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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

© 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

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

Revolution came with Röntgen's discovery of the X-ray

3

• 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

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 ”

PACS consists of many interrelated system components and is most

efficient when integrated with the Hospital- and Radiology information

system

5

PACS components

Source: Canadian Association of Radiologist Hospital IT-architecture

Source: Muller et al., 2004

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.)

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

7

X–Ray Exam with PACS: an efficient process

Patient

Registered Exam Performed

GEYMS

CT

Radiologist Read

Dictate & Approve

Referring Physician

Accesses Report

and Films

8

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?’

© 2010 Deloitte Touche Tohmatsu

PACS maturity concepts

PACS maturity: an evolutionary plateau of process improvement including a

checklist to evolve on to the next level

12

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).

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

A conceptual model was developed combining (1) PACS maturity, (2) PACS

alignment and (3) PACS performance

15

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

© 2010 Deloitte Touche Tohmatsu

PACS Maturity results from Dutch hospitals

Dutch hospitals matured PACS towards the beginning of level four and have

the ambition to mature PACS much further

17

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

Dutch hospitals matured PACS towards the beginning of level four and have

the ambition to mature PACS much further

18

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

Dutch hospitals have the ambition to mature their PACS towards the

Enterprise PACS Chain while simultaneously improving their alignment

19

PACS alignment Average scores

Hospitals can formulate strategies and maturity roadmaps to further

improve the performance of the adopted PACS system

20

Technical IS

perspective

Clinical

contributions

Service outcomes

Organizational

efficiency

PACS performance constructs

© 2010 Deloitte Touche Tohmatsu

Trends and developments

In search for metrics that allow standardized measurement of productivity,

for comparative evaluation and ongoing efforts to improve efficiency

23

Source: Hu et al. (2011) Informatics in Radiology.

Efficiency Metrics for Imaging Device Productivity

An illustrative example for automating real-time reporting on Imaging

procedures and productivity monitoring

24

Source: Hu et al. (2011) Informatics in Radiology.

Efficiency Metrics for Imaging Device Productivity

Q&A