A hospital-wide picture archiving and communication system (PACS): the views of users and providers of the radiology service at Hammersmith Hospital

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Abstract

Objective: To obtain users’ views of the new picture archiving and communication system (PACS) from clinical and radiological staff at Hammersmith Hospital, UK. Methods: Semi-structured interviews were used to ascertain the views of staff, following an interview schedule which covered aspects of: (1) their use of PACS, (2) facilities available, (3) the perceived quality of images, (4) reporting, (5) image availability, (6) image accessibility, (7) training, and (8) ease of use of PACS. Results: Interviews were carried out with 34 key users and providers of the radiological service at Hammersmith Hospital. Overall, staff were very satisfied with PACS particularly in terms of image availability. All staff said that they preferred PACS to the previous, conventional radiology service. Conclusions: The key implications of issues raised by staff were: the impact of ‘down-time’ and the importance of an efficient back-up system, the requirement for sufficient short-term storage to prevent images being off-line during clinical situations, the usefulness of the folder system for management of the images, the need to access images for teaching purposes, the advantage of having a default display protocol to facilitate radiological reporting, and the requirement for flexible, yet effective, training to ensure that the system is utilised to its full potential by users.

Introduction

Picture archiving and communication systems (PACS) are designed to replace traditional X-ray analogue film systems. In a PACS the acquisition, transport, storage, reporting and viewing of images is a completely digitised process, using a hospital-wide network of viewing stations. A number of hospital-wide PACS have been, or are currently being, installed in the UK and elsewhere [1]. However, the first hospital-wide PACS to be implemented in the UK was the Hammersmith Hospital PACS. One of the largest and most advanced systems of its kind in the world, the Hammersmith Hospital PACS features 136 viewing workstations (26 within the Radiology Department and 110 within the Hospital’s wards, clinics an specialities) and the reporting and viewing of soft-copy images by radiologists and clinicians emulates, as far as possible, their previous working practice with traditional hard copy film images.

In 1991, a proposal for the installation of a hospital-wide PACS at Hammersmith Hospital was funded by the Department of Health and the implementation of PACS formally began. A full evaluation of the implementation of PACS by independent researchers (the Health Economics Research Group, Brunel University) was subsequently commissioned. Full details of the main PACS evaluation, which took place from 1992 to 1997, are reported elsewhere [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. This paper describes the qualitative survey of clinicians and radiologists [11]. Acceptance by users is an essential element of the successful implementation of a new technology system, such as PACS, and this paper reports the views of the principal users of the Hammersmith PACS.

Section snippets

Methods

The study of users’ views of PACS was undertaken during October 1996, after PACS had been fully implemented. Five departments were used as the sample for the Hammersmith interviews about PACS. They were: Radiology; A&E (Accident and Emergency); Respiratory Medicine; Orthopaedics; and ICU (Intensive Care Unit). These five departments were chosen to reflect those focused upon in the quantitative element of the evaluation of the Hammersmith PACS and included referring departments where radiology

Image acquisition

Image acquisition relates to the physical specifications of the image processors (spatial resolution, image matrix size, number of bits per pixel, etc.) rather than to the specifications of the image display monitors. Thus, image quality, in this context, refers to the quality of the acquisition of the image (i.e. how the image was obtained) not the display of that image. Radiographic images produced at Hammersmith Hospital are produced using computed radiography (CR) with photostimulable

Key implications

When implementing a hospital-wide PACS, from the users’ perspective, it appears to be important to consider: (1) Downtime — the impact of ‘downtime’ during the initial phase of implementation, and the provision of a prompt back-up alternative, for use in the event of a system failure. (2) Short-term storage — the requirement for a sufficiently large short-term store (RAID) to prevent images being off-line during clinical situations, such as outpatient clinics. (3) Environmental viewing

Acknowledgements

The author would like to gratefully acknowledge the Policy Research Programme of the Department of Health for funding this project. Many thanks go to the staff at Hammersmith Hospital who took part, and who were so co-operative, from the Radiology Department, the Intensive Care Unit, the Orthopaedic Department, Accident and Emergency Department and Respiratory Medicine. Thanks also go to Stirling Bryan for his contributions and Karen Arnold for her secretarial support. Any remaining errors are

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