But the growing volume of data leads to the growing number of data management problems. Information has to be organized to be meaningful, and today’s volume of information is too large for any one person to manage, especially in the high-volume fields of medical imaging.

A recent study published in Radiology, authored by a team headed by Katherine Andriole of Brigham and Women’s Hospital in Boston, offered 5 suggestions for dealing with the huge volume of data in radiology work:

1. Improving the Signal-to-Noise Ratio to more quickly direct a radiologist’s gaze to difficult-to-recognize abnormalities.
2. Using Motion and Color to Convey Change Over Time. According to Andriole, advances in 3D volumetric rendering and the addition of time and other functional measures can, if used properly, make change over time easier for radiologists to see and analyze.
3. Time-Saving Interface Devices like joysticks, touch-sensitive screens, voice-activated commands, and other developments (many from the world of gaming).
4. Easy Access to Multiple Relevant Studies would enable radiologists to consult a wide range of situation-specific literature without leaving their chairs or their medical imaging programs.
5. Easy Methods for Annotating Images so that radiologists can quickly convey their analyses to other medical professionals. Likewise, incorporating handheld devices, wireless networks, and cloud computing into medical imaging communications will make it easier to convey images and their interpretations to primary caregivers.

In order to keep up with the need to manage ever-larger sets of data, radiologists and other medical imaging professionals have to be somewhat revolutionary. The ongoing revolution in the volume and management of information technology is leading to a revolution in the role of the medical imaging specialist in direct patient care, says Andriole.

Learn how intelligent workflow tools and a system optimized for high volume data sets improves the radiologist experience by viewing McKesson’s Horizon Medical Imaging™ demo .

Imaging the World (ITW), a US  based non-profit that develops medical training and technologies to bring medical imaging to remote areas around the world, recently received a $100,000 grant from Grand Challenges Explorations, which funds scientists and researchers worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges. Grand Challenges Explorations is one of many global health initiatives funded by the Bill & Melinda Gates Foundation.

ITW aims to use the money to support its efforts to bring low-cost ultrasound technology to areas of high maternal and neonatal mortality. According to ITW, advance warnings of critical maternal conditions made possible by ultrasound technology can dramatically improve maternal and foetal morbidity and mortality in the most vulnerable populations.

McKesson Medical Imaging vice presidents Joe Biegel and Rex Jakobovits serve on the Board of ITW. “Joe and I were personally inspired by the ITW team,” says Jakobovits. “Serving on the ITW Board is a golden opportunity: A chance to leverage our unique expertise in a ‘ground floor’ effort that has a good chance of making a real difference in the lives of millions of people by helping to usher in the ‘age of imaging’ in the developing world.

Biegel and Jakobovits don’t just help govern ITW. They recently coordinated a McKesson donation of a PACS and time from experts to the organization, and they devote many hours of their own time to help spread medical imaging around the world.

• Specialization and easy image transfer revolutionized medical imaging practice. As medical imaging technology improved, hospitals went from using medical imaging infrequently to demanding it in many different fields. PACS enabled radiologists and other medical imaging professionals to consult with one another easily, even if they were in different locations.
• Demand for radiology is not going to go down. It’s just too valuable as a diagnostic and interventional tool.
• Radiologists will have to adapt to a different payment model. Fee-for-service is slowly going away and quality-based payment is growing, which means that both in-hospital and independent radiology groups will probably have to get bigger and more efficient to survive. Radiologists will also gravitate toward larger groups when it becomes too cumbersome to be in a practice that demands lots of time without proportional reimbursement
• Radiologists need to get much more involved with their clinical colleagues, both as educators and consultants. Clinicians need interpretations on their patients’ schedules, and radiologists have to adapt to that.
• Full-service radiology practices will be the norm. These practices will include several specialties and subspecialties and will provide 24/7 service for emergency rooms and other after-hours practices.
• Constant improvement is a necessity. Hospitals and other healthcare providers want more value from their radiology and other medical imaging departments. Radiologists have to constantly learn how to deliver.

Subscribe to this blog for regular updates on improvements in medical imaging and other health care-related fields.

The rule would create a two-step EHR certification process:

1. First, organizations could get certified much quicker to meet deadlines to apply for the first round of meaningful use stimulus funding. The first round of funding would occur as soon as October for hospitals and Jan. 1, 2011 for physicians and other eligible professionals.

2. In phase two, the testing and certification would be transferred to private sector organizations.

HealthLeaders Media spoke with health care IT leaders from across the US, who by and large support the proposed rule. Health care IT leaders cited a number of benefits:

• Not only could financial incentives be provided more quickly, but patient care could be enhanced more quickly as well.
• Because meaningful use is a highly complex process, government would be slower to adapt to changes in technology
• Private certification organizations have worked well in other similar situations.

Tell us, do you support the new proposed rule regarding testing and certifying of Electronic Health Records (EHRs)?

For all the latest radiology and medical imaging technology news, subscribe now to the Medical Imaging Talk blog via RSS feed or email. Or follow us on Twitter today.

No more than:

• Proper staff training
• The right PACS solution
• Thorough assessment of user requirements
• Accurate budgeting in terms of costs and time

And of course, an experienced, knowledgeable PACS administrator.

Scott Griffin, PACS Administrator

PACS Administrator Scott Griffin’s previous experience with several large-scale implementations helped Southeast Alabama Medical Center seamlessly install a PACS. The implementation was so successful, the hospital was able to go 90% filmless in less than six months.

We sat down with Griffin to learn what it takes to successfully complete a PACS implementation, as well as what it takes to be an effective PACS administrator.

How did you get into the field of radiology and imaging, specifically as a PACS administrator?
When PACS was first introduced to me, I thought it would be the best use of my skills in that I have always been fascinated by computer technology.  Also being interested in radiology management, I knew knowledge of the systems that would ultimately one day be the life blood of the department would be a great tool to have on my side.

What makes a good PACS administrator?
Some of the important qualities are:

• The ability to think on your feet
• Not always knowing the answer ahead of time is ok
• The ability to work well with physicians and hospital personnel
• Always looking for ways to improve things

To what do you attribute getting the PACS at Southeast Alabama Medical Center up-and-running so quickly and smoothly?
I attribute that to having a great install team, knowledgeable and supportive IT staff with superior infrastructure, and a supportive medical staff. And a little experience never hurts either.

SAMC was my third install at a large hospital (over 400 beds) so a lot of the anxiety that I felt at previous installs was replaced with a running mental checklist of what needed to get done, along with, “What have I missed?”

What tips would you give to a hospital that hasn’t yet implemented a PACS?
Look at everything!  Many hospitals fail to remember all the locations where they view images. In many cases, they forget to budget for necessary upgrades/replacement of computers throughout the organization.  This may include complete replacement of key computers, as well as upgrades to memory and monitors throughout the facility. Planning and budgeting for this ahead of time makes a huge difference for all involved.

What advice would you give a hospital at the early stages of PACS consideration?
Run the ROI and talk with other facilities that have grown volume with no additional Full-Time Equivalents (FTEs).

Learn more about the PACS implementation at Southeast Alabama Medical Center by downloading the case study.

For all the latest medical imaging and PACS news, subscribe now to the Medical Imaging Talk blog via RSS feed or email. Or follow us on Twitter today.

Ken Olbrish on PACS implementation best practices

In this day and age, Picture Archiving and Communication Systems (PACS) are essential for providing images immediately and anywhere. Main Line Health System Enterprise Imaging Administrator Ken Olbrish understands that firsthand.

Main Line Health System, located outside of Philadelphia, successfully completed an enterprise PACS implementation. We sat down with Olbrish to discuss lessons learned from the PACS implementation.

When a PACS must be integrated with other devices, what challenges do administrators face?
There are several challenges for PACS administrators to overcome.

First, there is the initial set up. It would be nice to believe that devices are all standardized in terms of their interfaces because they utilize existing standards such as DICOM or HL7. While these standards help to get device integration working at a basic level, vendors may choose to implement these standards differently or choose to implement only certain aspects of these standards. As a result a PACS administrator may find that while a device can communicate, not all the information that is needed is present in the transactions or images, or data may not appear consistently across devices.

Second, there is an ongoing problem of having to deal with differences in versions. In an ideal environment, all similar devices would be upgraded at the same time. But it is not uncommon that a hospital or healthcare enterprise could have several of the same devices all operating on different software platforms or versions because of the timing on when they were implemented, when money was available for upgrades, when devices were available for upgrades, etc. PACS administrators must be constantly aware of changes being made to existing devices to ensure they are tracked and integration is tested following updates.

How can these challenges be overcome?
For all of the integration challenges outlined above, there are several basic things a PACS administrator can do to address them:

• Attempt to schedule defined time for integration and testing into the PACS implementation project timeline. This obviously doesn’t ensure the time will be available when it is time for the integration if there are earlier delays in the project, but it does at least help to ensure that time is allocated for the integration. If nothing more, this will raise awareness within the organization as to how much time it takes to perform the integration.
• Maintain current documentation that outlines versions and other relevant information. By tracking this information, a PACS administrator may have a better handle on what devices may behave differently and have information necessary to work with vendors on resolving integration issues.
  
• Create a test environment and test as thoroughly as possible before new implementations and upgrades. A PACS administrator should create test scripts for each integration that can then be updated and reused for subsequent upgrades over time. By working out integration issues in a test environment, there is less likelihood that issues will arise in a production environment. It is extremely helpful to get key users engaged in the testing, whether these are physicians, technologists or other super users of the systems involved.

What are a few of your top tips to ensure a smooth PACS implementation?
1. Assess user needs and requirements before the PACS implementation begins. To obtain user buy-in, the users need to be engaged in the process and feel that their needs are being met through the implementation of whatever system is ultimately selected and implemented. When assessing user needs, it is also important to include representatives from all impacted areas.

2. Look at workflow and processes as much as or more than the system being selected. System implementations often fail not because the system doesn’t work, but because the processes associated with using the system fail. Trying to duplicate inefficient or bad processes with new systems or technology leads to failure.

3. Include more training in the rollout than you think you need. When systems are implemented and there is not enough training, it limits the likelihood of success. An environment and schedule need to be created to allow users to attend training and not be rushed or interrupted during training. Furthermore, training often works better when it is spread over time. Initially users will just need to learn the basics of the system. But after several weeks or months of using the system, users will most likely need additional training to take their use of the system to another level.

4. Budget accordingly in terms of costs and time. Estimating capital costs for a new PACS implementation is easy. Estimating ongoing operating costs, costs for professional services, costs for integration, etc., are much more difficult to assess without proper planning. Sites often look at PACS needs at the time of implementation, but fail to look at more long-term needs. For instance, it may take only one or two resources to support a PACS initially. But if use of the PACS expands significantly for referring physicians or multiple clinical areas, or additional support responsibilities are added for those resources, then more PACS support resources may be needed in subsequent years. These should be included in the initial planning.

For the latest news and insight on PACS implementations, subscribe to the Medical Imaging Talk blog via RSS feed or email. Or follow us on Twitter today.

Glen Falls Hospital

Glens Falls Hospital and its affiliated private practice radiology group, Adirondack Radiology Associates, needed a way to effectively manage medical imaging and reports across the enterprise. Faced with fragmented imaging records across a wide geographic region and facilities, these providers opted for a Picture Archiving and Communication System (PACS) implementation to create a unified view of patient records and increase clinician productivity and satisfaction.

The Medical Imaging Talk Blog discusses the successful PACS implementation with Dr. Dan Chernoff, radiologist and director of radiology at Adirondack Radiology Associates.

How has the recent implementation of the PACS improved efficiencies and cost savings?
The PACS improves department efficiencies in a myriad of ways, including no lost or misplaced films, images available to multiple users simultaneously, much more efficient soft-copy review of studies compared to film, much better and faster access to prior studies for comparison, and faster turn-around time from imaging to diagnosis.

What reaction have you received from staff and doctors in regards to the PACS implementation?
The response to PACS from staff and clinicians has been overwhelmingly positive. Gone are the days when clerical staff and clinician time was wasted pulling studies from a film library, shuffling through a huge film jacket and discovering films were lost or signed out. Being able to view imaging studies from home has been a god-send not just for radiology calls but also for clinical specialists on call (e.g. neurosurgery, orthopedics).

In terms of introducing staff to the new system, what lessons learned would you offer other hospitals and clinics?
Radiology staff and radiologists were trained directly by McKesson. These radiology super users then trained all others once they were up-to-speed. A lesson I can offer others is to assume that some users will be difficult to train and/or reluctant to change their method of accessing radiology studies. Either accentuate the positive and accept some level of dissatisfaction over change, or have a plan to satisfy “special needs” providers. For example, we did not plan well for PACS in the OR. The mobile carts were not well accepted, and we went back to printing film for the OR until their needs were met.

Can you give some specific examples of how the PACS implementation has affected staff?
The orthopedists, neurosurgeons and neurologists on call were extremely happy that they could review studies at home and do not have to drive in to see every ER patient for whom there is a questionable imaging finding.

For radiologists, we implemented a Master Patient Index, allowing studies performed at the hospital and the radiologist-owned outpatient imaging centers to be contained within a single “virtual jacket” for each patient. This has saved untold hours of trying to get images up from disparate PACS databases for comparison purposes and has probably saved a life on more than one occasion – without for the combined database, a critical comparison would not have been made in the name of expediency.

Were there any surprises during the PACS implementation?
Lack of planning, or more properly lack of thorough consultation, for the OR was one mistake. At the time of purchase, we did not have the resources to fully implement a fault-insensitive system (backup servers, backup network, etc). We are now about 75% there and would like to be at 100%, as PACS is now mission-critical for the hospital.

What risks are there for hospitals that choose not to move forward with a PACS implementation?
Risks to not implementing a PACS include lower department efficiency, higher costs, lack of scalability, slower turn-around time, opportunity to lose images and overall poorer patient care due to limitations of image storage on film.

What do you think will be the next greatest advancement in Radiology Information Systems (RIS)?
I think advances in RIS will include improved data mining tools, more standardization to allow interoperability with other information systems, growth of SAAS or hosted RIS, opening of radiology scheduling to patients and referring physicians, growth and integration of critical results reporting software, and growth of integrated decision-support tools.

Allan Noordvyk

For Picture Archiving and Communication Systems (PACS), the future looks very bright. Medical Imaging PACS is quickly becoming the standard for healthcare organizations across the country. In fact, thousands of healthcare enterprises have already upgraded to PACS technology – with more organizations joining the list every day.

Earlier this month, Imaging Economics sat down with Allan Noordvyk, director of radiology/product management for the McKesson Medical Imaging Group – along with Tim Kulbago of Merge Healthcare and Michael Green of Agfa HealthCare North America – to discuss the future for PACS.

Below are excerpts from the Imaging Economics interview with Noordvyk:

How have PACS systems changed over the last decade?

Noordvyk: PACS is considered a mission-critical component for patient care and service delivery; hospitals cannot afford for the system to be down. Hospitals are replacing the single use/departmental solutions that do not improve efficiencies or position them for future success (and health care dollars). Products and improvement must focus on workflow and productivity enhancements, not just adding a button or isolated feature. Real improvements help hospitals improve their operations, service delivery, patient care outcomes and operational goals.

There’s a sense of urgency in the market – hospitals that haven’t planned for the future may get left behind. Buying another scanner is not a solution for long-term success – investing in IT is. And image management is at the core.

PACS is now pretty standard in most large hospital settings. What about community hospitals and imaging centers? What’s the biggest barrier to adopting a PACS system these days?

Noordvyk: In reality, few facilities have not adopted PACS. [The issue is that] facilities are re-evaluating their PACS decision. Does their existing PACS position them for future success, government funds, etc? They’re looking for replacement solutions that deliver on the promise (and take them into the 21st century).

What are customers demanding these days regarding PACS? Are you seeing that radiologists are becoming savvier about digital imaging and technology in general?

Noordvyk: Radiologists and administrators are looking for solutions that enable them to acquire, distribute, and archive medical images and diagnostic reports across the enterprise. Integrating images from multiple modalities with clinical patient data, streamlining the department’s workflow, and contributing to improved radiologist efficiency.

Additionally, they need systems that provide referring physicians with patient images as part of a comprehensive medical record. The status quo is not a viable business plan – they’re looking for vendors that get them closer to their goals and objectives and deliver on expectations.

We hear a lot about thin-client, Web-based, and even zero-client PACS systems – what are the key benefits of each? Who needs what most?

Noordvyk: McKesson pioneered the concept of the zero-download PACS client with our eJacket interface for referring physicians. The two main benefits of zero-download are immediate access to patient information from a new device and cross-platform support. Both are of increasing importance as recent generation iPhones, Blackberries and other PDAs become commonplace in the hands of health care workers and thus mobile access to images on modest, non-Windows platforms is increasingly in demand.

If it’s done correctly, zero-download clients can also be zero-training clients. However, the technology currently available for zero-download clients remains insufficient for high-performance sophisticated image manipulation and the underlying required network and data management strategies. Thus, for radiologists classic downloadable Web clients are still required.

What are the latest trends? How is PACS continuing to enhance workflow and efficiencies for radiologists?

Noordvyk: Health care providers/radiology service providers are finding the limitations in the PACS they purchased years ago hinder their success now, have not lived up to the promises and their expectations, and are restricting their ability to plan for future success. Users are often still forced to use 19th-century workflow and technology but in an increasingly more complex and demanding 21st-century environment.

What you’ll be seeing from McKesson is optimizing workflow and productivity in the breast center. By minimizing the duplication of effort caused by disparate systems and removing redundant hardware, the potential for errors is reduced. The automation of tasks provides maximum efficiency for the radiologists and other clinical personnel while providing better, safer patient care.

Discover even more about PACS’ future by reading the full Imaging Economics article.

Dr. Jonathan B. Kruskal

The advancement of medical imaging technologies, such as Picture Archiving and Communication Systems (PACS) and Radiology Information Systems (RIS), is contributing to a host of clinical advantages. At the top of that list of advantages are radiology risk management and improved safety – for patients and staff alike.

During the 2009 RSNA Scientific Assembly and Annual Meeting, Dr. Jonathan B. Kruskal shared insight on safety and risk management in radiology departments. We sat down with Dr. Kruskal, chairman of the Department of Radiology at Beth Israel Deaconess Medical Center in Boston, to learn how RIS can contribute to reduced errors.

How can RIS help reduce errors in clinical radiology departments?
RIS allow certain loops to be closed, such as communication of abnormal results and follow-up of recommendations for abnormal results. But it can also be used for and linked to facilitating a peer review process, a quality and safety reporting and management process, and minimizing variation in reports and communication to referring physicians through structured reporting. I believe that in the future, RIS will be an essential component for any quality program.

You spoke during RSNA 2009 on radiology risk management. What were some of the top points you made during your session?
During my RSNA talk, I covered radiological errors. The major points I made are that errors occur commonly. We all make mistakes, but it is essential to use analytic processes to turn each error into an opportunity for improvement.

I described a new error classification system that, instead of focusing on the human component, will bring in the spectrum of latent or organizational contributors and will place the patient at the center of this classification. The essential message is that when an error occurs, a variety of other minor contributors have also been set in motion to facilitate this error from taking place. Error detection systems are essential in order to manage errors, minimize the degree of harm, manage personnel involved and identify contributing factors so they can be eliminated.

What measures have been taken at Beth Israel Deaconess to reduce errors and improve radiology risk management?
At Beth Israel Deaconess, we have established a comprehensive program as was recently described in our manuscript, “Strategies for Establishing a Comprehensive Quality and Performance Improvement Program in a Radiology Department,” in RadioGraphics. We have a triple reporting system:

• The first is a web-based patient safety reporting system managed by our Health Care Quality Department in the hospital.
• The second is a mandatory peer-review process where each physician is expected to peer-review at least 5% of his or her prior year’s volumes – these are actively managed and audited.
• Lastly, is an intradepartmental web-based reporting system for all errors, be these technical or clinical.

It is our cultural expectation that all staff, be they technical, physician or trainees, participate and report all errors freely, including those that are near misses. These are all managed by our Quality Management Team, who audit and seek trends.

Can you offer a real-world example illustrating how errors were reduced through radiology risk management?
To reduce errors, we have a vigorous evaluation of all reported errors and link this to ongoing safety walkabouts and hazard analyses. All errors undergo root cause analysis, seeking to identify contributing causes. Any sentinel event undergoes a thorough root cause analysis with action plans and assigned accountable personnel to follow-up and ensure that this strategy is working.

A good example was a wrong joint injection under fluoroscopy. The error was immediately detected and reported, and disclosure was made to all relevant personnel, including an apology to the patient. A same-day visit to the site took place to identify exactly what happened, and a root cause analysis then took place 48 hours later.

At this analysis, the human factors were fully evaluated, from the decision to order the study to the interaction with our schedulers, office staff, technologists, sonographers, nurses, radiology fellow and radiology attending. We also looked at the contribution from the patient to identify any potential patient factors that may have contributed to this.

We then looked further at the latent contributors and identified a number of contributing factors to this error. Specifically, an unusual abbreviation was used in the requisition. All other steps were performed correctly, including performance of a time-out. However, the time-out demonstrated some variation in that the requisition was not read out aloud, but the patient ID, the perceived request and the location of the correct left third toe were all verified. The patient, indeed, even verified the procedure.

Latent contributors were that the section was understaffed (one staff member was out sick) and the attending had read over 170 cases before. The fellow was experienced and excellent, and therefore, the attending perceived no risk in working with this fellow. Both the fellow and the attending never had any prior similar experiences.

As a result of this root cause analysis, we have now established a new policy for not using even unfamiliar abbreviations when scheduling. We have also introduced a scripted pre-procedure time-out so that all elements of the time-out are not only documented, but described, and are all participated in, specifically in reading out the requisition for the study. Subsequent to this time, we have not had a wrong site procedure.

Looking ahead, how do you foresee technology advances allowing for even greater radiology risk management?
In terms of further reducing errors in radiology departments, several steps need to take place.

Beyond simply adhering to the Joint Commission requirements that all hospital systems have error reduction systems and perform vigorous root cause analyses, cultural shifts are required. All staff working in a department must view errors as important opportunities for analysis and identification of contributing factors. In addition, this cultural shift will require the free, anonymous and non-punitive reporting of errors so that opportunities for improvement can be identified.

The requirement that all trainees now undertake an outcomes project is a unique opportunity for training in this culture. We now expect each of our residents to undertake a month-long quality and safety rotation where they are exposed to the tools of quality and safety. They also undertake a project aimed at improving safety for all patients and staff in our department.

In addition, the ability of RIS to link to PACS and to allow peer-review, easy, auditable, manageable reporting of all events will facilitate this improvement. This could also be further improved by allowing dosage of radiation exposure to be continuously recorded within the studies. That way, when a study is ordered, the ordering physician is fully aware of what prior studies have been performed and what the patient’s prior exposure dose is.

Beth, as an associate professor in radiologic sciences at Midwestern State University, do you think PACS is being incorporated into medical school curricula?
Veale: Most programs include PACS in their discussion of digital radiography. If the program teaches their own computer course, I have found they will place the PACS information in that course. Upon graduating, medical students need to understand the purpose of PACS, what their responsibilities will be regarding the storage of medical images and the repercussions of incomplete information entries. 

What aspects of medical imaging most interest your students?
Veale: At the beginning of their education, they like hearing about real-life situations, things that connect the more technical aspects with human aspects. They love to create images. Once they continue to clinical practice, they tend to drift towards certain areas like CT, MR or emergency room procedures.

In researching for your book, what did you find to be the greatest radiology PACS achievements over the past few years? What will be the next greatest advancement?
Carter: The biggest achievement seen in PACS has been the full integration of Health Information System (HIS)/Radiology Information System (RIS)/Voice Recognition Dictation.

The next greatest advancement will be the use of images more portably. Perhaps the use of handheld devices at the bedside will be used by a larger audience once the resolution of those devices can properly handle medical images.

When moving from a film-based system to a radiology PACS, how can hospitals ensure their staff has the proper training?
Carter: The department administration must first understand the impact the system will have on their department. They must take the time to learn the system just as much as the PACS administrator. They may not be day-to-day hands-on with the system, but they must have a thorough understanding.

The most important thing a PACS administrator can do is train several super users for the system. These folks will be the front line defense when issues arise in the department or outside the department for general users (OR, ER, ICU, floors, etc.). I am a firm believer that the PACS is only as good as its users. If they are properly trained, the system will meet their needs. 

What advice would you give to healthcare organizations about to begin a radiology PACS implementation?
Veale: Planning, planning and more planning. There are so many details concerning implementation that, if ignored, will cause many issues later. Do the research and make sure the project is well laid out and that enough people are informed and involved so that the process goes smoother. 

For organizations not considering a radiology PACS, what advice would you give?
Veale: The time for physical storage and slow retrieval of images is past. Healthcare organizations will find in the near future that if they cannot provide information as quickly as other providers, they will lose business.

What thoughts do you have on the future of radiology PACS?
Carter: As long as computer equipment and networks continue to advance, PACS will continue to move forward also. Many early adopters of PACS have seen the life cycle of their systems come to an end. Many have moved on to different vendors offering newer technology. The PACS vendors must keep up with the upwardly mobile IT industry or they risk losing their long-time customers.