ISSUES IN THE EVALUATION OF PICTURE ARCHIVING AND COMMUNICATION-SYSTEMS

Picture archiving and communication systems (PACS) are an example of t he application of computer technology in the medical field, PACS autom ates image handling in a hospital and has the potential to transform t he way radiology is currently performed. This paper focuses on the eva luation of the PACS technology, and considers the claims that have bee n made for PACS, how these claims might be turned into questions to be addressed by evaluation and the appropriate methods for the evaluatio n of PACS. A distinction is drawn between evaluation questions for whi ch the hospital is the appropriate focus and those for which the patie nt is the appropriate focus, The preferred research design is differen t for hospital focused PACS evaluation and patient-focused evaluation of small scale PACS systems. A contemporaneous experimental comparison within hospitals is the preferred design for the patient-focused eval uation of small scale PACS systems. The patient-focused evaluation of large scale systems and the hospital-focused evaluation of all PACS sy stems could feasibly be conducted as contemporaneous experimental comp arisons between hospitals but the large research costs implied by such a design almost certainly mean that non-contemporaneous, nonexperimen tal comparisons within hospitals are more realistic. The current situa tion for the PACS technology is that it has potential, but as yet unpr oven, benefits and a large capital cost. Thus, the primary purpose of funding additional PACS implementations must be to add to the currentl y small body of evaluation evidence.