Rheumatology Advance Access originally published online on December 13, 2005
Rheumatology 2006 45(3):354-355; doi:10.1093/rheumatology/kei235
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LETTER TO THE EDITOR |
The impact of Picture Archiving and Communication Systems (PACS) implementation in rheumatology
Highfield Unit, Worcester Centre for Rheumatic Diseases, Worcestershire Royal Hospital, Worcester, UK
Correspondence to: Z. Paskins, Department of Rheumatology, University Hospital of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK. E-mail: zpaskins{at}doctors.org.uk
SIR, Radiology plays an important role in the decision-making processes of rheumatologists. Therefore, the implementation of Picture Archiving and Communication Systems (PACS) as part of the National Programme for Information Technology (NPfIT) is an agenda that affects us all. PACS is a filmless digital storage system of X-ray images that allows images to be viewed on a workstation or PC. At our Trust, hard copies are no longer routinely available. Some hospitals already have PACS, with the intention that PACS will be fully available nationally by March 2007 [1]. Although concerns exist about the timetable for implementation [2], eventual widespread use of PACS with integration into an electronic patient record is inevitable.
The benefits of a fully digital X-ray storing and reporting system are fairly obvious: images should be quick and easy to retrieve; comparison with old films should be easily facilitated; digital manipulation may aid interpretation (for example, by zooming in), images can be easily shown to colleagues at other hospitals or sites; films should not be lost; images can easily be accessed for use as teaching aids; and there are theoretical beneficial long-term cost implications.
We performed a survey across four different NHS Trusts where PACS had already been implemented to assess users’ views of using PACS in rheumatology. The aims of this project were to gather structured feedback to present to the local radiology department; to collect information that may be of interest to other rheumatologists not yet using PACS; and to establish local standards for use in a future cross-speciality audit planned within our Trust.
We designed a questionnaire that included a five-point Likert scale to assess users’ views on a number of areas, particularly concerning quality of images, usability, reliability of retrieval and overall perceptions. A record of the software used at the different NHS Trusts was also recorded. For reference purposes, the questionnaire is included as supplementary data at Rheumatology Online.
The questionnaires were distributed to each rheumatology department involved and participants were asked to complete the questionnaire once, based on their overall experience of using PACS. Twenty questionnaires were returned. Each Trust used a different software system. Ten (50%) of the respondents had not been trained on PACS; of these, six (60%) had not been offered training. Mixed views were obtained relating to quality and usability, which are summarized in Table 1. Specifically, there was no clear consensus about digitized films compared with hard films for viewing erosions or periarticular osteopenia. Eighty-five per cent (17) of the respondents were sometimes unable to retrieve images. Forty per cent (8) had difficulty in retrieving images in more than 50% of estimated total time that PACS was used. Seventy-five per cent (15) of the respondents felt PACS delays resulted directly in clinic delays and, worryingly, 70% (14) reported having to bring patients back for unnecessary clinic appointments to review films that they had been initially unable to trace on PACS. The top two advantages of PACS were listed as quality of images and the ability to digitally manipulate images. The top two disadvantages were the poor reliability and the speed of retrieval of images.
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This small study has a number of limitations and direct comparisons between sites are inappropriate due to the fact that different software was used, and respondents had varying levels of training and experience. However, a number of important points are raised. The technology clearly has enormous potential, and undisputable theoretical advantages over a hard film system. A number of studies of users’ perceptions report high levels of satisfaction with this technology [3, 4], although concerns have also been expressed regarding confidentiality [5]. The main problems that our study identified concerned the retrieval of images and usability, which have implications for risk management and clinical governance. The usability of a system is affected by a number of factors, including training and the type of software used. We consider that some of the problems identified may have been alleviated by improved communication between radiology, information technology, hospital management and non-radiology clinicians, particularly at the time of implementation.
Although it is unlikely that clinicians will have influence over the choice of software, especially in the context of the NPfIT, clinicians should liaise, where possible, with radiology and IT departments locally concerning issues of training and implementation, to ensure PACS works as well for clinicians as it does for radiologists [6]. Pilling describes his experience of PACS installation, and suggests that exciting the interest of clinicians in the early phases is challenging, but also describes the importance of working with non-radiologists who have different needs from the system [7]. If PACS implementation is looming at your hospital, we recommend early consideration of the needs of your department in relation to the training of staff, the number and quality of PC screens or workstations available, arrangements for the reporting of films, and contingency arrangements for a transition phase during implementation.
We would like to thank the doctors who completed the questionnaire and specifically acknowledge the help of Professor D. G. I. Scott, Dr W. Hassan, Dr A. Kinder, Dr J. Dixey, and the Clinical Audit Department at Worcestershire Acute Hospitals NHS Trust.
The authors have declared no conflicts of interest.
Supplementary data
Supplementary data are available at Rheumatology Online.
References
- Department of Health. Connecting for Health. Available at http://www.connectingforhealth.nhs.uk/delivery/programmes/pacs (accessed 5 September 2005).
- Hendy J, Reeves BC, Hutchings A et al. Challenges to implementing the national programme for information technology (NPfIT): a qualitative study. BMJ 2005;331:331–6.
[Abstract/Free Full Text] - Bryan S, Weatherburn GC, Watkins JR, Buxton MJ. The benefits of hospital-wide picture archiving and communication systems: a survey of clinical users of radiology services. Br J Radiol 1999;72:469–78.[Abstract]
- Pilling JR. Picture archiving and communication systems: the users’ view. Br J Radiol 2003;76:519–24.
[Abstract/Free Full Text] - Anon. Lack of confidentiality with the Picture Archiving and Communication Systems. J R Soc Med 2004;97:455.
[Free Full Text] - Shaw G. A clinician's guide to digital X-ray systems. J R Soc Med 2001;94:391–5.
[Free Full Text] - Pilling JR. Lessons learned from a whole hospital PACS installation. Clin Radiol 2002;57:784–8.[Medline]
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