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Deconstructed PACS vs. a Home Remodel

Posted on 08/25/15

Clario’s CEO, Chris Wood, talks about what it means to break down a PACS, and why you should build up a deconstructed PACS.

Deconstructed PACS is a topic receiving a lot of press lately. This new system architecture allows practices to design and build best of breed solutions with components such as a vendor neutral archive (VNA), unified worklist, viewer(s) and voice recognition VR(s).

As a vendor who has been supplying unified worklists since 2008, we at Clario are thrilled that the market is catching on to how powerful a deconstructed PACS can be. We have, however, noticed that some of the less exciting (but still important) benefits of deploying a deconstructed PACS are often overlooked. Two examples of this are, 1) a clean-up of systems that have become nearly unmanageable, and 2) a clean-up of processes demonstrating what needs to be done, instead of what should be done.

Deconstructing and reconstructing a PACS can be a lot like a home remodel. When you tear open a wall, you may discover that there is more work than you originally anticipated.

Problems are often caused by system administrators who will do almost anything to get a new site live or “band aid” a critical issue quickly. These quick fixes can add up to a poor system design, which is often uncovered when you “tear open the walls” and start implementing deconstructed PACS.

When deconstructing a PACS, the existing design needs to be fully understood, even if there is sparse documentation. Uncover why accessions are being prepended, and which systems are dependent upon the modified values. Determine which exams have ‘special handling’ and which exams are discarded before they are read. Document which exams are completed in the RIS, which sites are unreliable at completing exams, and how exams are cancelled and/or modified. Understand when and how sticky notes and paper systems are used. Is data cut and pasted into other systems manually? Are technologists performing tasks that front desk should, but can’t perform, because the front desk does not have access to PACS?

Just as the homeowner who takes the time and money to fix a problem when the problem is first realized, ultimately improving the quality and value of the home, doing the same when deconstructing and reconstructing a PACS will save you time and money in the end. When walls are taken down, use this opportunity to do things in an organized and consistent way. It is a great chance to document how the system is working (really working) while improving reliability, performance and quality.

When installing a deconstructed PACS, you will invariably run into a complicated and disorganized clinical workflow. Often times it is discovered that it is not intentional to have a workflow in such a manner, but more because it is the way that the person has always done it or, the PACS only lets them do it that way.

Now is the time to figure out the best practices for your practice. Who should be doing what tasks? How are we going to measure our performance? When should tasks get escalated? What is the workflow? Once these questions get answers, your deconstructed PACS can actually help you manage your day and getting the most out of your time, imagine that.

Remember, there is a training cost, but it will pay off many times over when you have better workflow.

A reconstructed PACS designed correctly will allow you to switch vendors relatively easily. This means that what you design could be something you live with for a VERY long time. Design your dream workflow. Will you discover that there is more work than you originally anticipated, probably. But, if you keep your eye on the prize your workflow will become everything you ever wanted it to be. Just remember, you are not in this alone, Clario will be there each step of the way.