With the conclusion of the recent AHRA meeting (Anaheim, August 10–14), PACS again ranks as the primary educational topic for the majority of radiology departments. Of course, this may be a leading indicator that the end of the PACS trend must be coming soon. However, broader and more extensive health care networks may be next in line.

To recap the AHRA briefly, the how-to PACS presentations covered numerous real-world situations at a broad spectrum of institutions, including rural sites, imaging centers, ordinary hospitals, research hospitals, and referring physicians. These presentations were light on technical details, with a predominant focus on project management issues and sage advice (productive meetings run on coffee and donuts).

It appears that most every radiology department is achieving moderate to high levels of success with PACS projects today—which seems pretty amazing given the quantity and quality of problems that can play havoc with computer-based network systems these days. So it’s probably worth spreading some well-deserved credit among the buyers, users, and suppliers of PACS for acquiring and installing these systems.

It is all too frequently mentioned that it takes a village to populate a PACS committee, but the truth is this broad level of participation nips many problems before they bud. Actual site visits to see working PACS dispel many preconceived ideas, too. Not all systems are created equal, even if they all look that way after the 10th vendor presentation.

Where are PACS headed in the next few years? In previous PACS reviews, special mention was made of current technologies infiltrating today’s projects, including Giga-bit Ethernet, multiple networks, multiple archives, state-of-the-art PCs, wireless, new reading rooms, and broadband, which are all extensions of current PACS technologies.

It may be more noteworthy how radiology services change as PACS are introduced—in essence, radiology now delivers reports and images faster and cheaper, at least by productivity measures. It is now extremely difficult to find anyone who wants to return to the good old pre-PACS days.

So it is becoming possible to view PACS as a leading indicator for how patient services will continue to improve as more extensive hospital and health care networks are needed to address clinical data and care delivery efforts on a broad scale. The patient-centric EMR (electronic medical record) is the leading candidate for breaking open the current logjam here, especially as work has been recently launched to develop a standardized EMR. This is big stuff for radiology and may, in fact, become the patient’s version of DICOM, meaning a standard data set that can be communicated and shared among different computer and network systems.

With a focus on exchanging clinical data throughout the health care system, the Department of Health and Human Services has recently commissioned the Institute of Medicine to design a standard model for an industry-wide electronic health record, targeting a product that should be ready sometime in 2004. This development is expected by all to lay the foundation for the first-generation standards-based EMR.

This effort also is expected to take advantage of the recently announced agreement between the College of American Pathologists and the National Library of Medicine regarding SNOMED CT. No, this is not another multislice scanner but a standard language model, which will be licensed free of charge beginning in January 2004 to all US–based organizations. More details can be found on this at www.snomed.org.

SNOMED (Systematized Nomenclature of Medicine) was developed in an effort to standardize clinical terminology for encoding the medical record. SNOMED Clinical Terms (SNOMED CT) represent a comprehensive and precise clinical reference terminology that health care providers, health care information technology suppliers, providers, and payors can use to improve the exchange of data related to individual or groups of patient health care episodes. SNOMED CT’s common language makes health care information accessible and usable, whenever and wherever it is needed. Government entities and health care organizations in more than 30 countries have adopted SNOMED CT since its release in January 2002.

So these two significant achievements, scarcely reported to date, are expected to enable health care institutions to fund and launch substantial efforts in the EMR area over the next 5+ years. These efforts may in fact dwarf PACS projects, as computer workstations begin to populate every desk, nursing station, portable wireless device, and bedside in maintaining and updating a patient-focused record.

If your institution or organization is involved in a PACS project today, the technical area to focus on in your system should be IHE, Integrating the Healthcare Enterprise. This effort is fast becoming the de facto racing engine in state-of-the-art PACS. The best recommendation is to begin wading through the literature in this area through either the HIMSS or RSNA Web sites (www.rsna.org/ihe) and to understand the potential for driving PAC systems to the next level of productivity, far beyond the simple image-file-sharing networks.

If these projections of the future proceed as planned, hospitals may soon look like modern-day corporations, where every health care provider is a knowledge worker that employs computers, laptops, and mobile PDAs to deliver patient-focused care.

Doug Orr, president of J&M Group (Ridgefield Conn, consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to dforr@aol.com.