Can PACS Have its Cake?

Ms. PACS: If you look at the entire radiology imaging cycle, according an interview I did with Paul J. Chang, M.D. last week, one of the most efficient areas, he said, is the reading room.

Dr. Chang is conducting a “Closed Loop Imaging” research trial (see video) in which his team identifies the bottlenecks and inefficiencies not just in PACS, but throughout the whole loop - from reception, to the imaging suite with setting up the injector and scanner, to post-processing images and of course getting the report in front of the right doctor in the necessary amount of time – whether urgent or not.

What surprised Dr. Chang was the efficiency of PACS. “What I noticed was that PACS companies in general along with speech recognition companies and the integration of speech recognition basically have resulted in incredibly efficient and very optimized reading rooms,” he said. “Here’s the problem, it doesn’t matter how efficient we are in the reading room if the rest of what we do in radiology is inefficient. I can be incredibly accurate in radiology in the reading room, but if the study was not acquired accurately, it’s the old garbage in, garbage out.”

So this is a good report card for PACS – or is it? Perfection leaves little to room for repair, i.e., if it’s not broken, how can you fix it? Of course we know nothing is perfect – especially not PACS – because it continues to evolve and there are always bugs with every upgrade. So what is the next step in the evolution of PACS?

According Dr. Chang once again (hey, he’s a great source) – it’s Web services. Right, Web-based PACS has existed, but it has provided rudimentary tools and thus far has not been very relevant, until now. So as the world – including healthcare – turns to service-oriented architecture (SOA), the role PACS will play will reside predominantly in Web services.

“Everything is a service. So the first step is to expose everyone of these resources: PACS, 3D, modalities, RIS, EMR, CPOE, all of these things, as services. Web-services is the spinal chord and SOA is the brain. What we are building is a workflow engine that can take as services and orchestrate this complexity…It makes no sense to have a PACS, the RIS or a modality drive this; you need to have an optimized workflow engine that uses all of these services as services,” said Chang. “That’s what closed loop imaging is based on – SOA.”

It will be a long while before they close the loop - air tight - on imaging, but if the researchers can effectively look at the entire loop and improve efficiency, quality and safety – then, according to Chang, “We will have our cake and eat it too.”

So, under the SOA umbrella, will PACS get its just desserts?