Several interesting posts popped up on Auntminnie’s PACS Forum today. Two were related to display software for referring physicians, and two others were related to the log-term archive. In my first response , I spoke about the importance of picking a PACS that featured a single display package that allowed system managers to create individual user profiles by assigning display features through user privileges. I also suggested that the Health System should consider providing the display hardware and IT support for their high volume users, because it would be cheaper in the long run than producing and managing film. In a follow-up response, I flat out stated that as much or more attention should be paid to the display software that is going to be used by the referring physicians as is paid to the display software being used by the radiologists. Failure to win over the referring physicians, especially the surgeons, will surely doom a PACS project.
The first of my responses to the archive issue focuses on using a spinning disk solution for the Disaster Recovery subsystem, and the need for some sophisticated Information Lifecycle Management software in the archive that would make it possible to migrate data from media to media and delete data based on information about the study contained in the DICOM header. In the same article, I couldn’t help but ask the question why anyone would create an exact duplicate of the original image data, if the PACS utilized any proprietary formats. It seems to me that if you are going to invest good money in a DR solution, the second copy should be 100% DICOM and 100% inter-changeable with another PACS. This would eliminate future data migration costs. In a second response, I suggested once again that the time has come to separate the Archive from the PACS. The PACS vendors insistence on using Private Tags and proprietary encoding is blatant vendor lock. It is expensive (data migrations) and it should be stopped.
So here is my simple Guideline for picking the best PACS
1) Distributed server architecture. Each facility gets its own Directory and Data database servers and there is one shared long-term archive. Each facility is self-sufficient, yet there is one consolidated patient folder. The central shared server “aggregates” all of the information from the facility servers. The user doesn’t have to know where to look for any study on any patient in the system.
2) Single master copy of display software, one common GUI, fat client for performance, web-delivered for zero administration. Each user can be granted access to whatever display features and tools they think they need.
3) Software license fee is based on the number of studies under management, NOT the number of users, or the mix of features/tools being assigned.
4) PACS-neutral Archive: guaranteed universal connectivity, ability to morph DICOM Header Tags in order to copy any meta data in Private Tags to Public Tags, no future data migration necessary. If the PACS vendor that ranks the highest in every other category cannot provide this kind of archive, buy the archive from the vendor who can and configure the PACS with a small working cache.
5) Make sure the archive supports a sophisticated ILM strategy, one that migrates data from media to media or deletes data based on information in the DICOM Tags, data transfers have zero impact on the PACS or Archive application server.
There are other important issues and features to be sure, but they pale in significance to these five.