The impact of PACS on radiologists' work practice

The retention duration of digital images in picture archiving and communication systems

Introduction

Every year, a large number of medical images such as MRIs, CT scans, and radiographs are prepared in hospitals, and a lot of money is spent on their preparation. Picture archiving and communication system (PACS) is an integrated image management system for maintaining and storing digital images. The objective of this study was to determine the storage duration of digital images in PACS.

Methods

This was a scoping review study in which we searched the PubMed and Embase databases using a combination of terms related to radiography, storage, and duration. The reference lists of included articles were checked to identify other relevant articles. Moreover, we searched Google to retrieve relevant gray literature and other information sources including guidelines. The selection process was carried out in three stages and was reported based on the PRISMA flowchart and the data were extracted using the data collection form.

Results

Based on the database search 2867 articles were identified, of which 13 articles were eligible for inclusion. Searching for gray literature identified 7 relevant sources. The results showed that based on the institutions' plans and regulations, different countries have different storage policies. In general, to store images between 6 and 240 months for short-term storage and between 0 and 240 months for long-term storage were considered.

Conclusion

Due to financial constraints and storage space requirements, healthcare organizations can provide a solution by drafting guidelines on the appropriate storage duration for medical images. The findings of this study can assist healthcare authorities and healthcare centers in employing PACS systems to manage and minimize storage space for medical images, thereby reducing storage costs.

Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users' Work

The impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different dimensions of the users' work. The objective of this study was to evaluate the impact of the PACS on different dimensions of users' work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. This study was performed on the PACS users (n = 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users' work. Data were analyzed using descriptive statistics, ANOVA, and Pearson's correlation coefficient statistical tests. The mean of scores given by the PACS users was 4.31 ± 0.86 for external communication, 4.18 ± 0.96 for user intention to use the PACS, 3.91 ± 0.7 for service quality, 3.16 ± 0.56 for daily routine, and 3.08 ± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P < 0.01, CI = 95%). Factors such as user age (P < 0.01, CI = 95%), job (P < 0.001, CI = 95%), work experience (P < 0.001, CI = 95%), and PACS training method (P=0.037, CI = 95%) were related to the impact of the PACS on different dimensions of users' work. This study showed that the PACS has a positive effect on different dimensions of users' work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users' work and to maintain and strengthen the capabilities and functions of radiology departments.

A Qualitative Analysis of the Needs and Experiences of Hospital-based Clinicians when Accessing Medical Imaging

As digital imaging is now a common and essential tool in the clinical workflow, it is important to understand the experiences of clinicians with medical imaging systems in order to guide future development. The objective of this paper was to explore health professionals’ experiences, practices and preferences when using Picture Archiving and Communications Systems (PACS), to identify shortcomings in the existing technology and inform future developments. Semi-structured interviews are reported with 35 hospital-based healthcare professionals (3 interns, 11 senior health officers, 6 specialist registrars, 6 consultants, 2 clinical specialists, 5 radiographers, 1 sonographer, 1 radiation safety officer). Data collection took place between February 2019 and December 2020 and all data are analyzed thematically. A majority of clinicians report using PACS frequently (6+ times per day), both through dedicated PACS workstations, and through general-purpose desktop computers. Most clinicians report using basic features of PACS to view imaging and reports, and also to compare current with previous imaging, noting that they rarely use more advanced features, such as measuring. Usability is seen as a problem, including issues related to data privacy. More sustained training would help clinicians gain more value from PACS, particularly less experienced users. While the majority of clinicians report being unconcerned about sterility when accessing digital imaging, clinicians were open to the possibility of touchless operation using voice, and the ability to execute multiple commands with a single voice command would be welcomed.

Quality of radiologists' communication with other clinicians--As experienced by radiologists

OBJECTIVE

The objective was to study radiologists' experiences of written and oral communication with referring clinicians, and its potential implications for decision making and patient care.

METHODS

Focus group discussions with 12 radiologists were carried out. Content analysis was used for interpretation of the data.

RESULTS

Radiologists reported many problems with the request forms: improper choice of imaging examinations and procedures, insufficient patient history/information, unclear clinical questions, lack of specific terms and unclear abbreviations on the request form. Radiologists also mentioned other difficulties: insufficient attention among participating clinicians during conferences, difficulties in reaching the referring clinicians by telephone, and communication difficulties in making priorities between patients. To overcome these problems, radiologists suggested increased contacts between radiologists and clinicians, and educational activities.

CONCLUSION

A number of difficulties in oral and written communication were highlighted. The use of medical imaging may be optimized by joint discussions on indications and methodology and educational activities, such as lectures, seminars and conferences, directed to the medical community at large.

PRACTICE IMPLICATIONS

Improved communication between radiologists and referring clinicians should be encouraged to ensure diagnostic quality, correct patient prioritization and patient safety, and to avoid unnecessary delays and costs.

The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature

OBJECTIVE

To assess evidence of the impact of Picture Archiving and Communication Systems (PACS) on clinicians' work practices in the intensive care unit (ICU).

METHODS

We searched Medline, Pre-Medline, CINAHL, Embase, and the SPIE Digital Library databases for English-language publications between 1980 and September 2010 using Medical Subject Headings terms and keywords.

RESULTS

Eleven studies from the USA and UK were included. All studies measured aspects of time associated with the introduction of PACS, namely the availability of images, the time a physician took to review an image, and changes in viewing patterns. Seven studies examined the impact on clinical decision-making, with the majority measuring the time to image-based clinical action. The effect of PACS on communication modes was reported in five studies.

DISCUSSION

PACS can impact on clinician work practices in three main areas. Most of the evidence suggests an improvement in the efficiency of work practices. Quick image availability can impact on work associated with clinical decision-making, although the results were inconsistent. PACS can change communication practices, particularly between the ICU and radiology; however, the evidence base is insufficient to draw firm conclusions in this area.

CONCLUSION

The potential for PACS to impact positively on clinician work practices in the ICU and improve patient care is great. However, the evidence base is limited and does not reflect aspects of contemporary PACS technology. Performance measures developed in previous studies remain relevant, with much left to investigate to understand how PACS can support new and improved ways of delivering care in the intensive care setting.

Double vision: An exploration of radiologists’ and general practitioners’ views on using picture archiving and communication systems (PACS)

This article explores the perspectives of two user groups, general practitioners (GPs) and consultant radiologists (CRs), on the rollout of picture archiving and communications systems (PACS) within acute trusts and eventually to primary care as part of the electronic patient record. Qualitative interviews were conducted with 16 CRs and 31 GPs. Analysis was carried out using a grounded theory approach. Radiologists expressed positive views about the implementation of PACS in secondary care, but were wary of GPs accessing radiological images. GPs expressed concerns about the added burdens that PACS might bring to primary care, but most felt that sharing images with patients could benefit doctor—patient communication and increase patient satisfaction. This study highlights both impediments and pathways to the implementation of PACS in primary care, and illustrates the importance of regarding PACS as socially embedded and users as culturally disparate.

Evolutionistic or revolutionary paths? A PACS maturity model for strategic situational planning

PURPOSE

While many hospitals are re-evaluating their current Picture Archiving and Communication System (PACS), few have a mature strategy for PACS deployment. Furthermore, strategies for implementation, strategic and situational planning methods for the evolution of PACS maturity are scarce in the scientific literature. Consequently, in this paper we propose a strategic planning method for PACS deployment. This method builds upon a PACS maturity model (PMM), based on the elaboration of the strategic alignment concept and the maturity growth path concept previously developed in the PACS domain.

METHODS

First, we review the literature on strategic planning for information systems and information technology and PACS maturity. Secondly, the PMM is extended by applying four different strategic perspectives of the Strategic Alignment Framework whereupon two types of growth paths (evolutionistic and revolutionary) are applied that focus on a roadmap for PMM. This roadmap builds a path to get from one level of maturity and evolve to the next.

RESULTS

An extended method for PACS strategic planning is developed. This method defines eight distinctive strategies for PACS strategic situational planning that allow decision-makers in hospitals to decide which approach best suits their hospitals' current situation and future ambition and what in principle is needed to evolve through the different maturity levels.

CONCLUSIONS

The proposed method allows hospitals to strategically plan for PACS maturation. It is situational in that the required investments and activities depend on the alignment between the hospital strategy and the selected growth path. The inclusion of both strategic alignment and maturity growth path concepts make the planning method rigorous, and provide a framework for further empirical research and clinical practice.

Introducing PACS to the late majority. A longitudinal study

The purpose of this study was to study whether the benefits from introducing a picture archiving and communication systems (PACS) reported by innovators and early adopters also can be achieved by a hospital belonging to the "late majority" and to see whether such benefits are sustained, using report turnaround time (RTAT) as an indicator. Activity-related data was retrieved from the radiology information system (RIS) over a 2-year period. The median RTAT for preliminary reports was initially reduced from 12 to 2 h then increased to 3 h. For final reports, the median RTAT was initially reduced from 23 to 13 h then gradually reverted back to 22 h. Innovators and early adopters demonstrate not only that positive results can be achieved but also the importance of involving key personnel. We believe that such involvement and the focus on wider organizational concerns are important when introducing PACS to the late majority, both for achieving and sustaining positive results.

Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study

OBJECTIVE

To assess the impact of components of the national programme for information technology (NPfIT) on measures of clinical and operational efficiency.

DESIGN

Quasi-experimental controlled before and after study using routinely collected patient level data.

SETTING

Four NHS acute hospital trusts in England.

DATA SOURCES

Inpatient admissions and outpatient appointments, 2000-5.

INTERVENTIONS

A system for ordering pathology tests and browsing results (computerised physician order entry, CPOE) and a system for requesting radiological examinations and displaying images (picture archiving and communications system, PACS).

MAIN OUTCOME MEASURES

Requests per inpatient, outpatient, or day case patient for full blood count, urine culture and urea and electrolytes tests, and plain x ray film, computed tomography, and ultrasonography examinations.

RESULTS

CPOE was associated with a reduction in the proportion of outpatient appointments at which full blood count (odds ratio 0.25, 95% confidence interval 0.16 to 0.40), urea and electrolytes (0.55, 0.39 to 0.77), and urine culture (0.30, 0.17 to 0.51) tests were ordered, and at which full blood count tests were repeated (0.73, 0.53 to 0.99). Conversely, the same system was associated with an almost fourfold increase in the use of urea and electrolytes tests among day case patients (3.63, 1.66 to 7.94). PACS was associated with a reduction in repeat plain x ray films at outpatient appointments (0.62, 0.44 to 0.88) and a reduction in inpatient computed tomography (0.83, 0.70 to 0.98). Conversely, it was associated with increases in computed tomography requested at outpatient appointments (1.89, 1.26 to 2.84) and computed tomography repeated within 48 hours during an inpatient stay (2.18, 1.52 to 3.14).

CONCLUSIONS

CPOE and PACS were associated with both increases and reductions in tests and examinations. The magnitude of the changes is potentially important with respect to the efficiency of provision of health care. Better information about the impact of modern IT is required to enable healthcare organisations to manage implementation optimally.