Computers in imaging and health care: Now and in the future

Early picture archiving and communication systems (PACS) were characterized by the use of very expensive hardware devices, cumbersome display stations , duplication of database content, lack of interfaces to other clinical inf ormation systems, and immaturity in their understanding of the folder manag er concepts and workflow reengineering. They were implemented historically at large academic medical centers by biomedical engineers and imaging infor maticists. PACS were nonstandard, home-grown projects with mixed clinical a cceptance. However, they clearly showed the great potential for PACS and fi lmless medical imaging. Filmless radiology is a reality today. The advent o f efficient softcopy display of images provides a means for dealing with th e ever-increasing number of studies and number of images per study. Compute r power has increased, and archival storage cost has decreased to the exten t that the economics of PACS is justifiable with respect to film. Network b andwidths have increased to allow large studies of many megabytes to arrive at display stations within seconds of examination completion. PACS vendors have recognized the need for efficient workflow and have built systems wit h intelligence in the management of patient data. Close integration with th e hospital information system (HIS)-radiology information system (RIS) is c ritical for system functionality. Successful implementation of PACS require s integration or interoperation with hospital and radiology information sys tems. Besides the economic advantages, secure rapid access to all clinical information on patients, including imaging studies, anytime and anywhere, e nhances the quality of patient care, although it is difficult to quantify. Medical image management systems are maturing, providing access outside of the radiology department to images and clinical information throughout the hospital or the enterprise via the Internet. Small and medium-sized communi ty hospitals, private practices, and outpatient centers in rural areas will begin realizing the benefits of PACS already realized by the large tertiar y care academic medical centers and research institutions. Hand-held device s and the Worldwide Web are going to change the way people communicate and do business. The impact on health care will be huge, including radiology. C omputer-aided diagnosis, decision support tools, virtual imaging, and guida nce systems will transform our practice as value-added applications utilizi ng the technologies pushed by PACS development efforts. Outcomes data and t he electronic medical record (EMR) will drive our interactions with referri ng physicians and we expect the radiologist to become the informaticist, a new version of the medical management consultant. Copyright (C) 2000 by W.B . Saunders Company.