Using technology assessment as the picture archiving and communication system spreads outside radiology to the enterprise

Picture archiving and communication systems (PACS) are being implemented wi thin radiology departments, and many facilities are entering the next stage of PACS use by deploying PACS to departments outside of radiology and to o ther facilities located at a distance. Many PACS vendors and department adm inistrators have based cost-justification analyses on the anticipated savin gs from expanding PACS to these areas. However, many of these cost-savings analyses can be highly suspect in their assumptions and findings. Technolog y assessment (TA) at the hospital/health system level is an organized, syst ematic approach to examining the efficacy of a technology in relation to th e health system's mission and clinical needs. It can be an organized and un ifying approach to aid in the distribution of limited capital resources. As extra-radiology PACS deployment is a costly endeavor, TA may be used to pl an for PACS implementation throughout the enterprise. In many organizations , PACS is thought of as a radiology domain as its first uses were centered on this image-producing service. Now, as PACS technology spreads to other s ervice areas, such as cardiology, dermatology, pathology, orthopedics, obst etrics, etc, the need to incorporate other viewpoints in a system-based PAC S is necessary to avoid having independent PACS that may duplicate archives and may not communicate with each other. How to meet the diverse PACS need s of clinical services can be a challenging task; a TA program has been dem onstrated to effectively handle the clinical needs, demands, and timeframes of PACS planning and support throughout hospitals and health systems. A ho spital-based TA program can assist health care organizations to present PAC S as a system-wide need and program rather than a radiology-based program g obbling up the capital budget. Submitting PACS to the TA review process can identify essential elements in planning and help avoid many of the pitfall s of PACS implementation and operations. Thorough cost and/or return on inv estment analyses, phasing decisions, workflow re-engineering, and outcomes assessment programs are a few of the issues that a TA program can address t o help in the transition to a complete electronic image environment. The TA process includes clinician selection, evaluation criteria and their select ion for technologies under review, a policy for review/authorization/denial , and measurement of expected outcomes. Copyright (C) 2000 by W,B. Saunders Company.