Having a robust picture archival and communications system (PACS) no longer falls into the realm of a "nice-to-have" but may now be essential for hospitals trying to satisfy new value-based reimbursement metrics.

The case for enterprise PACS systems that communicate across departments and facility locations was laid out yesterday in an SIIM webinar by Gary Wendt, M.D., MBA enterprise director of medical imaging at the University of Wisconsin - Madison. His presentation offered a sense of urgency for hospitals that have not yet implemented a singular PACS strategy.

"These are not just financial issues," said Wendt referring to both PACS implementation costs and reimbursements.

Under value-based purchasing, Wendt said imaging is no longer the revenue center it used to be, and bundled payments do not pay for retests needed because physicians don’t have access to current images.

In order to reduce unnecessary radiation exposure to the patient and make faster lifesaving treatment decisions, the ability to quickly and efficiently share medical images has become a necessity. Unfortunately, that doesn't mean it's always happening.

"In any large city, it's not uncommon for patients to visit four organizations in a day," he said. "They may start with their HMO, then go to an imaging center, then to their primary care doctor, who may refer to a tertiary care center. And the patient may be carrying CDs with past images, to which all their providers need access."

All of those providers, he noted, will need to view current and prior images across specialties, ranging from cardiology, pathology, ophthalmology and dermatology, in addition to radiology.

Wendt cited savings from his system's commitment to a multi-site PACS - known as enterprise imaging. By sharing current and prior images across 70 sites in five states with multiple electronic medical records, they were able to reduce exams by more than 800,000 a year and slow their image growth rate to 14 percent annually compared to a non-system growth rate of 56 percent. This reduced radiation exposure to patients through less retesting, helped their physicians make faster patient care decisions and reduced operating costs.

He said the interface between the PACS and EMR must be configured to meet the needs of all specialists, not just radiologists. This included a search function that automatically brings up all prior images.

A lot of work still needs to be done in developing a full-functioning enterprise imaging system, according to Wendt. While the DICOM imaging format development is getting better among imaging devices (such as in scopes), equipment vendors still have work to do in support of multi-department and enterprise imaging.

He cited pathology and ophthalmology images, which rely on huge image files, as providing special challenges to enterprise imaging integration.

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