The benefits of hospital-wide picture archiving and communication systems: a survey of clinical users of radiology services

[Clinical photography by smartphone in plastic surgery and protection of personal data: Development of a secured platform and application on 979 patients]

BACKGROUND

The clinical photography in plastic and reconstructive surgery has known a numerical breakthrough. The storage of online data, massive means of analysis such as facial recognitions algorithms poses a serious issue when it comes to the protection of personal data. We will assess a platform's benefits in connection with the computerized medical record, which will allow keeping the photos filed and centralized in a smart and secure manner.

METHOD

We interviewed 300 plastic surgeons about the role of smartphone in their clinical practice. Concomitantly, we developed an innovative platform called Surgeon^©, a secure way to index, file and send photographs with a smartphone on our hospital's server. Each photographic sequence was qualified using a specific form. We then collected prospectively, between May 1st 2017 and March 30th 2018, the number of patients photographed, the number of sequences and photographs taken and the average number of sequences per patient.

RESULTS

Out of 86 French plastic surgeons surveyed, 81% say that they could not go on with their daily practice today without their smartphone. Photographs taken were stored in their smartphones (50%) or synced with virtual storage (25.6%). A majority (80.2%) would use a dedicated secured smartphone application. Our application allowed us to photograph 979 patients, or 2345 sequences and 8112 photographs, with an average of 2.28 sequences per patient.

CONCLUSION

Thanks to its ergonomics and security, this platform can be set up in a hospital ward and beyond.

Augmentation of the think aloud method with users' perspectives for the selection of a picture archiving and communication system

OBJECTIVES

Users attitude toward a picture archiving and communication system (PACS) and their interaction with this system are among the most important factors that influence its acceptance. This study aimed to augment the user's interaction with the user's perspective to select a usable PACS among three systems available on the market.

METHODS

We augmented the think aloud (TA) usability evaluation method with the Post-Study System Usability Questionnaire (PSSUQ) to compare user interaction problems of three PACS user interfaces. Four radiologists and four internist physicians participated in this study. Usability characteristics including efficiency, effectiveness, learnability, error, and satisfaction were used to assess the usability of each PACS.

RESULTS

There was a significant difference in efficiency (p = 0.01), effectiveness (p = 0.005), learnability (p = 0.001), and satisfaction (p = 0.009). However, no significant difference in the number of errors (p = 0.18), mouse clicks and keystrokes (p = 0.12), and the number of usability problems (p = 0.6) were observed among the three PACS systems studied.

CONCLUSIONS

This study showed that applying the proposed approach to augment TA with the user's perspective addresses almost all of the theoretical aspects of usability and can be employed to select the most usable PACS.

Users' Perspectives on a Picture Archiving and Communication System (PACS): An In-Depth Study in a Teaching Hospital in Kuwait

Background

Picture archiving and communication system (PACS) is a well-known imaging informatics application in health care organizations, specifically designed for the radiology department. Health care providers have exhibited willingness toward evaluating PACS in hospitals to ascertain the critical success and failure of the technology, considering that evaluation is a basic requirement.

Objective

This study aimed at evaluating the success of a PACS in a regional teaching hospital of Kuwait, from users’ perspectives, using information systems success criteria.

Methods

An in-depth study was conducted by using quantitative and qualitative methods. This mixed-method study was based on: (1) questionnaires, distributed to all radiologists and technologists and (2) interviews, conducted with PACS administrators.

Results

In all, 60 questionnaires were received from the respondents. These included 39 radiologists (75% response rate) and 21 technologists (62% response rate), with the results showing almost three-quarters (74%, 44 of 59) of the respondents rating PACS positively and as user friendly. This study’s findings revealed that the demographic data, including computer experience, was an insignificant factor, having no influence on the users’ responses. The findings were further substantiated by the administrators’ interview responses, which supported the benefits of PACS, indicating the need for developing a unified policy aimed at streamlining and improving the departmental workflow.

Conclusions

The PACS had a positive and productive impact on the radiologists’ and technologists’ work performance. They were endeavoring to resolve current problems while keeping abreast of advances in PACS technology, including teleradiology and mobile image viewer, which is steadily increasing in usage in the Kuwaiti health system.

Design, implementation and operation of a multimodality research imaging informatics repository

Background

Biomedical imaging research increasingly involves acquiring, managing and processing large amounts of distributed imaging data. Integrated systems that combine data, meta-data and workflows are crucial for realising the opportunities presented by advances in imaging facilities.

Methods

This paper describes the design, implementation and operation of a multi-modality research imaging data management system that manages imaging data obtained from biomedical imaging scanners operated at Monash Biomedical Imaging (MBI), Monash University in Melbourne, Australia. In addition to Digital Imaging and Communications in Medicine (DICOM) images, raw data and non-DICOM biomedical data can be archived and distributed by the system. Imaging data are annotated with meta-data according to a study-centric data model and, therefore, scientific users can find, download and process data easily.

Results

The research imaging data management system ensures long-term usability, integrity inter-operability and integration of large imaging data. Research users can securely browse and download stored images and data, and upload processed data via subject-oriented informatics frameworks including the Distributed and Reflective Informatics System (DaRIS), and the Extensible Neuroimaging Archive Toolkit (XNAT).

Web based tools for visualizing imaging data and development of XNATView, a zero footprint image viewer

Advances in web technologies now allow direct visualization of imaging data sets without necessitating the download of large file sets or the installation of software. This allows centralization of file storage and facilitates image review and analysis. XNATView is a light framework recently developed in our lab to visualize DICOM images stored in The Extensible Neuroimaging Archive Toolkit (XNAT). It consists of a PyXNAT-based framework to wrap around the REST application programming interface (API) and query the data in XNAT. XNATView was developed to simplify quality assurance, help organize imaging data, and facilitate data sharing for intra- and inter-laboratory collaborations. Its zero-footprint design allows the user to connect to XNAT from a web browser, navigate through projects, experiments, and subjects, and view DICOM images with accompanying metadata all within a single viewing instance.

Implementation of a departmental picture archiving and communication system: a productivity and cost analysis

BACKGROUND

Digital radiology enhances productivity and results in long-term cost savings. However, the viewing, storage, and sharing of outside imaging studies on compact discs at ambulatory offices and hospitals pose a number of unique challenges to a surgeon's efficiency and clinical workflow.

OBJECTIVE

To improve the efficiency and clinical workflow of an academic neurosurgical practice when evaluating patients with outside radiological studies.

METHODS

Open-source software and commercial hardware were used to design and implement a departmental picture archiving and communications system (PACS).

RESULTS

The implementation of a departmental PACS system significantly improved productivity and enhanced collaboration in a variety of clinical settings. Using published data on the rate of information technology problems associated with outside studies on compact discs, this system produced a cost savings ranging from $6250 to $33600 and from $43200 to $72000 for 2 cohorts, urgent transfer and spine clinic patients, respectively, therefore justifying the costs of the system in less than a year.

CONCLUSION

The implementation of a departmental PACS system using open-source software is straightforward and cost-effective and results in significant gains in surgeon productivity when evaluating patients with outside imaging studies.

Picture Archiving and Communication System (PACS): Clinician's Perspective About Filmless Imaging

Picture archiving and communication systems (PACS) are most appropriate means of acquiring, archiving, and communicating all forms of radiology imaging. The present study is to decide applicability of PACS, its exact role in patient care, and benefit as a teaching tool. To compare conventional imaging with picture archiving and communication system from user's point of view, impact of PACS on patient care and teaching. This was a single center, observational study over a period of 4 weeks from 15 January 2010 to 15 February 2010 carried out in Pravara Rural Hospital. For the present study, 100 users from various clinical disciplines were included who routinely use PACS. A pretested questionnaire related to various aspects of PACS was devised considering its advantage to clinicians, role in patient care, and as tool for teaching. Out of 100 users, 85 % users reported PACS easy to very easy for handle. Ninety-four percent users reported PACS as useful tool for the hospital. Fifty-one percent of users found image quality at image review workstation to be good to very good against 49 % found it poor to very poor. There have been several studies to demonstrate the benefits of PACS to users, but many of these have concentrated on radiology trainees, users in a particular department. Present study concentrates on the impact that PACS has made to the working of the clinicians in many different disciplines. The perceived benefits of PACS outnumbered the disadvantages and reflected the widely documented benefits of PACS in the literature.

Physicians' views and assessments on picture archiving and communication systems (PACS) in two Turkish public hospitals

A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of and convenient access to images from multiple modalities (source machine types). PACS have been widely introduced as a credible alternative to the traditional film-based radiological service. This study was planned and conducted to determine the physicians' views and assessments on PACS in two public hospitals in Turkey. A questionnaire was prepared by viewing the literature related to PACS. The questionnaires were distributed several times to a total of 150 physicians two public hospitals in Ankara, Turkey. The overall response rate is 46%. Some questions required a graduated score in response and others an open ended response. The majority of physicians judged PACS to be a major advance for their hospitals with less frustration than using film high quality images and an improvement in their working lives and patient care. They reported that PACS gave them to radiology reports in short time. Also physicians believed that PACS has improved their consultations. Open ended questions were prepared with concerning the benefits and disadvantages of PACS. The assessments of the physicians demonstrated many more benefits than disadvantages of PACS in their hospitals. PACS has been accepted well by a wide percentage of hospital physicians. PACS evolves over time components are frequently replaced and so the users must expect continuous learning about new updates and improved functionality. The implementation of the PACS clearly contributes to an increase in the productivity of health professionals and physicians.

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.

Short history of PACS (Part II: Europe)

Although the concept of picture archiving and communications systems (PACS) was developed in Europe during the latter part of the 1970s, no working system was completed at that time. The first PACS implementations took place in the United States in the early 1980s, e.g. at Pennsylvania University, UCLA, and Kansas City University. Some more or less successful PACS developments also took place in Europe in the 1980s, particularly in the Netherlands, Belgium, Austria, the United Kingdom, France, Italy, Scandinavia, and Germany. Most systems could be characterized by their focus on a single department, such as radiology or nuclear medicine. European hospital-wide PACS with high visibility evolved in the early 1990s in London (Hammersmith Hospital) and Vienna (SMZO). These were followed during the latter part of the 1990s by approximately 10-20 PACS installations in each of the major industrialized countries of Europe. Wide-area PACS covering several health care institutions in a region are now in the process of being implemented in a number of European countries. Because of limitations of space some countries, for example, Denmark, Finland, Spain, Greece, as well as Eastern European countries, etc. could not be appropriately represented in this paper.

Virtual organization of hospital medical imaging: a user satisfaction survey

A virtual medical imaging department is an innovative and demanding organizational model, to the extent that the underlying goal is to achieve a continuous and advanced organizational integration of human and physical resources, clinical data, and clienteles. To better understand the kind of benefits offered, we conducted a survey of three groups of users--radiologists, radiological technologists, and medical specialists--working in a five-site virtual organization. We received 127 valid questionnaires, for an overall response rate of 66%. The assessments vary according to the use made of the system. The scores for system quality and the quality of the data produced were markedly higher for intra-hospital use (respectively 7.9 and 8.7 out of 10) than for inter-hospital use (5.4 and 7.0). Despite the negative assessments they made of inter-hospital use, users maintained a positive attitude toward some type of virtual organization of medical imaging. Indeed, the score for Overall satisfaction with the system was very high, 8.9 out of 10. Moreover, the scores for Intended future use of the system were very high for both intra-hospital use (8.9) and inter-hospital use (8.7). We also found significant differences in perceptions among user groups.

Impact of picture archiving communication systems on rates of duplicate imaging: a before-after study

Background

Electronic health information systems, such as picture archiving communication systems (PACS), are commonly believed to reduce the need for duplicate testing. However, empirical data to support this belief are not available.

Methods

Before-after study using administrative claims data from the Ontario Health Insurance Plan to determine whether the introduction of PACS at 10 hospitals in the Thames Valley region of southwestern Ontario, Canada between June 2004 and December 2005 reduced the frequency of duplicate imaging examinations. The imaging modalities studied were: chest and abdominal X-ray; computed tomography of the abdomen/pelvis, head, and chest. The frequency of duplicate testing was examined at 3 different time frames: 7 days, 30 days, and 60 days after a given index test.

Results

Overall frequencies of duplicate imaging were: 2.7% within 7 days of an index imaging test, 6.7% within 30 days, and 9.8% within 60 days. Comparing the 12 months before and 12 months after PACS, absolute reductions in the frequency of duplicate X-rays using 7-day, 30-day, and 60-day time frames were: 0.2% (P = 0.01), 0.6% (P < 0.001), and 0.9% (P < 0.001), respectively. In contrast, there were absolute increases in the frequency of duplicate CT scans after PACS of 0.0% (P = 0.92), 0.5% (P = 0.01), and 0.5% (P = 0.01), respectively.

Conclusion

The frequency of duplicate imaging is relatively low and we did not find large reductions in duplicate imaging after the introduction of PACS. Independent evaluation of electronic medical systems should be conducted to confirm widely held beliefs of their potential benefits.

Monitoring the PACS implementation process in a large university hospital--discrepancies between radiologists and physicians

Successfully introducing a new technology in a health-care setting is not a walk in the park. Many barriers need to be overcome, not only technical and financial but also human barriers. In this study, we focus on the human barriers to health-care information systems' implementation. We monitored the acceptance of a Picture Archiving and Communication System (PACS) by radiologists and hospital physicians in a large Belgian university hospital. Hereto, questionnaires were taken pre-implementation (T1) and 1 year after the radiology department stopped printing film (T2). The framework we used to perform the study was the Unified Theory of Acceptance and Use of Technology. Main findings were that both groups were positive toward PACS prior to the introduction and that each group was even more positive at T2 with extensive PACS experience. In general, the ratings of the radiologists were higher than those of the physicians, as the radiologists experienced more of the benefits of PACS and had to use PACS throughout the day. Two factors were salient for predicting users' intention to use PACS: the usefulness of PACS (performance expectancy) and the availability of support of any kind (facilitating conditions). The results show that our approach was successful. Both radiologists and physicians give evidence of an excellent level of user acceptance. We can conclude that the implementation of PACS into our hospital has succeeded.

Financial assessment of a picture archiving and communication system implemented all at once

The objective of this study was to determine the differential cost between film-based radiology and a hospital-wide picture archiving and communication system (PACS) implemented all at once. The cash flow and running costs of PACS and film-based operation were measured over an 8-year time horizon. When the hospital-wide PACS was implemented over a short period, there was instant conversion into digital film and archives. The net present value (NPV) for PACS operation is US $1,598,698, whereas the NPV for film-based operation is US $2,083,856, indicating a net saving of US $485,157. The payback period is 4 years. The costs of computed radiography and image plates account for 40% of the initial capital expenditure in PACS implementation, followed by computer hardware (30%) and software (9%) costs. Our experience shows that implementation of hospital-wide PACS all at once can produce cost savings. For hospitals intending to go filmless, this study offers a model for financial evaluation of PACS to help in decision making.

Impact of PACS deployment strategy on dictation turnaround time of chest radiographs

RATIONALE AND OBJECTIVES

The aim of the study is to measure the impact of a picture archive and communication system (PACS) on dictation turnaround time of chest radiographs in a multisite hospital and relate variations across sites to local factors and implementation strategy.

MATERIALS AND METHODS

The multisite hospital is composed of three sites. Dictation turnaround time was calculated by using data obtained from the radiology information system for examinations performed during three 90-day periods (immediately before PACS implementation, immediately after PACS implementation, and 1 year after implementation). Productivity, expressed as number of examinations dictated per full-time-equivalent radiologist, also was calculated. For each 3-month period, average interval delay was calculated. Values for average interval delay obtained during the different pre- and post-PACS periods were compared by using analysis of variance. This was done for each hospital.

RESULTS

In the immediate post-PACS period at site 1, dictation turnaround time decreased 5% (P < .05), whereas productivity decreased 16.5%. The implementation strategy was revised for the next two sites, and dictation turnaround time decreased 21% (P < .001) in both sites in the immediate post-PACS period. Productivity increased 2% and 3% in these sites. One year after implementation, decreases in turnaround ranged from 28% to 55% (P < .001) in the three sites.

CONCLUSION

Our experience suggests that PACSs cannot be isolated from their contexts; therefore, implementation strategy matters in the realization of projected benefits. In addition, regardless of differences in film-based environments before PACS, all three sites benefited from conversion to filmless operation, with the greatest benefits seen in the site that was least efficient before implementation.

Knowledge barriers to PACS adoption and implementation in hospitals

PURPOSE

Drawing on the classical theory of diffusion of innovations advanced by Rogers [E.M. Rogers, Diffusion of Innovations, 4th ed., Free Press, New York, NY, 1995] and on the theory of barriers to innovation [P. Attewell, Technology diffusion and organizational learning: the case of business computing. Organ. Sci. 3 (1992) 1-19; H. Tanriverdi, C.S. Iacono, Knowledge barriers to diffusion of telemedicine. Proceedings of the 20th International Conference on Information Systems, Charlotte, NC, 1999, pp. 39-50; S. Nambisan, Y.-M. Wang, Roadblocks to web technology adoption? Commun. ACM, 42 (1) (1999) 98-101], this study seeks a better understanding of challenges faced in PACS implementations in hospitals and of the strategies required to ensure their success.

METHODS

To attain this objective, we describe and analyze the process used to adopt and implement PACS at two Canadian hospitals.

RESULTS

Our findings clearly demonstrate the importance of treating any PACS deployment not simply as a rollout of new technology but as a project that will transform the organization. Proponents of these projects must not lose sight of the fact that, even if technological complexity represents a significant issue, it must not garner all the project team's attention. This situation is even more dangerous, inasmuch as the greatest risk to the implementation often lies elsewhere. It would also appear to be crucial to anticipate and address organizational and behavioral challenges from the very first phase of the innovation process, in order to ensure that all participants will be committed to the project.

CONCLUSIONS

In order to maximize the likelihood of PACS success, it appears crucial to adopt a proactive implementation strategy, one that takes into consideration all the technical, economic, organizational, and human factors, and does so from the first phase of the innovation process.

Toward a multidimensional assessment of picture archiving and communication system success

OBJECTIVES

Based on a prevalent framework in the information systems field, this study proposes and describes an integrated model for evaluating picture archiving and communication system (PACS) success from multiple users' perspectives.

METHODS

Our study details the validation process of the proposed model at a large tertiary-care teaching hospital in Canada. Both qualitative and quantitative data were collected to assess the psychometric properties of the measurement instrument and test the research hypotheses.

RESULTS

Our findings clearly reveal that radiologists, technologists, and clinicians have different views regarding the factors influencing PACS success. For instance, the results for radiologists show that their concern with efficiency and productivity is best guaranteed by a system that is reliable and easy to use. Furthermore, that only perceived system usefulness influenced clinicians' satisfaction with PACS is a reflection of the primary impact that technology has on their work, namely, the ability to have instant access to images from any point in the hospital. Even though, overall, all three groups view the adoption of PACS positively, the mean scores indicate that radiologists and technologists seem to be more satisfied and their expectations to be met at a higher level than clinicians.

CONCLUSIONS

We believe the measurement instruments developed in this study can be used as a diagnostic tool by project managers interested in better understanding the extent to which different groups of stakeholders perceive the deployment of PACS as being successful and how factors influencing perceptions of PACS success vary across user types.

Picture archiving and communication systems: the users' view

A study was undertaken to assess the acceptability to users of a Picture Archiving and Communication System (PACS). A questionnaire was issued to 208 users. Some questions required a graduated score in response and others a free text response. 101 responses were received from a cross section of hospital staff. The majority of users judged PACS to be a major advance for the hospital, with high quality images, less frustration than using film and an improvement in their working lives. They judged that it had made a positive change in their working practices and had met their expectations. They welcomed the access it gave them to Radiology reports. There was more ambivalence about the impact it had made to the efficiency of clinic consultations and the conduct of ward rounds. Free text responses were made concerning the benefits and disadvantages of PACS. Analysis of these demonstrated many more benefits than disadvantages. The Radiology department has been enabled to address the concerns of staff raised through the questionnaire, and has been encouraged by the positive responses. PACS has been accepted well by a wide cross section of hospital staff. It has improved their working lives and made a major contribution to the working of the hospital as a whole.

PACS utilization in radiologic research

RATIONALE AND OBJECTIVES

The authors investigated patterns of utilization of the digital picture archiving and communication system (PACS) in radiologic publications in order to ascertain whether there may be a correlation between PACS use and demographic/cultural factors such as geographic location, radiologic specialization, and use of advanced radiologic technologies.

MATERIALS AND METHODS

A total of 1,037 articles in 22 randomly selected issues of AJR: American Journal of Roentgenology and of Radiology (1999-2001) were reviewed for the rate of PACS use and the type of PACS used. Articles for which PACS use or nonuse was established were further classified according to originating continent or region, imaging modality, study design (whether retrospective or prospective), and the use of advanced radiologic technology. The use of a PACS was then correlated with these factors. The data were recorded and statistics were prepared by means of statistical software. The nonparametric (chi2) test also was run by using this software.

RESULTS

PACS had been used and reported in the preparation of 225 of the 1,037 articles. The type of PACS used was mini PACS (eg, systems using digital imaging and communications in medicine [DICOM] protocols or precursors) in 55 (24%) and department- or hospital-wide PACS in 161 (72%). Most of the articles for which use of a PACS was reported had originated in North America (60%), Europe (22%), or Asia (14%). PACS were used in almost half of retrospective studies and in one-fourth of prospective studies (P < .01). A low correlation was found between utilization of PACS and use of other advanced technologies.

CONCLUSION

Although PACS were utilized in the preparation of a substantial proportion of articles published in the two major radiology journals, there was a great disparity in the rate of PACS use among world regions. The proportion of studies originating in North America for which a PACS was used was nearly three times the number of similar studies originating in Europe, and more than four times the number originating in Asia.

Evaluation of the impact of a PACS system on an intensive care unit

Describes part of a wider evaluation exercise undertaken to assess the impact of the introduction of a picture-archiving and communication system (PACS) on the adult intensive care unit (AICU) at the Royal Brompton NHS Trust in London. The objectives of this research were to evaluate the perceptions of PACS of the medical and ancillary staff working within AICU as well as to undertake a preliminary assessment of its impact on the workload of radiographers. Questionnaires, interviews and a process analysis were undertaken. The research findings indicate that the overall perception of staff towards the introduction of the PACS was positive. The impact of the system on the workload of radiographers was significant, reducing the time taken to obtain an image from 90 to 60 minutes. However, lessons to be learned for future PACS implementations include the need to ensure compatibility with existing IT systems, adequate IT support and initiatives to ensure that the benefits of PACS are communicated to the hospital at large.

The Legnano radiology picture archiving and communication system/radiology information system project implementation

The necessity to meet the ever-increasing diagnostic and interventional demands in the most cost-effective and efficient way led to the decision to turn the Department of Radiology at Legnano City Hospital nearly filmless. Crucial for the implementation of this challenging project was the development of a sophisticated and efficient digital architecture along with a nearly global renovation of the whole department, connecting it in the meantime to the hospital asynchronous transfer mode (ATM) backbone. The highlights and drawbacks faced in the implementation of the project are described and discussed.

A hospital-wide picture archiving and communication system (PACS): the views of users and providers of the radiology service at Hammersmith Hospital

OBJECTIVE

To obtain users' views of the new picture archiving and communication system (PACS) from clinical and radiological staff at Hammersmith Hospital, UK.

METHODS

Semi-structured interviews were used to ascertain the views of staff, following an interview schedule which covered aspects of: (1) their use of PACS, (2) facilities available, (3) the perceived quality of images, (4) reporting, (5) image availability, (6) image accessibility, (7) training, and (8) ease of use of PACS.

RESULTS

Interviews were carried out with 34 key users and providers of the radiological service at Hammersmith Hospital. Overall, staff were very satisfied with PACS particularly in terms of image availability. All staff said that they preferred PACS to the previous, conventional radiology service.

CONCLUSIONS

The key implications of issues raised by staff were: the impact of 'down-time' and the importance of an efficient back-up system, the requirement for sufficient short-term storage to prevent images being off-line during clinical situations, the usefulness of the folder system for management of the images, the need to access images for teaching purposes, the advantage of having a default display protocol to facilitate radiological reporting, and the requirement for flexible, yet effective, training to ensure that the system is utilised to its full potential by users.

Evaluation of a hospital picture archiving and communication system

OBJECTIVES

To establish the net costs to the hospital and the broad range of benefits associated with a hospital-wide picture archiving and communication system (PACS) that comprised digital acquisition, storage and transmission of radiological images via a hospital-wide network to 150 workstations.

METHODS

'Before and after' comparisons and time series analyses at Hammersmith Hospital (London, UK), and comparison with five other British hospitals where PACS was not being installed. The cost analysis considered implementation costs and changes in key elements of hospital running costs, including the impact of changes in the length of inpatient stays. A range of benefit measures were investigated, including image availability, avoidance of repeat imaging, avoidance of exposure to radiation, patient turn-round speed, time from examination to image availability in intensive care, avoidance of diagnostic 'errors' by casualty doctors, the additional diagnostic value of PACS-based images and clinician satisfaction.

RESULTS

The annual equivalent capital cost of the PACS was 1.7 million Pounds (annual equivalent replacement cost: 0.8 million Pound). Overall, the PACS substantially increased running costs. No convincing evidence of a PACS-induced change in length of inpatient stay was found. PACS was associated with some improvements in the performance of the radiology department: improved image availability (97.7% versus 86.9%), lower repeat imaging rate (7.3% versus 9.9%) and 20% lower total radiation doses for examinations of the lateral lumbar spine. No improvements were identified in the quality of the radiology reporting service. Benefits outside radiology included shorter time from examination to image availability for routine uses in intensive care (19 versus 37 minutes), and a lower rate of diagnostic 'errors' in casualty (0.65% versus 1.51%). High levels of satisfaction with PACS were found amongst both providers and clinical users.

CONCLUSIONS

PACS was almost universally preferred by users and brought many operational and clinical benefits. However, these advantages came at a significant capital and net running cost.