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Picture Archiving and Communication Systems
Utrecht, May 22, 2012
Theoretical principles and practical implications
dr. Rogier van de Wetering
Seminar Medical Informatics
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© 2012 Deloitte The Netherlands
Contents
1
A brief history of medical imaging
What is PACS?
Exercise
PACS Maturity concepts
Break! (10 min.)
Results from Dutch hospitals
Trends in medical imaging
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A brief history of medical imaging – the Classical time
2
Careful anatomical lessons in 17th century
The Anatomy Lesson of Dr. Nicolaes Tulp (1632) by Rembrandt
Src: retrieved from Wiki 2012
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Revolution came with Röntgen's discovery of the X-ray
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• Wilhelm Conrad Röntgen (1845 - 1923)
• German physicist
• Discovered penetrating “X-ray” (invisible beam) on November 8, 1895
• A brief article was published on January 5, 1896
• He earned the first Noble Prize in 1901 in Physics
Src: retrieved from Auntminnie.com
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PACS – background and definition
• Due to the changing health care environment, hospitals are obliged to utilize the full potential of
Information Systems and Information Technology and (IS/IT)
• Hospitals have taken on this challenge by moving towards filmless operations and investing in Picture
Archiving and Communication System (PACS)
• The concept of PACS was introduced as early as 1982
4
Acquire images
Store into central
repositories
Distribute upon
request
Display images
“Workflow-integrated imaging systems”
“Designed to streamline
operations”
“Many interrelated
system components ”
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PACS consists of many interrelated system components and is most
efficient when integrated with the Hospital- and Radiology information
system
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PACS components
Source: Canadian Association of Radiologist Hospital IT-architecture
Source: Muller et al., 2004
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Related terms and standards in the PACS environment
• Digital Imaging and Communications in
Medicine
• Facilitates interoperability of devices claiming
conformance
• DICOM applies to medical images and
acquisition systems (CT, MRi, X-ray etc.)
• DICOM standard also specifies services that
can be used with respect to these information
objects (e.g. find, move, store, get)
6
• Health Level 7
• HL7 provides standards for interoperability that
improve care delivery and optimize workflow
• Communication of textual information between
different systems (RIS, HIS, PACS, etc.)
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X–Ray Exam without PACS: an inefficient process
Un–Hang Films
& Attach Report
Patient
Registered Exam Performed
Patient Data
Re–Entered
at Acq Device
Previous Exams
hung in Reading
Room
GEYMS
CT
Return Films
to File Room Re–assemble
Film Jacket
Send Films &
Report to Referring
Physician
Retrieve Films &
Report to Referring
Physician
Radiologist Read
Dictate & Approve
Develop
Film Quality
Assurance
Hang
Films
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X–Ray Exam with PACS: an efficient process
Patient
Registered Exam Performed
GEYMS
CT
Radiologist Read
Dictate & Approve
Referring Physician
Accesses Report
and Films
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PACS are thus workflow-integrated imaging systems designed to streamline
operations throughout the entire patient-care delivery process (Huang)
9
To: Digital Workflow
From: Film Based Workflow
‘How can hospitals mature their PACS?’
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© 2010 Deloitte Touche Tohmatsu
PACS maturity concepts
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PACS maturity: an evolutionary plateau of process improvement including a
checklist to evolve on to the next level
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The PMM describes five levels of PACS maturity and towards higher levels
of maturity, operational efficiencies, IT-integration and effective care expand
13
References:
Van de Wetering, R. and R. Batenburg (2009). "A PACS maturity model: a systematic meta-analytic review on maturation and evolvability of PACS in the hospital
enterprise." Int J Med Inform 78(2): 127-40. &
Van de Wetering, R., R. Batenburg and R. Lederman (2010). "Evolutionistic or revolutionary paths? A PACS maturity model
for strategic situational planning." Int J CARS (in press).
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Does this sound familiar to you?
14
“… we see the computer age everywhere but in the productivity statistics.” Robert Solow, New York Review of Books, 12 juli 1987
Business/IT alignment
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A conceptual model was developed combining (1) PACS maturity, (2) PACS
alignment and (3) PACS performance
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Reference:
Van de Wetering, R., Batenburg, R., Oudkerk, M., Van Ooijen, P.M.A., Brinkkemper, S., and Scheper, W., A situational alignment framework for PACS. Published online 5 March
2011 in the Journal of Digital Imaging
a: PACS is compatible with current international
standards and classifications
b: PACS exchanges information with the RIS and
HIS without any complications
a: End-users affect the decision making process in
selecting a specific PACS vendor
b: End-users affect digital PACS-workflow and
functionality improvements
a: Impact and opportunities for chain partners with
respect to PACS
b: External environment is consciously inquired for
new developments to optimize PACS functionality
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© 2010 Deloitte Touche Tohmatsu
PACS Maturity results from Dutch hospitals
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Dutch hospitals matured PACS towards the beginning of level four and have
the ambition to mature PACS much further
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Lowest scores:
a: All departments of the hospital can request and plan
radiology exams using an electronic order-entry
system
b: All diagnostic images from other departments are
stored into one central PACS archive
Highest scores:
a: PACS is compatible with current international
standards and classifications
b: PACS exchanges information with the radiology
information systems (RIS) and hospital information
system (HIS) without any complications
a: (HIGHEST) Primary interpretation by radiologists
using uncompressed (highest resolution) images from
all modalities
b: (LOWEST) Strategic and operational (multiyear)
plans contain impact and opportunities
for chain partners with respect to PACS
Van de Wetering, 2011: A Strategic PACS Maturity Approach
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Dutch hospitals matured PACS towards the beginning of level four and have
the ambition to mature PACS much further
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a: (HIGHEST) Radiologist are aware of the fact that
PACS has the potential to influence the
competitive position of the hospital
b: (LOWEST) Innovative solutions (e.g. integration of
new tools and applications) with PACS are discussed
during clinico-radiological meetings
Lowest scores:
a: PACS generates comprehensive management
information that is always on time
b: The hospital has an accurate overview of the
contribution of PACS to overall cost prices per
radiology exam
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Dutch hospitals have the ambition to mature their PACS towards the
Enterprise PACS Chain while simultaneously improving their alignment
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PACS alignment Average scores
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Hospitals can formulate strategies and maturity roadmaps to further
improve the performance of the adopted PACS system
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Technical IS
perspective
Clinical
contributions
Service outcomes
Organizational
efficiency
PACS performance constructs
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© 2010 Deloitte Touche Tohmatsu
Trends and developments
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In search for metrics that allow standardized measurement of productivity,
for comparative evaluation and ongoing efforts to improve efficiency
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Source: Hu et al. (2011) Informatics in Radiology.
Efficiency Metrics for Imaging Device Productivity
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An illustrative example for automating real-time reporting on Imaging
procedures and productivity monitoring
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Source: Hu et al. (2011) Informatics in Radiology.
Efficiency Metrics for Imaging Device Productivity
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Q&A