Radiology volumes are growing larger and more complex, thanks to the proliferation of new, advanced modalities supporting the needs of an aging baby boomer generation. Studies take longer to read while the radiologist shortage means each physician is expected to read more and more studies each year. Along with this, reimbursement rates are decreasing for both radiology groups and facilities.

Radiologists and groups are being asked to do more work for less money. This creates a huge efficiency problem. Where will groups get the extra capacity needed to manage this increasing workload? Where will new efficiencies come from at a rate that will make up for unavailable FTEs?

Radiology groups must become more automated, gaining access to images quickly and cost-effectively while performing reads across multiple sites. Many of these groups have been led to believe that a vendor-supplied, enterprise-wide PACS solution is the best technology approach. The vendors offering this type of solution can be divided into two main categories:

• Large diagnostic imaging equipment and healthcare IT vendors (e.g., GE, Siemens, Philips, Carestream, Agfa, McKesson and Cerner); or
• Smaller PACS/Teleradiology vendors (e.g., Merge-eMed, Emageon, Amicas, ScImage, Intelerad, Novarad)

Radiology group leaders must realize that the industry is moving at light speed toward a post-PACS era, fueled by the broken technology promises of PACS technology providers.

Traditional PACS and Radiology Groups: A Dangerous Combination

One of the major problems with solutions offered by technology vendors is that they are not designed to meet the needs of radiology groups but are hospital-oriented “hand-me-downs” that are modality-influenced, film-influenced or HIS-influenced. They are not really focused on solving the problems of today’s radiology groups, but are prejudiced toward the needs of the film supplier, PACS provider or HIS vendor, and motivated to:

• Sell new MRIs at your facility
• Replace your HIS/RIS system; or
• Try desperately to replace money you previously spent on film

These vendors are trapped in a feature/function race that is focused on delivering more “bells and whistles” than the next vendor and not on the needs of radiologists and patients. Implementing a PACS solution is a resource-intensive money-pit, when it comes to up-front costs, shipping, set-up, testing and then waiting for version 2.0 because version 1.0 is “buggy” or simply doesn’t work. The list of problems with PACS for radiology groups includes:

• Traditional PACS not optimized for a multi-site radiology model
• Inability to easily scale system with radiology group growth
• Poor or no workflow
• No Internet connectivity
• Expense and complexity of managing onsite hardware, applications, databases
• Technology obsolescence
• High-upfront capital outlay
• Long, complicated implementation cycle

Why PACS Fail in a Multi-site Radiology Group Environment

Using PACS to move images around inside the four walls of a hospital and push them to a physician's worklist is easy. When you attempt to go outside the walls to try and deliver images effectively, you face the problem of lower bandwidth networks that are a reality in the radiology group world. PACS companies fail in teleradiology and virtual radiology because they are not engineered to send thousands of studies across T1 and DSL lines to support reading at multiple sites.

What are the Risks of PACS Solutions for Radiology Groups?

Risks of implementing a PACS solution for your group can come in many forms:

• The risk of making an upfront million-plus dollar investment and never actualizing the value of that investment;
• The risk of needing to make a change that will help you adjust to new industry requirements and being saddled with technology whose potential for adaptation is cost prohibitive; or
• The risk of needing to embrace new, innovative ideas and approaches that could provide a strategic competitive advantage and not being nimble enough technologically to pull them off.

These are significant risks to your practice growth, profitabilityand longevity that should be thoroughly considered before entering into such a serious, expensive and long-term commitment.