Definition

From a market perspective, PACS is best defined as an integrated set of information technology (IT) system designed to provide a complete solution for image management in a film-less radiology department.

According to Frost & Sullivan, PACS solution includes dedicated display and review workstations with their associated servers, viewing and image distribution software, database servers, web servers, and archive servers, archiving software solutions, as well as all necessary additional software and any implementation or integration efforts, which incur costs.

The segmentation of the PACS solution is as follows:

• Enterprise PACS A Complete turnkey PACS with film-less operation
• Modality PACS Single-modality PACS such as ultrasound PACS, mammography PACS, Cardiology PACS etc.

Key Features

Some of the key features of PACS includes:-

• Teaching repository
• Automated offline centralized mechanism
• Automated offline indexing
• Disaster recovery functionality
• Modality perform procedure steps (MPPS)
• Medical grade display
• Central archiving
• Interoperability with other hospitals information systems
• Teleradiology support
• Interoperability with DICOM / Non-DICOM compliant
• modalities
• Scalable architecture

Prerequisites

When introducing PACS to the hospital environment, it is critical to establish a Hospital Information System (HIS) or Radiology Information System (RIS) before a PACS. Often a retrospective merger of the PACS database lends itself to higher costs and data entry inconsistencies. All components of HIS or RIS and PACS must also be bi-directional and integrated fully with electronic patient records if present. If this is not coordinated, a hospital may find itself film-less in the radiology department, but resigned to copying images on costly laser film for other departments to use -an incredibly costly state of affairs.

The following are among the other major concerns that a PACS team should also consider:

The order of implementation of technology
The sales team of the chosen vendor: a good fit is crucial for success since these are likely to be frequently long term relationships
Workflow capacities: ideally only full solution systems should be adopted
Service and support provided by the vendor

The Technology

According to Frost & Sullivan technical insights, interactions between picture archiving and communications systems (PACS) and radiology information systems (RIS) require compatible hardware, a common protocol for handling the data, and commensurate operational definitions. However, PACS and RIS are based on different protocols. PACS operates on the Diagnostic Imaging and Communications in Medicine (DICOM) standard, while RIS operates on Health Level Seven (HL7). DICOM is a transmission protocol that formats, stores, prints and transmits images to and from the imaging modalities and the PACS. HL7 is used to register patients, process orders, and store reports, but it cannot manage DICOM image data. In order for the PACS to do its job, it must be able to communicate with RIS. Therefore, interfaces are used to create an interface between the two systems. The interface (also known as a PACS “gateway” or “broker”) is a hardware- and/or software-based module that allow PACS to communicate with the RIS. However, it has its drawbacks, including added cost to the PACS, and a potential point of failure that may result in orphaned studies (studies that are “lost” or inaccessible to the data system).

Although the leading vendors continue to support RIS/PACS integration through the standard HL7 interface, current developments in image management technology are leaning towards a completely integrated RIS-PACS solution that manages all radiology-related numerical and imaging data from a single database. This is known as the fully integrated RIS-PACS. Although a number of current systems use the embedded or internal PACS broker and call them “brokerless,” a truly integrated RIS-PACS is one in which both types of data are indexed in a common database allowing immediate interaction of both types of data within the complete RIS-PACS system

Trends

PACS implementation is slowly catching up in India with more hospitals aiming towards a paper-less environment. The Indian PACS market is estimated to be $5.5 – 6 Million and is expected to grow at a compound annual growth rate of 27 percent from 2007 � 2011.

Corporate hospitals are the front-runners with some of the mid-size and Government hospitals following suit.

Private hospitals are opting for PACS to provide services efficiently and have an edge over their competitors, whereas, Government hospitals use it to help in keeping patient records, reduce the number of films used, and also the cost of record maintenance.

Radiologists are using it even for Tele-radiology services to provide consultation and second opinion to remote areas in India as well as abroad.

Technology savvy doctors are providing consultation and opinion even when away from healthcare facilities by accessing the records online from the comforts of their home or clinics.

Major Players

Some of the major foreign PACS application providers in India include

• Agfa
• Carestream Health (earlier Kodak)
• Fuji
• GE
• Siemens
• Vepro

Local players include �

• 21st Century Healthcare solutions
• Amrita Medvision
• Ashva Technologies
• Karishma Software
• Perfint Technologies
• Sobha Renaissance IT Ltd. (SRIT)
• Softlink International
• Srishti Software
• Matrixview

Drivers, Restraints and Challenges

Market Drivers

For the Indian PACS market the key market drivers are:-

• The need for film-less environment
• Cost savings
• Better workflow through accessibility and availability
• Centralized storage
• Entry of local players
• Teleradiology services
• Increase in Medical tourism
• Increasing competition amongst hospitals
• Increasing awareness and demand for quality healthcare

Market Restraints

• Inadequate IT infrastructure (at referral doctors’ level)Low
• penetration of DICOM compliant modalities

Challenges Faced

• The low growth of the PACS market is attributed to
• High cost of installation (that is, cost of required software and hardware)
• Low IT budgets of healthcare facilities
• Demand for films by patients and referral doctors
• No clear ROI (perceived)
• Attitude towards adoption of IT

Benefits of PACS

Easy accessibility and availability of images
Teleradiology services
Cost reduction due to –
Film reduction
Increased productivity
Faster transcription
Reduced rates of repeated imaging

The Work done so far

Major PACS implementations in India are at:

• Aditya Birla Memorial Hospital, Pune
• Amrita Institute of Medical Sciences, Coimbatore
• Apollo Hospital, Chennai
• Christian Medical College, Vellore
• Deenanath Mangeshkar Hospital, Pune
• Dr Shyama Prasad Mukherjee Hospital, Delhi
• Fortis Hospital, Mohali and Delhi
• G Kuppuswamy Naidu Memorial Hospital, Coimbatore
• Indraprastha Apollo Hospital, Delhi
• Jehangir Hospital, Pune
• Kidwai Memorial Hospital, Bangalore
• KIMS, Bangalore
• LNJP Hospital, Delhi
• M S Ramaiah Memorial Hospital, Bangalore
• Max Devki Devi Hospital, Delhi
• Madras Medical Mission, Chennai
• NIMHANS, Bangalore
• P D Hinduja Hospital, Mumbai
• Rajiv Gandhi Cancer Institute, Delhi
• Ruby Hall Clinic, Pune
• Sahyadari Hospital, Pune
• Sree Chitra Tirunal Institute of Medical Sciences, Trivandrum
• Tata Memorial Hospital, Mumbai
• Vallabhbhai Patel Chest Institute, Delhi
• Vikram Hospital, Mysore
• Wockhardt Hospital, Bangalore

(References: Frost & Sullivan Technical Insights and reports)

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