A post on AuntMinnie’s PACS Forum on April 21 posed the question “Will EHR impact PACS?”. A number of the regulars on this forum, including myself have posted their opinions. I find it interesting to see a number of individuals suggesting that the Electronic Health Record (EHR) will morph into some kind of Super PACS supporting Radiology, Cardiology, etc. and featuring a universal viewer.
Last time I checked, the major PACS vendors were still having difficulty integrating their own Radiology and Cardiology PACS into the same platform, so I don’t hold out much hope for these PACS solutions suddenly becoming EHR systems, nor do I believe the EHR vendors are going to burden their development schedules with the effort it would take to add Radiology and Cardiology data management and display applications to their systems.
PACS will continue to focus on the individual imaging departments work flow and diagnostic applications, and EHR will continue to focus on aggregating all sorts of clinical information required to manage a patient’s course of treatment or general healthcare. I realize that all this stimulus money targeted at EHR usage will “stimulate” the market, but I don’t think there is enough time for any of the vendors of any of these systems to reinvent their wheels. The fastest route to market is to simply sell what already exists.
EHR systems have historically deferred to the PACS for the image management and the clinical review applications. A relatively simple interface, currently based on a URL call, retrieves the image data referenced in the EHR listing and activates the corresponding PACS display application to display the images. This model has been working just fine for some time now, with Radiology PACS being the principal data management system.
Unfortunately, as additional department PACS are deployed, each additional PACS would require its own URL interface to the EHR. Multiple interfaces mean individual, separate viewing sessions based on individual separate display applications. The physicians would have to learn to use separate and different display applications. There would be no way to consolidate all of a patient’s images from separate departments into a single viewing session within a single viewing application.
My answer to the question posed by the AuntMinnie thread is that the stimulus package will most likely have an immediate impact on the PACS-Neutral Archive rather than the department PACS.
Assuming the EHR will continue to defer to another system for the image data management and display applications, it makes much more sense for that other system to be a consolidated PACS-Neutral Archive (PNA) than multiple department PACS. The PNA is much further ahead of even the best departmental PACS in managing image data from disparate systems. The PNA is much further ahead of the best departmental PACS in managing image data for the lifetime of the study. The PNA is the better platform for managing non-DICOM image data and supporting a multi-modality universal viewing application. Even before the promise of stimulus money, the PNA had a very positive ROI based on the cost of future data migrations avoided.
In conclusion, I don’t see PACS enveloping the EHR applications, and I don’t see the EHR enveloping the departmental PACS applications. I see the EHR and the PACS remaining pretty much what they already are, separate entities. Because of that focus, I do see them becoming more proficient at their respective tasks. As a consequence, I see the PACS-Neutral Archive coming into its own as the central multi-modality image data repository and provider of the UniViewer display application.