The trend: IT service models ease shift of PACS to enterprise IT

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A session at this year’s HIMSS conference, and covered in a recent Auntminnie article, spotlighted the trend of moving imaging informatics away from radiology to enterprise IT, and the culture clash it can generate between the two departments.

But it doesn’t have to be that way, especially today, when virtually every sale or major upgrade has IT involvement.
While some workstations and minipacs (e.g., echo, OB systems, or related reporting systems) may sneak in under the radar, the fact is that picture archiving communication system (PACS) is no longer a purely departmental purchase; even PACS that were originally purchased as a radiology department expenditure are upgraded under the IT budget—at the very least for hardware refreshes.
There are two major drivers of this trend. First is the drive by organizations to put as much as possible into virtual environments such as VMware or HyperV. These are always IT-run systems. There is some danger in that resources provisioned for the PACS may get “stolen” or over-committed to other systems. PACS servers are notoriously “peaky” in that CPU, disk and RAM usage over a period of time (e.g. 24 hours) will not seem high. The majority of the traffic (>80%), however, takes place during the eight-hour workday and peak workloads are 3-10 greater than that average.
Second, as more radiologists, cardiologists and orthopedic surgeons read remotely, and as referring physicians are encouraged to use the PACS or enterprise viewers, there are new demands for Internet access to these systems with greater bandwidth needs, enhanced security, inclusion in the facility internet, or use of specialized “Reverse Proxies” or firewalls and enforcement of desktop or laptop encryption. All of these services are IT services.
As evidenced, structured change-control processes – including sound testing processes with the entire PACS ecosystem for both the desktop (integrations to the electronic medical record, radiology information, dictation/voice recognition and document management systems) and the server (HL7 integration and storage) – are key to a successful transition and partnership between radiology and IT.
HL7 testing resources have traditionally come up short in the isolated departmental implementations and upgrades. With IT involvement, it now seems far easier to get “scheduled in” for integration changes and testing. There are still old PACS that do not have an HL7 ADT or an orders feed, resulting in a real demographics mess to clean up. Here again, IT resources come to the rescue in getting the interfaces implemented and in creating the clean-up tables (crosswalks, or was-is lists).
There’s also the fact that many older PACS don’t have real backups or real tested disaster recovery (DR) or business continuity (BC) processes, along with the presence of “no longer used” or “box in the corner” systems with ancient software and hardware that should be migrated to the newer PACS or vendor-neutral archive. The reason they are still there is that they contain records that must still be retained for legal reasons and are liable to loss due to natural disaster, malware or potential hardware failures.
Additionally, as departmental budgets are increasingly stretched thin, there are often corporate IT funds available for strategic initiatives like real DR and BC, privacy protection, VM infrastructure and others.
Ultimately, radiology benefits from partnering with IT for PACS and RIS needs that positively impact the entire organization.
Do you think the two teams should collaborate? What has worked well for your organization?

Originally posted on: 5/7/2014 10:39:10 AM

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