I read an article today in the Health Imaging & IT electronic publication.  In this article on the next generation PACS, the author states his belief  that the next generation system will have to become bigger, become all-encompassing, become a PACS for every department; or at least be able to interface with the other systems across the enterprise.  For good measure, the article mentions the need for a web product good enough to support meaningful use.

There’s nothing much new here, in fact the vision is distorted.

The major PACS vendors have been working on their Enterprise PACS for some time now, assuming that the “enterprise” consists of Radiology and Cardiology.  How’s that been working out?  How many vendors have achieved fully functional Radiology and Cardiology application packages that run on a single platform with a consolidated Directory database and can exchange image data with each other?  After all this time, there are perhaps two, depending on one’s interpretation of the adjectives I used in the definition.  History suggests that folding in Pathology, Ophthalmology, Dental, etc. is going to take some time.  I don’t think we can afford to wait.

As for interfacing with other systems across the enterprise…that certainly sounds easier for the major PACS vendors to achieve than trying to be pretty good at all those individual department PACS applications.  Unfortunately that’s not going to be easy either, because there are simply too many idiosyncrasies in the way the individual vendors have implemented DICOM.  Don’t misunderstand, the implementations are largely “conformant”, they’re simply not completely compatible.  You know that, right?

I offer as simple irrefutable evidence two well known issues:  [1] data exchange between PACS via CD is problematic, and [2] replacement of one generation PACS by another requires a costly and time-consuming data migration.

I’m making an issue of this issue again, because it is my opinion that the next generation PACS is not going to become the bigger Enterprise PACS, nor is it going to suddenly start playing nice with the other PACS.

In my opinion, the next generation PACS is going to get a lot smaller, focusing on and becoming very good at supporting a specific imaging department’s workflow and providing its diagnostic tools.  Some of this functionality will most likely migrate up-stream to the actual modalities and their associated workstations, making this generation PACS even smaller.  The next generation PACS will also lose a lot of weight.  There will be the appropriate but minimal working storage, but certainly nothing like the TeraBytes of girth in the current systems.  As for short-term and long-term archiving…nothing.  That’s not where to put archiving.

Basically the next generation of PACS will be individual department-specific applications sitting on their own dedicated servers, each embellished with the logo of that department’s favorite vendor, and interfaced to a PACS-Neutral Enterprise Archive.

The Neutral Archive will dynamically manage all those cross-vendor idiosyncrasies, which the PACS vendors should really  appreciate, because that means they can stop pretending that they are going to fix the problem they created in the first place.  The PACS vendors can go back to doing what they do well, building work flow and diagnostic tools.  The Neutral Archive vendors will take over the significant task of managing all of the data from across the enterprise, assuring full interoperability between the PACS, and providing the level of Information Lifecycle Management that is long overdue in this industry.

As for the holy grail…enterprise-wide access to all of the enterprise data through the EMR Portal using a single viewer…the PACS Vendors can give up trying to figure that one out as well.  Most of their “Web Viewer” solutions can barely lift a radiology image.  There are some truly good “UniViewers” as I call them on the market, and more in the works.  What’s more,  they’re simple, standalone applications that don’t have to be embedded into the bowels of the Archive.  They could be as easily changed as a tie, albeit more expensive than a tie, but you get my point.

My point is that rather than looking for PACS to become more than they already are, and rather than taking up pitch forks in the name of DICOM convergence, think small.  It’s time to think specialization.  Award true excellence that has been surgically applied to a specific task: a department-specific PACS, a Neutral Enterprise Archive, and a UniViewer for the Portal.  Think “meaningful use”.