Advertisement

Limitations in and Solutions for Improving the Functionality of Picture Archiving and Communication System: an Exploratory Study of PACS Professionals’ Perspectives

  • Mona Alhajeri
  • Syed Ghulam Sarwar Shah
Article

Abstract

Picture Archiving and Communication System (PACS) technology is evolving leading to improvements in the PACS functionality. However, the needs and expectations of PACS users are increasing to cope with the rising demands for improving the workflow and enhancing efficiency in healthcare. The aim was to study the limitations in the current generation of PACS and solutions for improving PACS functionality. This was a longitudinal online observational study of the perspectives of PACS professionals accessed through four online discussion groups on PACS using the LinkedIn network. In this exploratory study, the methodology involved a thematic analysis of qualitative data comprising 250 online posts/comments made by 124 unique PACS professionals collected between January 2014 and December 2015. Participants were mostly male (n = 119, 96%) from the North America (n = 88, 71%). Key themes on limitations in the current generation of PACS were image transmission problems, network and hardware issues, difficulties in changing specific settings, issues in hardcoded Digital Imaging and Communication in Medicine attributes, and problems in implementing open source PACS. Main themes on solutions for improving PACS functionality were the integration of multisite PACS, multimedia for PACS, web-based PACS, medical image viewer, open source PACS, PACS on mobile phones, vendor neutral archives for PACS, speech recognition and integration in PACS, PACS backup and recovery, and connecting PACS with other hospital systems. Despite ongoing technological developments, the current generation of PACS has limitations that affect PACS functionality leading to unmet needs and requirements of PACS users, which could impact workflow and efficiency in healthcare.

Keywords

PACS technology Digital medical imaging Electronic images Radiology workflow Ubiquitous PACS Online access 

Notes

Acknowledgements

The authors wish to thank to the moderators of LinkedIn based four online discussion groups on PACS for allowing access to their discussions and posts and harnessing their conversations for this study.

Author Contributions

MA collected and analysed data and drafted the manuscript. SGSS revisited the data and data analysis and extensively revised and finalised the manuscript. Both authors approved the final version of the manuscript.

Funding

Ministry of Health, State of Kuwait awarded a scholarship to MA for doctoral studies.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was a part of doctoral research by MA and ethics approval was provided by the Research Ethics Committee of School of Information Systems, Computing and Mathematics at Brunel University London in July 2014.

References

  1. 1.
    Law MY, Zhou Z: New direction in PACS education and training. Comput Med Imaging Graph 27:147–156, 2003CrossRefGoogle Scholar
  2. 2.
    Arora D, Mehta Y: Use of picture archiving and communication system for imaging of radiological films in cardiac surgical intensive care unit. J Anaesthesiol Clin Pharmacol 30:447–448, 2014CrossRefGoogle Scholar
  3. 3.
    Liu BJ, Huang HK: PACS and Medical Imaging Informatics for Filmless Hospitals. Amsterdam: Academic Press, 2008CrossRefGoogle Scholar
  4. 4.
    Top M: Physicians’ views and assessments on Picture Archiving and Communication Systems (PACS) in two Turkish public hospitals. J Med Syst 36:3555–3562, 2012CrossRefGoogle Scholar
  5. 5.
    van de Wetering R, Batenburg R: Towards a theory of PACS deployment: an integrative PACS maturity framework. J Digit Imaging 27:337–350, 2014PubMedPubMedCentralGoogle Scholar
  6. 6.
    Huang HK: PACS and Imaging Informatics: Basic Principles and Applications. Hoboken: Wiley-Blackwell, 2010Google Scholar
  7. 7.
    Duerinckx AJ: Introduction to two PACS’ 82 Panel Discussions edited by André J. Duerinckx “Equipment Manufacturers’ View on PACS” and “The Medical Community’s View on PACS”. J Digit Imaging 16:29–31, 2003Google Scholar
  8. 8.
    Inamura K, Kousaka S, Yamamoto Y, Sukenobu Y, Okura Y, Matsumura Y, Takeda H: PACS development in Asia. Comput Med Imaging Graph 27:121–128, 2003CrossRefGoogle Scholar
  9. 9.
    Huang HK: Short history of PACS. Part I: USA. Eur J Radiol 78:163–176, 2011CrossRefGoogle Scholar
  10. 10.
    Mendel JB, Schweitzer AL: PACS for the developing world. J Glob Radiol 1:5, 2015Google Scholar
  11. 11.
    Strickland NH: PACS (picture archiving and communication systems): filmless radiology. Arch Dis Child 83:82–86, 2000CrossRefGoogle Scholar
  12. 12.
    Xue Y, Liang H: Understanding PACS development in context: the case of China. IEEE Trans Inf Technol Biomed 11:14–16, 2007CrossRefGoogle Scholar
  13. 13.
    Mackinnon A, Billington R, Adam E, Dundas D, Patel U: Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit. Clin Radiol 63:796–804, 2008CrossRefGoogle Scholar
  14. 14.
    Schooley B, Hikmet N, Atilgan E: Health IT Maturity and Hospital Quality: Effects of PACS Automation and Integration Levels on US Hospital Performance. Proc. The 2016 International Conference on Computational Science and Computational Intelligence (CSCI 2016) Las Vegas, Nevada, USA, Dec 15–17, 2016 YearGoogle Scholar
  15. 15.
    Sevenster M, Travis AR, Ganesh RK, Liu P, Kose U, Peters J, Chang PJ: Improved Efficiency in Clinical Workflow of Reporting Measured Oncology Lesions Via PACS-Integrated Lesion Tracking Tool. Am J Roentgenol 204:576–583, 2015CrossRefGoogle Scholar
  16. 16.
    Matta EJ, Nunez-Atahualpa L, West OC: Use of a PACS-Based Tool for Improving Communications With Referring Physicians. J Am Coll Radiol 14:1455–1458, 2017CrossRefGoogle Scholar
  17. 17.
    Mendoza J, Mallari-Ramos P, Thoren K, Kitley C: Interventional Radiology in the Combat Environment. Curr Trauma Rep 3:249–256, 2017CrossRefGoogle Scholar
  18. 18.
    Godinho TM, Almeida E, Silva LAB, Costa C: Integrating multiple data sources in a cardiology imaging laboratory. Proc. e-Health Networking, Applications and Services (Healthcom), 2016 IEEE 18th International Conference on: Munich, GermanyGoogle Scholar
  19. 19.
    Sarkar AK, Khan R, Pandey C: Challenges in Data Migration in Super Speciality Tertiary Care Hospital: A case study. Int J Adv Res Comp Sci 8, 2017CrossRefGoogle Scholar
  20. 20.
    Reiner BI: The challenges, opportunities, and imperative of structured reporting in medical imaging. J Digit Imaging 22:562–568, 2009CrossRefGoogle Scholar
  21. 21.
    Graban M: Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. Boca Raton: CRC Press, 2016CrossRefGoogle Scholar
  22. 22.
    Zheng K, Padman R, Johnson MP, Diamond HS: An interface-driven analysis of user interactions with an electronic health records system. J Am Med Inform Assoc 16:228–237, 2009CrossRefGoogle Scholar
  23. 23.
    Da Cunha JV, Orlikowski WJ: Performing catharsis: the use of online discussion forums in organizational change. Info Organ 18:132–156, 2008CrossRefGoogle Scholar
  24. 24.
    LinkedIn Corporation About LinkedIn. Available at https://press.linkedin.com/about-linkedin. Accessed 2nd August 2018.
  25. 25.
    Grajales, III FJ, Sheps S, Ho K, Novak-Lauscher H, Eysenbach G: Social media: a review and tutorial of applications in medicine and health care. J Med Internet Res 16:e13, 2014CrossRefGoogle Scholar
  26. 26.
    Barley SR: Images of imaging: notes on doing longitudinal field work. Organ Sci 1:220–247, 1990CrossRefGoogle Scholar
  27. 27.
    QSR International Pty Ltd: NVivo qualitative data analysis Software, 2012Google Scholar
  28. 28.
    Seale C, Charteris-Black J, MacFarlane A, McPherson A: Interviews and internet forums: a comparison of two sources of qualitative data. Qual Health Res 20:595–606, 2010CrossRefGoogle Scholar
  29. 29.
    Adair CE, Marcoux G, Williams A, Reimer M: The Internet as a source of data to support the development of a quality-of-life measure for eating disorders. Qual Health Res 16:538–546, 2006CrossRefGoogle Scholar
  30. 30.
    Sixsmith J, Murray CD: Ethical issues in the documentary data analysis of internet posts and archives. Qual Health Res 11:423–432, 2001CrossRefGoogle Scholar
  31. 31.
    Eysenbach G, Till JE: Ethical issues in qualitative research on internet communities. BMJ 323:1103–1105, 2001CrossRefGoogle Scholar
  32. 32.
    Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 3:77–101, 2006CrossRefGoogle Scholar
  33. 33.
    Braun V, Clarke V: Successful Qualitative Research: A Practical Guide for Beginners. London: Sage, 2013Google Scholar
  34. 34.
    Matar R, Renapurkar R, Obuchowski N, Menon V, Piraino D, Schoenhagen P: Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network. J Cardiovasc Comput Tomogr 9:524–533, 2015CrossRefGoogle Scholar
  35. 35.
    Choudhri AF, Norton PT, Carr TM, Stone JR, Hagspiel KD, Dake MD: Diagnosis and treatment planning of acute aortic emergencies using a handheld DICOM viewer. Emerg Radiol 20:267–272, 2013CrossRefGoogle Scholar
  36. 36.
    Nagy P: Open Source in Imaging Informatics. J Digit Imaging 20:1–10, 2007CrossRefGoogle Scholar
  37. 37.
    Ratib O, Rosset A, Heuberger J: Open Source software and social networks: disruptive alternatives for medical imaging. Eur J Radiol 78:259–265, 2011CrossRefGoogle Scholar
  38. 38.
    Ratib O, Roduit N, Nidup D, De Geer G, Rosset A, Geissbuhler A: PACS for Bhutan: a cost effective open source architecture for emerging countries. Insights Imaging 7:747–753, 2016CrossRefGoogle Scholar
  39. 39.
    Valente F, Silva LAB, Godinho TM, Costa C: Anatomy of an Extensible Open Source PACS. J Digit Imaging 29:284–296, 2016CrossRefGoogle Scholar
  40. 40.
    Valeri G, Zuccaccia M, Badaloni A, Ciriaci D, la Riccia L, Mazzoni G, Maggi S, Giovagnoni A: Implementation, reliability, and feasibility test of an Open-Source PACS. La Radiologia Medica 120:1138–1145, 2015CrossRefGoogle Scholar
  41. 41.
    Costa C, Ferreira C, Bastiao L, Ribeiro L, Silva A, Oliveira JL: Dicoogle - an open source peer-to-peer PACS. J Digit Imaging 24:848–856, 2011CrossRefGoogle Scholar
  42. 42.
    Kagadis GC, Alexakos C, Langer SG, French T: Using an open-source PACS virtual machine for a digital angiography unit: methods and initial impressions. J Digit Imaging 25:81–90, 2012CrossRefGoogle Scholar
  43. 43.
    Gray M: ACS Paradigm Shift: Moving control of the data from display applications to an enterprise access infrastructure. Context Magazine:1–16, 2014Google Scholar
  44. 44.
    Dennison D: PACS in 2018: an autopsy. J Digit Imaging 27:7–11, 2014CrossRefGoogle Scholar
  45. 45.
    Cook R: Is VNA the future of image delivery? A platform independent archival system has strong appeal. Healthcare IT News, 2014Google Scholar
  46. 46.
    Digital Health Intelligence Limited Special Report: VNA and Data Storage. Available at https://www.digitalhealth.net/2016/11/special-report-vendor-neutral-archiving/. Accessed 2nd August 2018.
  47. 47.
    Kagadis GC et al.: Cloud computing in medical imaging. Med Phys 070901:40, 2013Google Scholar
  48. 48.
    Sun Y, Zhang J, Xiong Y, Zhu G: Data Security and Privacy in Cloud Computing. Int J Distrib Sens Netw 10:190903, 2014CrossRefGoogle Scholar
  49. 49.
    Hamrioui S et al.: A Systematic Review of Security Mechanisms for Big Data in Health and New Alternatives for Hospitals. Wirel Commun Mob Comput 2017:6, 2017CrossRefGoogle Scholar
  50. 50.
    NHS Digital NHS Digital publishes guidance on data off-shoring and cloud computing for health and social care. Available at https://digital.nhs.uk/news-and-events/latest-news/nhs-digital-publishes-guidance-on-data-off-shoring-and-cloud-computing-for-health-and-social-care. Accessed 2nd August 2018.
  51. 51.
    Joshi V, Lee K, Melson D, Narra VR: Empirical investigation of radiologists' priorities for PACS selection: an analytical hierarchy process approach. J Digit Imaging 24:700–708, 2011CrossRefGoogle Scholar
  52. 52.
    Joshi V, Narra VR, Joshi K, Lee K, Melson D: PACS administrators’ and radiologists’ perspective on the importance of features for PACS selection. J Digit Imaging 27:486–495, 2014CrossRefGoogle Scholar
  53. 53.
    Torrieri M: Talk vs. Type: Taking Another Look at Voice Recognition. Physicians Practice 21, 2011Google Scholar
  54. 54.
    Fox MA, Aschkenasi CJ, Kalyanpur A: Voice recognition is here comma like it or not period. Indian J Radiol Imaging 23:191, 2013CrossRefGoogle Scholar
  55. 55.
    Hayt DB, Alexander S: The pros and cons of implementing PACS and speech recognition systems. J Digit Imaging 14:149–157, 2001CrossRefGoogle Scholar
  56. 56.
    Hwang I-C, Lee KW, Park SS, Chanthanoulay S, Sisavanh M, Rajpho V, Kim M, Billamay S, Phangmanixay S, Oudavong B: The first picture archiving and communication system in Lao People’s Democratic Republic: Changes in the utilization rate of imaging tests in the first year after implementation. Int J Med Inform 94:31–38, 2016CrossRefGoogle Scholar
  57. 57.
    Shah SGS, Farrow A: Trends in the availability and usage of electrophysical agents in physiotherapy practices from 1990 to 2010: a review. Phys Ther Rev 17:207–226, 2012CrossRefGoogle Scholar
  58. 58.
    Shah SGS, Farrow A, Esnouf A: Availability and use of electrotherapy devices: a survey. Int J Ther Rehabil 14:260–264, 2007CrossRefGoogle Scholar
  59. 59.
    Faggioni L, Neri E, Castellana C, Caramella D, Bartolozzi C: The future of PACS in healthcare enterprises. Eur J Radiol 78:253–258, 2011CrossRefGoogle Scholar
  60. 60.
    Chunn T, Honeyman J: Chapter 9. Storage and Database. Bellingham: Spie Press, 2000Google Scholar
  61. 61.
    Gutiérrez-Martínez J, Núñez-Gaona MA, Aguirre-Meneses H: Business Model for the Security of a Large-Scale PACS, Compliance with ISO/27002:2013 Standard. J Digit Imaging 28:481–491, 2015CrossRefGoogle Scholar
  62. 62.
    Mansoori B, Rosipko B, Erhard KK, Sunshine JL: Design and Implementation of Disaster Recovery and Business Continuity Solution for Radiology PACS. J Digit Imaging 27:19–25, 2014CrossRefGoogle Scholar
  63. 63.
    Thurston S: ASP Configuration Handbook. A Guide for ISPs. Syngress: Rockland, 2001Google Scholar
  64. 64.
    Martin G, Ghafur S, Kinross J, Hankin C, Darzi A: WannaCry—a year on. BMJ 361, 2018Google Scholar
  65. 65.
    Kun W, Rui-dan S, Zeng-Xin L, Zhen C, Li-Hua Z: Robust disaster recovery system model. Wuhan Uni J Nat Sci 11:170–174, 2006CrossRefGoogle Scholar
  66. 66.
    Anonymous: Lack of confidentiality with the Picture Archiving and Communication System (PACS). J R Soc Med 97:455–455, 2004CrossRefGoogle Scholar
  67. 67.
    Mahlaola TB, van Dyk B: Reasons for Picture Archiving and Communication System (PACS) data security breaches: intentional versus non-intentional breaches. Health SA Gesondheid 21:271–279, 2016CrossRefGoogle Scholar
  68. 68.
    Alhajeri M, Aldosari H, Aldosari B: Evaluating latest developments in PACS and their impact on radiology practices: a systematic literature review. Informatics Medicine Unlocked 9:181–190, 2017CrossRefGoogle Scholar

Copyright information

© Society for Imaging Informatics in Medicine 2018

Authors and Affiliations

  1. 1.Jaber Al Ahmad Center for Molecular ImagingKuwait CityKuwait
  2. 2.Department of Computer ScienceBrunel University LondonUxbridgeUK
  3. 3.Department of Occupational Health, Guy’s and St. Thomas’ NHS Foundation Trust, The Education CentreSt Thomas’ HospitalLondonUK

Personalised recommendations