Empirical investigation of radiologists' priorities for PACS selection: an analytical hierarchy process approach

Quantitative Evaluation of PACS Query/Retrieve Capabilities

The PACS (Picture Archiving and Communication System) market is heterogenous with dozens of PACS providers having deployed installations in healthcare facilities. The DICOM® query and retrieve interfaces provided by PACS have multiple variations, related to the implemented SOP (Service Object Pair) Classes, transfer syntaxes, extended negotiations, matching attributes, and matching types. These variations can make integration of a new DICOM® consumer with a PACS complex and time consuming. Even if most of PACS products provide a DICOM® conformance statement with a description of its query/retrieve capabilities, there is no collective analysis describing the various PACS query and retrieve capabilities and variations. Also, application developers and healthcare facilities lack a method to evaluate the PACS capabilities and classify its functionalities. GE designed a method to evaluate the PACS capabilities in terms of query retrieve functionalities. Our aim is to analyze several PACS in test and production environments, using our method to provide the DICOM® object consumers a macroscopic knowledge of query/retrieve capabilities of PACS functionalities and its different variations. Our evaluation can also be used by PACS and VNA (Vendor Neutral Archive) developers to evaluate their query/retrieve capabilities, for quality improvement purpose.

A multi-criteria methodology for evaluating alternative ultrasound devices

Several surveys and clinical studies report high prevalence of work-related musculoskeletal disorders (WMSDs) among sonographers and sonologists. Better performing ultrasound devices can increase the number and quality of examinations, but also reduce the user comfort and increase the risk of WMSDs. This should lead the choice of the device to buy and use. To support hospitals or diagnostic centres in selecting the best ultrasound device, this study provides a structured methodology based on a multi-criteria approach, the Analytic Hierarchy Process. It has a Goal (to optimise workers' well-being and satisfy company production objectives) and 45 evaluation elements. It was applied in an Italian hospital comparing 3 alternatives: wireless, portable, and cart-based. The latter proved to be the best in satisfying the Goal, whereas a previous study obtained that the wireless device was preferable considering only the ergonomic point of view. The case study validated the applicability of the methodology. Practitioner summary: This paper provides the decision-makers of hospitals or diagnostic centres with a multi-criteria methodology to select the best ultrasound device capable of optimising workers' well-being and satisfying company production objectives. The methodology can also support manufacturers of ultrasound devices in improving their products. Abbreviations: AHP: analytic hierarchy process; AIUM: American Institute of Ultrasound in Medicine; BSI: British Standards Institution; CEN: European Committee for Standardisation; EU-OSHA: EU Agency for Occupational Safety and Health; ISO: International Organisation for Standardisation; MCMD: multiple criteria decision-making; NIOSH: US National Institute for Occupational Safety and Health; SDMS: society of diagnostic medical sonography; WHO: World Health OrganizationWMSD: work-related musculoskeletal disorder.

Optimization of Decision Making in the Supply of Medicinal Gases Used in Health Care

Systems that supply medicinal gases—oxygen, nitrous oxide and medical air—serve all care units of a hospital; for example, they feed distribution systems for operating theatres, neonatal and pediatric units, dialysis, X-ray, casualty, special tests, outpatients, etc. Systems for the provision of medicinal gases are therefore critical in guaranteeing hospital sustainability, since the functionality or availability of other hospital systems depends on them. Availability of 100% in these systems would avoid the need to reschedule patient appointments. It would also eliminate repeat testing, which poses risk to staff and patients, and could avoid affecting people’s lives through unavailability of, for example, operating theatres or intensive care units. All this contributes to a more rational resource consumption and an increase in quality of care both for the hospital itself and for patients and visitors. Although these systems are of vital importance to health care organizations, no previous work has been found in the literature that optimizes the technical decisions on supply in these systems. This research describes a model for these systems via continuous-time Markov chains. The results obtained are used in a multicriteria model constructed with the measuring attractiveness by a categorical-based evaluation technique (MACBETH) approach. In order to assess reliability when incorporating doubt or uncertainty via the MACBETH approach, the model has been validated by means of the fuzzy analytic hierarchy process. The aim is to obtain the best objective decision, with respect to the design of these systems, by analyzing the use of economic resources, the risks, and the impact on hospital activity, all with the aim of guaranteeing the best quality of care. The models constructed by means of MACBETH and the fuzzy analytic hierarchy process give, as the most suitable alternatives, duplicate the external supply in medical oxygen systems and maintain the original design conditions for supply systems of nitrous oxide and medicinal air.

Limitations in and Solutions for Improving the Functionality of Picture Archiving and Communication System: an Exploratory Study of PACS Professionals' Perspectives

Picture Archiving and Communication System (PACS) technology is evolving leading to improvements in the PACS functionality. However, the needs and expectations of PACS users are increasing to cope with the rising demands for improving the workflow and enhancing efficiency in healthcare. The aim was to study the limitations in the current generation of PACS and solutions for improving PACS functionality. This was a longitudinal online observational study of the perspectives of PACS professionals accessed through four online discussion groups on PACS using the LinkedIn network. In this exploratory study, the methodology involved a thematic analysis of qualitative data comprising 250 online posts/comments made by 124 unique PACS professionals collected between January 2014 and December 2015. Participants were mostly male (n = 119, 96%) from the North America (n = 88, 71%). Key themes on limitations in the current generation of PACS were image transmission problems, network and hardware issues, difficulties in changing specific settings, issues in hardcoded Digital Imaging and Communication in Medicine attributes, and problems in implementing open source PACS. Main themes on solutions for improving PACS functionality were the integration of multisite PACS, multimedia for PACS, web-based PACS, medical image viewer, open source PACS, PACS on mobile phones, vendor neutral archives for PACS, speech recognition and integration in PACS, PACS backup and recovery, and connecting PACS with other hospital systems. Despite ongoing technological developments, the current generation of PACS has limitations that affect PACS functionality leading to unmet needs and requirements of PACS users, which could impact workflow and efficiency in healthcare.

Factors influencing the selection of a picture archiving and communication system: A qualitative study

BACKGROUND

Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection.

METHODS

This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim.

RESULTS

Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories.

CONCLUSION

The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.

Needs Assessment Using a Structured Prioritization Schema: An Open Letter to PACS Vendors

PURPOSE

The aim of this work was to prioritize in a quaternary academic environment necessary elements of a replacement PACS.

METHODS

This quality improvement work was conducted at one academic medical center and was "not regulated" by the institutional review board. Three workgroups (10-15 members each) with unique resident, fellow, and attending radiologists; IT specialists; and departmental leaders convened in 2018 to prioritize elements for a PACS replacement project, including integrated IT tools. Each workgroup met two or three times and represented one of three missions (clinical, research, and education). Six elements assigned the highest priority were distilled from each workgroup. The resulting 18 elements were condensed into survey format and distributed to all department residents, fellows, and faculty members for 5-point Likert-type prioritization stratified by mission. Data were collected over 2 weeks.

RESULTS

The survey response rate was 37% (71 of 192; 17 of 44 residents, 3 of 27 fellows, and 51 of 121 faculty members). Self-reported work effort was 63 ± 26% clinical, 14 ± 11% education, 15 ± 21% research, and 8 ± 14% administration. Aggregate priority ratings across all domains were highest for "stable system with predictable behavior" (mean, 4.51), "minimizes repetitive non-value-added work" (mean, 4.40), "interoperability" (mean, 4.12), and "near-instantaneous load times" (mean, 4.07). Clinical-specific ratings for these elements were even higher (means, 4.85-4.90). The lowest aggregate scores were mobile device compatibility (mean, 3.03), connectivity to nonaffiliated sites (mean, 3.01), and integrated instant messaging (mean, 2.87).

CONCLUSIONS

The department prioritized a stable and interoperable system that minimized non-value-added work. In other words, participants wanted a functioning PACS. PACS vendors should prioritize a reliable experience over niche add-ons.

PACS used while on-call: a national survey of radiology program directors and chief residents

The aim of this study was to determine the prevalence of different diagnostic image viewing platforms used by radiologists while on-call, and to assess the opinions and preferences of radiology program directors and chief residents regarding their use. An online survey was sent electronically to radiology residency program directors and chief residents via the Association of University Radiologists. Forty-two radiology program directors and 25 chief residents completed the survey, yielding response rates of 24.9 and 8.5 %, respectively. From the survey results, 10 different Picture Archiving Communications Systems (PACS) were identified; GE (25 %), Philips (17 %), and Agfa Impax (15 %) were the most prevalent. Interestingly, only 5 % of all respondents use a secondary "Digital Imaging and Communications in Medicine" viewer for on-call studies. Perceptions of PACS functionality were generally neutral to weakly positive. Most respondents strongly agreed that it is important to have a single integrated PACS for viewing on-call studies and agreed that the PACS should be integrated into the Electronic Medical Records (EMR). The overwhelming majority of respondents use their institution's PACS while on-call. The results show there is still a wide variety of PACS platforms used by different institutions; however, GE, Phillips, and Agfa were some of the most prevalent. Most radiologists surveyed have neutral to slightly positive perceptions about the functionality and ease of use of their PACS. Finally, while radiologists agree that PACS should be integrated with EMR, only 53 % of respondents currently have this arrangement.

Applying the Analytic Hierarchy Process in healthcare research: A systematic literature review and evaluation of reporting

Background

The Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context.

Methods

A systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: “Analytic Hierarchy Process,” “Analytical Hierarchy Process,” “multi-criteria decision analysis,” “multiple criteria decision,” “stated preference,” and “pairwise comparison.” In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies’ reporting.

Results

The systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30 %), followed by the US (25.6 %). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria.

Conclusion

The AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.

PACS administrators' and radiologists' perspective on the importance of features for PACS selection

Picture archiving and communication systems (PACS) play a critical role in radiology. This paper presents the criteria important to PACS administrators for selecting a PACS. A set of criteria are identified and organized into an integrative hierarchical framework. Survey responses from 48 administrators are used to identify the relative weights of these criteria through an analytical hierarchy process. The five main dimensions for PACS selection in order of importance are system continuity and functionality, system performance and architecture, user interface for workflow management, user interface for image manipulation, and display quality. Among the subdimensions, the highest weights were assessed for security, backup, and continuity; tools for continuous performance monitoring; support for multispecialty images; and voice recognition/transcription. PACS administrators' preferences were generally in line with that of previously reported results for radiologists. Both groups assigned the highest priority to ensuring business continuity and preventing loss of data through features such as security, backup, downtime prevention, and tools for continuous PACS performance monitoring. PACS administrators' next high priorities were support for multispecialty images, image retrieval speeds from short-term and long-term storage, real-time monitoring, and architectural issues of compatibility and integration with other products. Thus, next to ensuring business continuity, administrators' focus was on issues that impact their ability to deliver services and support. On the other hand, radiologists gave high priorities to voice recognition, transcription, and reporting; structured reporting; and convenience and responsiveness in manipulation of images. Thus, radiologists' focus appears to be on issues that may impact their productivity, effort, and accuracy.

Workflow continuity--moving beyond business continuity in a multisite 24-7 healthcare organization

As hospitals move towards providing in-house 24 × 7 services, there is an increasing need for information systems to be available around the clock. This study investigates one organization's need for a workflow continuity solution that provides around the clock availability for information systems that do not provide highly available services. The organization investigated is a large multifacility healthcare organization that consists of 20 hospitals and more than 30 imaging centers. A case analysis approach was used to investigate the organization's efforts. The results show an overall reduction in downtimes where radiologists could not continue their normal workflow on the integrated Picture Archiving and Communications System (PACS) solution by 94 % from 2008 to 2011. The impact of unplanned downtimes was reduced by 72 % while the impact of planned downtimes was reduced by 99.66 % over the same period. Additionally more than 98 h of radiologist impact due to a PACS upgrade in 2008 was entirely eliminated in 2011 utilizing the system created by the workflow continuity approach. Workflow continuity differs from high availability and business continuity in its design process and available services. Workflow continuity only ensures that critical workflows are available when the production system is unavailable due to scheduled or unscheduled downtimes. Workflow continuity works in conjunction with business continuity and highly available system designs. The results of this investigation revealed that this approach can add significant value to organizations because impact on users is minimized if not eliminated entirely.