Month: April 2009

Federal Stimulus Funding for Health IT will drive adoption of PACS-Neutral Archives

A post on AuntMinnie’s PACS Forum on April 21 posed the question “Will EHR impact PACS?”.  A number of the regulars on this forum, including myself have posted their opinions.  I find it interesting to see a number of individuals suggesting that the Electronic Health Record (EHR) will morph into some kind of Super PACS supporting Radiology, Cardiology, etc. and featuring a universal viewer.

Last time I checked, the major PACS vendors were still having difficulty integrating their own Radiology and Cardiology PACS into the same platform, so I don’t hold out much hope for these PACS solutions suddenly becoming EHR systems, nor do I believe the EHR vendors are going to burden their development schedules with the effort it would take to add Radiology and Cardiology data management and display applications to their systems.

PACS will continue to focus on the individual imaging departments work flow and diagnostic applications, and EHR will continue to focus on aggregating all sorts of clinical information required to manage a patient’s course of treatment or general healthcare.  I realize that all this stimulus money targeted at EHR usage will “stimulate” the market, but I don’t think there is enough time for any of the vendors of any of these systems to reinvent their wheels.  The fastest route to market is to simply sell what already exists.

EHR systems have historically deferred to the PACS for the image management and the clinical review applications.  A relatively simple interface, currently based on a URL call, retrieves the image data referenced in the EHR listing and activates the corresponding PACS display application to display the images.  This model has been working just fine for some time now, with Radiology PACS being the principal data management system.

Unfortunately, as additional department PACS are deployed, each additional PACS would require its own URL interface to the EHR.  Multiple interfaces mean individual, separate viewing sessions based on individual separate display applications. The physicians would have to learn to use separate and different display applications. There would be no way to consolidate all of a patient’s images from separate departments into a single viewing session within a single viewing application.

My answer to the question posed by the AuntMinnie thread is that the stimulus package will most likely have an immediate impact on the PACS-Neutral Archive rather than the department PACS.

Assuming the EHR will continue to defer to another system for the image data management and display applications, it makes much more sense for that other system to be a consolidated PACS-Neutral Archive (PNA) than multiple department PACS.  The PNA is much further ahead of even the best departmental PACS in managing image data from disparate systems.  The PNA is much further ahead of the best departmental PACS in managing image data for the lifetime of the study.  The PNA is the better platform for managing non-DICOM image data and supporting a multi-modality universal viewing application.  Even before the promise of stimulus money, the PNA had a very positive ROI based on the cost of future data migrations avoided.

In conclusion, I don’t see PACS enveloping the EHR applications, and I don’t see the EHR enveloping the departmental PACS applications.  I see the EHR and the PACS remaining pretty much what they already are, separate entities.  Because of that focus, I do see them becoming more proficient at their respective tasks.  As a consequence, I see the PACS-Neutral Archive coming into its own as the central multi-modality image data repository and provider of the UniViewer display application.

PACS-Neutral Archive Action Plan

Interest in the concept of PACS-Neutral Archive is growing as evidenced by the number of new inquiries reported by several vendors responding to my informal poll.  However a significant number of those inquiries are for basic information: “What exactly is a PACS-Neutral Archive?”, and “Which PACS are compatible with a PACS-Neutral Archive?”. So my suggested Action Plan would start appropriately at the beginning with a foundation in the concept.

Obviously it would be useful to have a consolidated list of features and functions that comprise a PACS-Neutral Archive (PNA).   Not only would that list help explain the concept, it would help differentiate the various vendor solutions in the current market.  Unfortunately that list does not seem to exist.  Vendor-Neutral Archive, PACS-Neutral Archive, Enterprise Archive are just some of the terms being used to describe what is supposed to be the same concept.  Frankly I believe that all of these different names and the associated product descriptions are causing confusion.  It almost seems like the concept is being invented and reinvented as we speak.

Actually that’s not far from the truth.

The basic concept started with a few simple objectives like consolidation of separate PACS archives and replacement/upgrade of old storage solutions, and soon included normalization of all of the data to a standard data format, hence the “PACS-Neutral” moniker.  This last feature was tacked on as soon as it became obvious just how painful and expensive DICOM data migrations were going to be in future years.  In truth, the list of Features and Functions for the PNA has been evolving at a rapid pace, as each new problem surfaces and a matching solution is developed.  At this point in time no consolidated Feature/Function list exists, at least none that I am aware of.  And while the list would surely stretch to nearly 100  items, the following major features will easily separate the more promising solutions from the pretenders.

  • Open Storage Solution – supports multiple media vendors and multiple storage solutions
  • Dynamic DICOM Tag Morphing – on-the-fly conversion of data formats in support of data exchange between disparate PACS
  • Methodology for accepting and managing both DICOM and non-DICOM data objects
  • HL-7 interface support
  • Pre-fetching and Auto-routing support
  • Automated and Manual QA/QC support for interfaces with non-PACS data sources
  • Intelligent Information Lifecycle Management – data movements internal and external to the system based on meta data
  • Automated Data Purge with manual supervision
  • Set of integrated display applications, one for simple viewing, the other for advanced viewing of the image data through the EMR Portal
  • Pseudo Master Patient Indexing capabilities and optional full-featured MPI
  • Creation of XDS-I manifest and optional XDS-I Registry and Repository applications
  • Integrated remote system monitoring application capable of tracking hardware and software operations

Step two of my suggested Action Plan is to find out if a specific PACS is compatible with a PNA.  That’s not an easy question to answer as there are a lot of issues that affect “compatibility”.  Once again, there is no simple list to check. The best way to assess the degree of compatibility for a specific PACS is to simply submit basic vendor/model and software version information to a PNA vendor and request a formal PACS Compatibility Assessment.  If that vendor has experience with the specified PACS, they should be able to provide a reasonable assessment.

  • A  high degree of compatibility would support the recommendation to deploy a PNA, migrate the oldest data from the PACS first, and then set up the PACS to use its own archive for new data and access the PNA for the old data.
  • A low degree or no compatibility would support the recommendation to deploy a PNA based on a very basic but upgradeable hardware platform and simply begin migration of the PACS data to the PNA to reduce the future data migration costs.

Step three of my suggested Action Plan is to conduct a Migration Liability Assessment for your organization.  This is essentially a matter of running study volumes, study sizes, growth rates, retention policies and associated business objectives through a spreadsheet that calculates projected data volumes in future years and the cost of migrating that data from the current PACS to a new PACS.  The two most important pieces of information needed are: how much the migrations will cost and how long the migrations will take.  Given the complexity of data migrations from PACS-A to PACS-B, it is not unusual for the migration to span several years and cost hundreds of thousands of dollars.

If you have a clear understanding of the concept of the PACS-Neutral Archive, understand where your current PACS stands with respect to compatibility, and have solid numbers to support a sense of urgency, you have the three main tools you need to develop a working strategy to address this major data management problem.

If you need help performing the PACS Compatibility Assessment or the Migration Liability Assessment, Gray Consulting has considerable experience in these areas and would be happy to provide assistance.