Picture Archiving and Communications System (PACS)

A Picture Archiving and Communications System (PACS) is used in digital radiography to manage the storage, retrieval, distribution and presentation of DICOM images (i.e., X-rays, MRIs, CAT scans). A picture archiving and communication system is often used in conjunction with a Radiology Information System (RIS) to efficiently execute the radiology workflow.

The picture archiving and communications systems market is fairly large and complex. There are a number of software companies and medical device manufacturing companies developing PACS for all sizes of medical organizations and all types of specialists. The result is a market that is fragmented and potentially confusing to buyers. We’ve assembled this guide of the PACS market to help buyers know where to begin their initial research and comparison. 

Here’s what we’ll cover:

What is a PACS?
Deployment Strategies
The PACS Vendor Landscape

What Type of Buyer Are You?
Market Trends You Should Understand
Benefits & Potential Issues

What is a PACS?

If “a picture is worth a thousand words,” then picture archiving and communications systems may give the Library of Congress a run for their money. PACS programs are used in digital radiography to store, manipulate, and distribute images. The universal standard format for these images is DICOM (Digital Imaging and Communications in Medicine), and they may include X-Rays, MRIs, CAT scans, or ultrasounds.  

A PACS consists of four major components: the image modality such as MRI or CT, the network by which images and patient information are securely transmitted, the individual client workstations for viewing images, and a database for storing image data. Web-based or web-enabled systems will allow for the distribution of image data across a distributed network of provider organizations. 

Deployment Strategies

Picture archiving and communications systems are often implemented as standalone systems. They may be sold along with an imaging device by vendors such as GE or Philips, or may be sold separately by software vendors. PACS will often need to be integrated with electronic medical records (EMR) systems, but these are rarely sold together since buyer needs vary so much and the timeframes for purchasing can be very different. Finally, radiology centers often purchase PACS integrated with radiology information systems (RIS) to have one integrated package to manage images and corresponding clinical patient data. 

What Type of PACS Buyer Are You?

Before you can evaluate picture archiving and communications systems, you’ll need to know what type of buyer you are. We have found that almost all buyers fall into one of the following three categories:

• Hospitals. These buyers typically have very robust needs for the storage and efficient retrieval of lots of images. Due to the varying nature of care provided, they need a flexible system that can be accessible from multiple departments or locations. 
• Midsized and large outpatient practices. These buyers work for private practices with robust enough imaging needs to warrant a formal PACS. These practices typically have multiple physicians on staff specializing in orthopedics, cardiology, neurology, ophthalmology, and other image-intensive specialties. 
• Radiology centers. These buyers typically process a high volume of images and require a robust system. They will often purchase a RIS and PACS as an integrated suite, although they may buy either system on a standalone basis. 

The PACS Vendor Landscape

While the picture archiving and communications systems landscape is highly fragmented and may at first appear confusing, the available solutions are differentiated by their appeal to the different buyer types.

Market Trends You Should Understand

These trends should be considered as you select a product and vendor.  

• Software as a Service (SaaS). SaaS applications have become very popular in enterprise computing and the healthcare market. Due to the distributed nature of many PACS users, SaaS can be a suitable option to many organizations. They can make it much easier to share images without complex network infrastructure. 
• Mobile applications. As physicians and other healthcare providers accomplish more on the go, the use of mobile devices such as iPhones and iPads has grown quickly. Many vendors are reacting to this trend and making systems accessible from handheld devices. 
• EMR adoption. Although not a substitute for PACS, government legislation requiring eligible providers to implement EMRs could potentially impact PACS purchases. Most organizations will need a picture archiving communications system with an HL7 interface to enable integration, or may even try to use a robust EMR to meet their image storage needs if they are not very complex. 

Benefits & Potential Issues

PACS are designed to benefit both clinical and administrative staff. Users should expect the following benefits when adopting a formal PACS:

• Efficiency. Organizations should be able to eliminate most or all of the hassle associated with printing images, storing them in folders, transporting them, and retrieving them. PACS enables all of these process to be accomplished much more quickly and efficiently, reducing a lot of bottlenecks experienced at hospitals and other busy imaging centers. 
• Security. Data encryption techniques can ensure data security and patient privacy much better than physical images and paper charts. Buyers should expect HIPAA-compliant systems and user-level password protection. 

As with all technology, buyers should be aware of the potential issues, costs, and return on investment as well. Buyers will want to make sure that their selected PACS vendor offers necessary data backup and encryption technologies. The critical metric for any PACS system is that the costs to store, review, and retrieve images go down. The costs associated with these tasks can be far-reaching, ranging from the staff required for repetitive tasks of putting away and pulling images, the time spent manually reviewing series of images, and the direct costs of paper, shelving, and other materials required to store physical images. Buyers should also expect to improve their ability to properly assess images and draw conclusions due to image viewing and annotation tools built into most PACS. 

Have an opinion on this guide? Email the authors. We appreciate the feedback.

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