data is managed in silos
• It is difficult to share imaging between cardiology, radiology and other departments with PACS
• Data flow is a bottleneck through PACS
  • EMR, modalities and other PACS integrations
  • Data must flow through PACS
• Data migration is required for:
  • PACS replacements
  • Infrastructure changes (media)
  • PACS upgrades
• Infrastructure interoperability is difficult with PACS
  • Progress is slow and there are no plans to leverage newer storage technologies
• PACS offer no support for clinical ILM policies, tiering, retention and deletion
• PACS have performance, management and scalability issues
• No solution for non-DICOM content

Meeting the Challenge Head-on

As most PACS vendors with proprietary solutions do not offer access to the latest innovations in standards such as DICOM, IHE and HL7, innovation is the first step to addressing the challenge. PACS vendors have developed a solution to the departmental image management and storage problem but the problem has changed.

Healthcare organizations face the consequences of departmental PACS as they acknowledge business cannot be done the same anymore, at least not where patient imaging is concerned. The realization that storage is enterprise focused means departmental silos for radiology, cardiology, pathology, OB‐GYN and non-DICOM content are going away.

Replacing PACS, storage media or upgrades require data migration. Most PACS don’t leverage newer grid and storage technologies, or include clinical information lifecycle management (ILM) policies for tiering, retention or deletion. With the need to share image data with the hospital’s EMR, it is difficult and expensive for most legacy PACS to pull this off.