With 36 to 40 percent of practices already using digital imaging, and 90 percent of those hospitals utilizing a picture archiving and communication system (PACS), colleagues looking to upgrade are investigating which PACS product would best suit their needs.
While vendors tend to be the common route in which veterinarians learn of their PACS options, some preliminary research gives practitioners a base from which to form questions and make decisions.
“Veterinarians should do legwork before contacting a vendor and research not only the different technologies but the software and the capabilities it can deliver with PACS,” says Fotine Sotiropoulos, DVM, marketing manager for digital imaging at Idexx Laboratories of Westbrook, Maine.
“Understanding the hospital’s needs and PACS capabilities will help the veterinarian ask the right questions and make an educated decision about the purchase. For example, does the system come with a full PACS? Is the PACS able to handle multiple modalities, such as digital dental or ultrasound? Does the software provide the option to integrate with their product integration modules (PIMS)?”
With a full PACS costing about $60,000, including hardware, software and support fees, veterinarians want to be satisfied with their purchase, says Emery Shelley, sales manager at VetRay Technologies in Arlington Heights, Ill.
“Veterinarians tend to be only as educated on PACS as the salesperson talking to them allows them to be,” Shelley says. “It’s obvious that every salesperson will shine his product in the best light. Veterinarians should keep in mind that an open format is an important PACS feature. This feature helps with compliance.”
Ed Heere, CEO and president of CoActiv Medical in Ridgefield, Conn., says a rule of thumb for a larger veterinary practice is to calculate a five-year cost of radiography needs—film, chemicals, etc.—to determine a PACS budget that will suit the practice’s needs.
“A smaller veterinary practice will benefit from PACS but will not get the return on investment as quickly as a practice that takes more radiographs, uses ultrasound and other imaging equipment,” Heere says. “A practice should also consider what its needs will be going forward.”
Most practitioners know that PACS keeps images for future access and for safekeeping. But these systems also allow for distribution in-house, and some interface with practice management software, ultrasound machines and other imaging modalities in an integrated digital environment. Different PACS packages are based on practice needs.
“It’s important for veterinarians to understand how they intend to use their digital images in the PACS so that they can assure the PACS will meet their practice’s needs before calling in a vendor,” Dr. Sotiropoulos says.
“For instance, if showing clients the patient’s digital images in the exam room, storing images with the patient record at PIMS and burning a CD with the patient image are all basic expectations in going digital, it’s important to ask the right questions of the vendor to see if those features are included in the standard package.
“The benefits of digital are a given: time saving with the elimination of the film processor, flexibility in over- and under-exposed images, and the ability to easily store and retrieve images. However, thinking about how digital can help take your practice to the next level and grow is equally important. For example, full PIMS integration can extend the ability to bill for radiographs automatically, but not all PACS are equipped to offer it.”
Sotiropoulos says PACS can be an important part of a practice regardless of its size. Storage, easy access and safety of images for future reference and legal issues are always benefits.
“If you decide to go digital, it is important to fully leverage all the tools that can be provided,” Sotiropoulos says. “Being able to quickly access images for review or interpretation is one of the primary benefits. Being able to easily share images with colleges and specialists is another benefit; without a PACS this may not be possible.”
Experts recommend that a buyer find out whether her current practice management software will integrate with the PACS and other in-house modalities.
“Integration can be useful as long as it is an open standard DICOM integration,” says Greg Stoutenburgh, vice president of marketing at Sound-Eklin in Carlsbad, Calif.
He advises against proprietary integration “because it completely locks the practice into a single vendor who has no need to perform with the various products for ‘trapped’ clients. Integration without DICOM is a performance mirage over quicksand.”
If querying the database and retrieving images with an outside software program are important in a practice, vendors say, a buyer should investigate DICOM compliance, which has become the standard in many new veterinary practice technologies.
“Query-retrieve, or Q/R, checks to see what studies meeting the search criteria exist in the PACS,” Stoutenburgh says. “Retrieving means the viewer pulls the imaging case from the server into the viewer. That study will then be stored in a database within that viewer on that workstation until it is removed.”
If a practice doesn’t need to store a variety of images with PACS, mini-PACS may work well. There are still things to check for before purchasing.
Questions to Ask PACS Vendors
What is the installation fee and what is included?
• Is the practice charged by study data volume and, if so, in what manner?
• Is the data backed up to multiple offsite and local locations?
• How long is data maintained on- and off-site?
• In the event of data loss, what is required to restore the data?
• Can different data-access rights be assigned by a system administrator?
• Can data be synchronized between multiple locations?
• Does the PACS allow for non-DICOM study data and support non-DICOM modalities?
• Are lossy compression algorithms used to store any of the data?
• Is 24/7 support included?
“It is important for veterinarians to consider how they will use PACS to view all of their modalities, including digital dental and ultrasound, and understand whether the PACS can support those capabilities,” Sotiropoulos says. “Many mini-PACS or image viewers are represented to have full PACS functionality but lack these capabilities.”
Offsite storage is an option veterinarians may want to consider bundling with a PACS agreement.
“The rule for digital data is redundancy times three, meaning all data lives in three distinct locations,” says J.K. Waldsmith, DVM, president of Vetel Diagnostics.
“Usually this means stored in two locations at the veterinary practice and one location off site. The best solution is Internet-based off-site archival. Many of these companies also offer an Internet-based PACS as part of the archival program. This can be a very good value for any veterinary practice that has all its computers on a high-speed Internet connection.”
Some veterinarians may have retained tidbits of information about PACS from colleagues or conferences but thought it wasn’t an immediate need. At some point, the practitioner might revisit the thought of a PACS purchase, but not know what to expect.
“I think many veterinarians do not realize what a PACS system is and what it can afford them,” Dr. Waldsmith says. “In some cases I see veterinarians expecting PACS functionality to be part of a new release of their practice management software. While I see practice management software companies moving in this direction, my experience so far has been that the architecture of practice management software did not contemplate the large volume of data, nor the hardware interconnectivity issues that are encountered when managing 2- and 3-D image data.”