Abstract
This contribution focuses on picture archiving and communication systems (PACS) in the Italian National Healthcare System (NHS). It finally aims to test the Chiefs Radiology Department’s perceptions about PACS along the main evaluation dimensions emerging from the literature. First, a brief review of the main literature concerning PACS evaluation leads the authors to classify the different approaches undertaken and highlight the main variables of investigation. Second, the evidence emerging from a survey is presented and discussed in the light of the literature review. The survey aims to: (a) map out the degree of PACSs diffusion and their main features in the Italian NHS; (b) verify whether and how PACS impact the dimensions analyzed in many evaluation studies carried out to date; (c) test the relationship between some measured impacts and specific PACS features.
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References
Lemke HU: PACS developments in Europe. Comput Med Imaging Graph 27:111–120, 2003
Siegel EL, Reiner BI: Filmless radiology at the Baltimore VA Medical Center: a 9 year retrospective. Comput Med Imaging Graph 27:101–109, 2003
Inamura K, et al: Status of PACS and technology assessment in Japan. Comput Methods Programs Biomed 66:5–15, 2001
Inamura K: PACS development in Asia.. Comput Med Imaging Graph 27:121–128, 2003
Fu H, et al: Picture archiving and communication system in China: the development, problem, and integrating strategy with IHE. Int Congr Ser 1256:915–923, 2003
Keen J, Bryan S, Muris N, Weatherburn G, Buxton M: Evaluation of diffuse technologies: the case of digital imaging networks. Health Policy 34:153–166, 1995
van de Wetering R, Batenburg R, Versendaal J, Lederman RLF: A balanced evaluation perspective: Picture archiving and communication system impacts on hospital workflow. J Digit Imaging 19:10–17, 2006
Bryan S, Keen J, Buxton M: Evaluation of picture archiving ad communications systems (PACS). Issues of methodology, Prague: Omnipress, 1992
Parè G, Lepanto L, Aubry D, Sicotte C: Toward a multidimensional assessment of picture archiving and communication system success. Int J Technol Assess Health Care 21:471–479, 2005
Giribona P: Principles for PACS evaluation. Proc. European Community workshop on PACS: City
Siegel EL, Reiner BI: The costs and benefits of PACS in the VA: Past experience, present reality, and future potential. Appl Radiol 27, 1998
Cox B, Dawe N: Evaluation of the impact of a PACS system on an intensive care unit. J Manag Med 16:199–205, 2002
Fang Y-C, Yang M-C, Hsueh Y-S: Financial assessment of a picture archiving and communication system implemented all at once. J Digit Imaging 19:44–51, 2006
Andriessen JH, Barnevald BM, Binkuysen FH, et al: Savings and costs of a picture archiving and communication system in the University Hospital Utrecht.. SPIE 1093::578–584,, 1989
Bakker AR, Stut WJJ, De Valk JPJ, et al: PACS costs: modelling and simulation. Med Inform (Lond.) 13:307–313, 1988
Beard D, Parrish D, Stevenson D: A cost analysis of film image management and four PACS systems. SPIE 1234:10–17, 1990
Bryan S, Keen J, Muris N, Weatherburn G, Buxton M: Issues in the evaluation of picture archiving and communication systems. Health Policy 33:31–42, 1995
Fiedler V, Haufe G: Clinical and technical aspects of PACS in radiology and throughout the hospital. RBM 18:122–125, 1996
Glass HI: Economic model of a whole hospital picture archiving and communication system installation. J Digit Imaging 4:71–74, 1991
Haar Romeny BM, van der Wielen JMM, Achterberg FH, et al: PACS efficiency: a detailed quantitative study of the distribution process of films in a clinical environment. In: Samuel J. Dwyer; R. Gilbert Jost; Roger H. Schneider; Eds. Medical Imaging III: PACS System Design and Evaluation Proc. SPIE, vol. 1093, 1989, p. 259
Hindel R, Preger W: Cost-effectiveness prospects of picture archiving and communications systems. Health Policy 9:91–101, 1988
Hirscorn D, Omar R, DaSilva R, et al: Speech recognition, the academic perspective, Virginia: Great Falls, 2003
Ukovich W, Dalla Palma L, Stacul F, Cuttin Zernich R, Giribona P: Justifying PACS: general considerations based on Trieste experience. International Conference on HU-PACS: Sapporo, Japan, 1989
van Gennip EM, Bakker AR: Challenges and opportunities for technology assessment in medical informatics. Case study: PACS. Med Inform (Lond.) 18(3):209–218, 1993
Warburton RN, Nosil J, et al: Digital diagnostic imaging with a comprehensive PACS: hypothetical economic evaluation at a large community hospital. J Digit Imaging 3:101–107, 1990
Buccoliero L, Calciolari S, Marsilio M: A methodological and operative framework for the evaluation of an e-health project. International Journal of Health Planning and Management 23(1) In press. Published online in Wiley InterScience (www.interscience.wiley.com) May 4, 2007
Hilsenrath PE, Smith WL, Berbaum KS, Franken EA, Owen DA: Analysis of the cost-effectiveness of PACS. AJR 156:177–180, 1991
Maass M, Kosonen M, Kormano M: Cost analysis of Turku University Central Hospital PACS in 1998. Comput Methods Programs Biomed 66:41–45, 2001
Siegel EL, Protopapas Z, Reiner B, Pomerantz S, Cameron EW, Pickar, E: A prospective evaluation of the impact of filmless operation on the Baltimore VA Medical Center. RBM 18:149–152, 1996
Bryan SWG, Watkins J, Buxton MJ: An assessment of the health service costs of PACS at Hammersmith Hospital. Proceedings of the 15th EuroPACS Annual Meeting, Pisa, Septemper 25–27, 1997, 1997
Pratt EA: Incremental cost of department-side implementation of a picture archiving and communication system and computer radiography. Radiology 206:245–252, 1998
Mariani C, Tronchi A, Oncini L, Pirani O, M , urri R: Analysis of the X-ray work flow in two diagnostic imaging departments with and without a RIS/PACS System. J Digit Imaging 19:18–28, 2006
Andriole KP: Applied imaging: Current trends in PACS. Computed and Digital Radiography 1:1–2, 2002
Andriole KP: Productivity and cost assessment of computed radiography, digital radiography, and screen-film for outpatient chest examinations. J Digit Imaging 15:161–169, 2002
Andriole KP, Luth DM, Gould RG: Workflow assessment of digital versus computed radiography and screen-film in the outpatient environment. J Digit Imaging 15:124–126, 2002
Beird LC: Bringing all modalities online: A PACS success story. Appl Radiol 28:10–12, 1999
Dackiewicz D, Bergsneider C, Piraino D: Impact of digital radiography on clinical workflow and patient satisfaction. J Digit Imaging 13:200–201, 2000
Gale B, Safriel Y, Lukban A, et al: Radiology report production times, voice recognition vs transcription. Radiol Mange 23:18–22, 2001
Hayt DB, Alexander S: The pros and cons of implementing PACS and speech recognition systems. J Digit Imaging 14:149–157, 2002
Honeyman-Buck JC: PACS Adoption. Semin Roentgenol 38:256–269, 2003
Kinnunen J, Pohjonen H: PACS in Toolo Hospital. Comput Methods Programs Biomed 66:31–35, 2001
Lemme PJ, Morin RL: The implementation of speech recognition in an electronic radiology practice. J Digit Imaging 13:153–154, 2000
May GA, Deer DD, Dackiewicz D: Impact of digital radiography on clinical workflow. J Digit Imaging 13:76–78, 2000
Mattern C, King B, Hangiandreou N, et al: Electronic imaging impact on image and report turnaround times. J Digit Imaging 12:155–159, 1999
Ramaswamy MR, Chaljiub G, Esch O, et al: Continuous speech recognition in MR imaging reporting, advantages, disadvantages, and impact. Am J Roentgenol 174:617–622, 2000
Reiner BI, Siegel EL, Hooper FJ, Pomerantz S, Dahlke A, Rallis D: Radiologists’ productivity in the interpretation of CT Scans: A comparison of PACS with conventional film. Am J Roentgenol 176:861–864, 2001
Reiner BI, Siegel EL: Technologists’ productivity when using PACS: Comparison of film-based versus filmless radiography. Am J Roentgenol 179:33–37, 2002
Bryan NR: The digital revolution: The millennial change in medical imaging1. Radiology 229:299–304, 2003
Hirota H, et al: Clinical evaluation of newly developed CRT viewing station: CT reading and observer's performance. Comput Med Imaging Graph 19:281–285, 1995
Hruby W, Partan G, Mosser H, Krampla W, Malcher J: The digital hospital information technology in radiology. RBM 18:153–158, 1996
Inamura K, et al: HIS:RIS contribution to image diagnosis and maximization of efficacy of PACS when coupled with HIS:RIS. Comput. Methods Programs Biomed. 57:41–49, 1998
Lau S-L, Mak AS-H, Lam W-T, Chau C-K, Lau K-Y: Reject analysis, a comparison of conventional film-screen radiography and computed radiography with PACS. Radiography 10:183–187, 2004
Siegel EL, Reiner BI: Work flow redesign: The key to success when using PACS. Am J Roentgenol 178:563–566, 2002
Siegel EL, Diaconis JN, Pomerantz S, Allman R, Briscoe B: Making filmless radiology work. J Digit Imaging 8(4):151–155, 1995
Reiner BI, Siegel EL, Flagle C, Hooper FJ, Cox RE, Scanlon M: Effect of filmless imaging on the utilization of radiologic services. Radiology 215:163–167, 2000
Vaden Brick JA: Medical Image Processing, Archiving and Communication (PACS). Tracking study, Des Plaines, Illinois: Technology Marketing Group, 1986
Vaden Brick JA: Medical Image Processing, Archiving and Communication (PACS). Tracking study, Des Plaines, Illinois: Technology Marketing Group, 1987
Watkins J: A hospital-wide picture archiving and communication system (PACS): the views of users and providers of the radiology service at Hammersmith Hospital. Eur J Radiol 32:106–112, 1999
Mullins ME, Mehta A, Patel H, McLoud TC, Novelline RA: Impact of PACS on the Education of radiology residents: The residents’ perspective. Acad Radiol 8:67–73, 2001
Kaplan B, Lundsgaarde HP: Toward an evaluation of an integrated clinical imaging system: identifying clinical benefits. Methods Inf Med 35:221–229, 1996
Williams SC, Contreras M, McBiles M, Cawthon MA, Shah RB: The impact of a picture archiving and communication system on nuclear medicine examination interpretation. J Digit Imaging 10:51–56, 1997
Brink JA, Neklesa VP, Mutalik P, Forman HP: PACS innovations leading to improved patient care. Appl Radiol 27:29–30, 1998
Desimone DN, Kundel HL, Arenson RL: Effect of a digital imaging network on physician behaviour in an intensive care unit. Radiology 169:41–44, 1988
Fillicelli T: Benefits of diagnosing from soft copy display. Appl Radiol 29:47–48, 2000
Gur D, Straub WH, Lieberman RH, Gennari RC: Clinicians’ access to diagnostic imaging information at an academic center: Perceived impact on patient management. AJR 158:893–896, 1992
Jorulf H, Finnbogason T, Jonsson V, Ringertz H: Pediatric PACS, Astrid Lindgren Children’s Hospital at Karolinska Hospital, Stockholm, technical and practical aspects. Comput Methods Programs Biomed 66:25–30, 2001
Reiner BI, Siegel EL, Hooper FJ: Accuracy of interpretation of CT Scans: Comparing PACS monitor displays and hard-copy images. Am J Roentgenol 179:1407–1410, 2002
Pea S: Assessing the impact of PACS on patient care in a medical intensive care unit. SPIE 1899:423–431, 1993
Hruby W, Mosser H, Urban M, Ruger W: The Vienna SMZO-PACS project: the totally digital hospital. Proc Proceeding of CAR ‘91: City
Feron M, et al: Practical aspects of HIS/PACS integration with emphasis on radiological workflow. International Congress Series 1230:805–811, 2001
Inamura K, et al: Time and flow study results before and after of a hospital information system and radiology information system and before clinical use of a picture archiving and communication system. J Digit Imaging 10(1):1–9, 1997
Bandon D, Trolliard P, Garcia A, Lovis C, Geissbühler A, Vallée J-P: Building an enterprise-wide PACS for all diagnostic images. International Congress Series 1268:279–284, 2004
Andersson T: Pax Vobiscum-a Swedish large PACS project. Comput Methods Programs Biomed 57:35–39, 1998
Leodolter W, Kocever K: PACS as a driver for integrating healthcare systems. International Congress Series 1256:910–914, 2003
Marsilio M, Mattavelli E: Analisi critica della bibliografia esistente sul tema della valutazione dei sistemi RIS-PACS-L’implementazione di sistemi RIS-PACS per la gestione delle immagini cliniche nelle aziende sanitarie: una metodologia per la valutazione degli impatti (organizzativi, gestionali ed economici) e del contributo all’integrazione informativa dell’azienda sanitaria (PAPER 2): SDA BOCCONI-Divisione ricerche, 2006
Ratib O, Swiernik M, McCoy JM: From PACS to integrated EMR. Comput Med Imaging Graph 27:207–215, 2003
Munch H, Engelmann U, Schroeter A, Meinzer HP: The integration of medical images with the electronic patient record and their web-based distribution. Acad Radiol 11:661–668, 2004
Kondoh H, Shimomura T, Kuwata S: Infrastructure of PACS linked to EPR. International Congress Series 1268:285–288, 2004
Schilling RB, Staab EV: Impact of PACS on the radiology team. Appl Radiol 28:10–13, 1999
Schilling RB, Staab EV: Transition strategies for the radiology team. Appl Radiol 29:12–14, 2000
Hanseth O, Lundberg N: Designing work oriented infrastructures. Comput Support Coop Work 10:347–372, 2001
Bryan S, Keen J, Buxton M, Weatherburn G: Evaluation of a hospital-wide PACS: costs and benefits of the Hammersmith PACS installation. SPIE 1654:573–576, 1992
DeMaster DR: Digital radiography offers major productivity gains over computed radiography: Results of a time-motion study. Appl Radiol 30:28–31, 2001
Li M, Wilson D, Wong M, Xthona A: The evolution of display technologies in PACS applications. Comput Med Imaging Graph 27:175–184, 2003
Herman SJ: Speech recognition and the creation of radiology reports. Appl Radiol 33:23–28, 2004
Lepanto L: Impact of electronic signature on radiology report turnaround time. J Digit Imaging 16:306–309, 2003
Dwyer SJ: Electronic image archival. Appl Radiol 27:33–34, 1998
DeJarnette WT: Web technology and its relevance to PACS and teleradiology. Appl Radiol 29:9–12, 2000
Margolin K: Web technology and its relevance to PACS and teleradiology—Take II. Appl Radiol 30:28–32, 2001
Huang HK: Enterprise PACS and image distribution. Comput Med Imaging Graph 27:241–253, 2003
Bonomo L: Appropriatezza diagnostica nell'imaging radiologico. Proc. VII Convegno Nazionale AIIC - Appropriatezza, integrazione, sicurezza ed innovazione tecnologica nell’imaging diagnostico: City, 26–27 Maggio 2006 Year
Cecchini C: Le tecnologie di imaging diagnostico quale strumento di marketing sanitario. VII Convegno Nazionale AIIC-Appropriatezza, integrazione, sicurezza ed innovazione tecnologica nell’imaging diagnostico: Bologna, Italy, 2006
Buccoliero L, Mattavelli E: Principali trend evolutivi dei sistemi per la gestione dei dati clinici e dei sistemi RIS PACS per la gestione delle immagini-L’implementazione di sistemi RIS-PACS per la gestione delle immagini cliniche nelle aziende sanitarie: una metodologia per la valutazione degli impatti (organizzativi, gestionali ed economici) e del contributo all'integrazione informativa dell'azienda sanitaria (PAPER 1): SDA BOCCONI-Divisione ricerche, 2006
Borgonovi E, Buccoliero L: L’impatto delle tecnologie dell’informazione e della comunicazione sulle amministrazioni pubbliche, Milano: EGEA, 2000
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This work was made possible by funding from SDA Bocconi Research Division
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Buccoliero, L., Calciolari, S., Marsilio, M. et al. Picture, Archiving and Communication System in the Italian NHS: A Primer on Diffusion and Evaluation Analysis. J Digit Imaging 22, 34–47 (2009). https://doi.org/10.1007/s10278-007-9101-0
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DOI: https://doi.org/10.1007/s10278-007-9101-0