Picture Archiving and Communications Systems (PACS)

SUMMARY

During the past 35 years, ultrasound and nuclear medicine were introduced into clinical medicine, computed tomography (CT) revolutionized diagnostic procedures and magnetic resonance imaging (MRI) emerged, bringing new diagnostic information at the cellular level. X-ray morphed from analog films to digital, and virtually all medical images became "soft" files on the electronic networks. As imaging departments in healthcare facilities have migrated from film to digital, the display and storage systems have had to migrate too. These new digital imaging storage and display systems are called picture archiving and communication systems (PACS). Most PACSs handle images from various medical imaging instruments, including ultrasound, MRI, positron emission tomography (PET), CT, endoscopy, mammograms, etc.

The focus of this TriMark Publications report is to analyze and describe the PACS market segments. PACS market penetration in the U.S. healthcare space has been significant, at almost 90%. A PACS network typically consists of a central server that stores a database containing the images connected to one or more clients via a local area network (LAN) or a wide area network (WAN) that provides or utilizes the images. More and more PACS utilize Internet-based technologies as their means of communication. This allows remote viewing and diagnosis with implications for both civilian and military healthcare facilities. Since radiology departments dominate the production of images, interconnections with radiology information systems (RIS) are also looked at in this study.

TABLE OF CONTENTS

1. Overview

• 1.1 Statement of Report
• 1.2 About This Report
• 1.3 Scope of the Report
• 1.4 Objectives
• 1.5 Methodology
• 1.6 Executive Summary

2. The Medical Imaging Market

• 2.1 Medical Imaging Industry Market Size
• 2.2 Medical Imaging Infrastructure
  • 2.2.1 Total Healthcare Expenditures and Demographics
  • 2.2.2 Number of Hospitals
  • 2.2.3 Number of Radiologists
  • 2.2.4 Radiology Services
  • 2.2.5 Medical Imaging Companies
  • 2.2.6 Market Drivers
    • 2.2.6.1 Product Enhancements Drive Adoption of Imaging Procedures Among End-Users
    • 2.2.6.2 Potential of Novel Contrast Agents Development to Drive Imaging Procedure Volumes
    • 2.2.6.3 Rapid Pace of Innovation Narrows Product Lifecycles and Restricts Spending
  • 2.2.7 Market Restraints
  • 2.2.8 Market Aspects
    • 2.2.8.1 Molecular Imaging
    • 2.2.8.2 Outpatient Facilities are the Best Growth Market
    • 2.2.8.3 Diagnostic Imaging Modalities Witness Several Technology Advancements
    • 2.2.8.4 Safety and Ergonomics Concerns Drive Technology Growth
    • 2.2.8.5 Volumetric Imaging and Post-Image Processing Techniques Develop Rapidly
    • 2.2.8.6 Increasing Implementation of PACS Units Pushes Digital Radiography into High Gear
    • 2.2.8.7 Future Price Reduction Set to Stimulate Wider Acceptance of DR Systems
    • 2.2.8.8 High-Performance Imaging Combined with Lower Radiation Doses Spurs DR Growth
• 2.3 Market Sector Analysis
  • 2.3.1 Competition
  • 2.3.2 Penetration Rates of PACS

3. PACS Market

• 3.1 PACS Technology
  • 3.1.1 PACS History
    • 3.1.1.1 In the Beginning
    • 3.1.1.2 PACS Pioneers
    • 3.1.1.3 Early Efforts
    • 3.1.1.4 Early PACS Efforts
    • 3.1.1.5 DICOM Begins
    • 3.1.1.6 Filmless
    • 3.1.1.7 Today and Tomorrow
  • 3.1.2 Image Acquisition
  • 3.1.3 Distribution and Communication
  • 3.1.4 Archiving
  • 3.1.5 Servers
  • 3.1.6 Image Display Systems
  • 3.1.7 PACS Drivers
  • 3.1.8 Barriers
• 3.2 PACS Vendors
• 3.3 Leading PACS Vendors
• 3.4 PACS Societies
• 3.5 PACS Forecasts
• 3.6 Market Dynamics
  • 3.6.1 Market Challenges
  • 3.6.2 Integrating Imaging Systems
  • 3.6.3 Lack of Funding can Stall Introduction of PACS
  • 3.6.4 Determining and Defining the Return on Investment (ROI) of PACS Solutions
  • 3.6.5 Effective PACS Training
  • 3.6.6 PACS Outside the Radiology Department and the Hospital
  • 3.6.7 Development of Web-based and GUI PACS Solutions
  • 3.6.8 How Much is Enough Storage?
  • 3.6.9 Information Lifecycle Management (ILM)
    • 3.6.9.1 The Process
    • 3.6.9.2 Automation
    • 3.6.9.3 Simplified Disaster Recovery
    • 3.6.9.4 Better Backups
    • 3.6.9.5 Solving the problem
  • 3.6.10 Always Online PACS
  • 3.6.11 Cost of Electronic Storage and Data Transfer Decreasing (Moore's Law)
  • 3.6.12 Hospital CEOs and PACS
  • 3.6.13 PACS and RIS Integration Benefits
    • 3.6.13.1 Brokered Versus Integrated RIS/PACS
  • 3.6.14 The Healthcare Leadership Council Congressional Recommendations
  • 3.6.15 Deployment of Filmless Environments Attracting the Best Recruits
    • 3.6.15.1 Planning for Migration from One PACS to Another?
    • 3.6.15.2 Critical Success Factors as Seen by the Referring Physicians
    • 3.6.15.3 Connecting PACS to Results: Text and Images Together
    • 3.6.15.4 ROI on PACS and RIS
    • 3.6.15.5 Advantages of Outsourcing Digital Storage Rather than Implementing an Archive in House
    • 3.6.15.6 Special Considerations in PACS for Extensive Remote or Outsourced Image Reading
    • 3.6.15.7 Enhancing Workflow to Optimize Service to Emergency Medicine
    • 3.6.15.8 Customer Support for PACS: Guidelines
    • 3.6.15.9 RIS/PACS Target Outcomes and Benefit Realization
    • 3.6.15.10 How PACS Helps Radiology Deal with CR?
    • 3.6.15.11 Interfaced, Integrated and Unified PACS
• 3.7 PACS Usage
• 3.8 Purchase Options
  • 3.8.1 Turnkey
  • 3.8.2 Software-only PACS (Best of Breed/Unbundled Solutions)
  • 3.8.3 Web-based PACS
  • 3.8.4 Application Service Provider
• 3.9 Telemedicine/Teleradiology
  • 3.9.1 Opportunities
    • 3.9.1.1 Civilian
    • 3.9.1.2 Military
• 3.10 Software (Image Processing, PACS, etc.) Companies
• 3.11 Software (PACS and RIS)

4. Regulations and Standards

• 4.1 HIPAA
  • 4.1.1 Title I: Healthcare Access, Portability and Renewability
  • 4.1.2 Title II: Preventing Healthcare Fraud and Abuse, Administrative Simplification and Medical Liability Reform
    • 4.1.2.1 The Privacy Rule
    • 4.1.2.2 The Transactions and Code Sets Rule
    • 4.1.2.3 The Security Rule
    • 4.1.2.4 The Unique Identifiers Rule (National Provider Identifier)
    • 4.1.2.5 The Enforcement Rule
• 4.2 DICOM
  • 4.2.1 History
  • 4.2.2 DICOM Data Format
  • 4.2.3 DICOM Services
    • 4.2.3.1 Store
    • 4.2.3.2 Storage Commitment
    • 4.2.3.3 Query/Retrieve
    • 4.2.3.4 Modality Worklist
    • 4.2.3.5 Modality Performed Procedure Step
    • 4.2.3.6 Printing
    • 4.2.3.7 Off-line Media (DICOM Files)
  • 4.2.4 Application Areas
• 4.3 HL7
  • 4.3.1 What Does the Name HL7 Mean?
  • 4.3.2 Why HL7?
  • 4.3.3 How is HL7 Organized?
  • 4.3.4 New and Ongoing Initiatives
    • 4.3.4.1 HIPAA
    • 4.3.4.2 The Reference Information Model (RIM)
• 4.4 Clinical Data Interchange Standards Consortium
• 4.5 The IHE
• 4.6 Optimal Patient Care
• 4.7 The Four Steps of the Process
• 4.8 The Technical Framework-Business and Technology Together
• 4.9 Leading by Example
• 4.10 IHE and the EHR
• 4.11 Nuclear Medicine Special Issues
  • 4.11.1 SNM and the IHE
  • 4.11.2 Problems interfacing PACS and NM
  • 4.11.3 The IHE Nuclear Medicine Profile
  • 4.11.4 The Next Step
• 4.12 Government Healthcare Initiatives Creates Opportunities for PACS Vendors

5. Technology Trends

• 5.1 Content-based Image Retrieval (CBIR)
• 5.2 Digital Dashboard
• 5.3 Digital Dashboard Example: PACSPulse
• 5.4 Paperless Workflow in PACS
• 5.5 Process and Workflow Example for RIS PACS Integration
• 5.6 Process and Workflow Example for High Speed CT

6. Company Profiles

• 6.1 Agfa-Gevaert Corp.
• 6.2 Canon
• 6.3 Carestream Health, Inc. (Formerly Kodak Health Imaging Division)
• 6.4 Cerner Corporation
• 6.5 DR Systems
• 6.6 Dynamic Imaging
• 6.7 Emageon
• 6.8 FujiFilm Medical Systems USA
• 6.9 GE Healthcare (RIS/PACS)
• 6.10 Hitachi Medical Systems America
• 6.11 IBM (PACS)
• 6.12 IMCO Technologies
• 6.13 Intelerad Medical System
• 6.14 McKesson Corporation
• 6.15 Merge Healthcare (Acquired eMed Technologies)
• 6.16 Philips Medical Systems (PACS)
• 6.17 ScImage
• 6.18 Siemens Medical Solutions (RIS/PACS)
• 6.19 SmartPACS (Newly Renamed to Infinitt)
• 6.20 Thinking Systems Corporation

7. Manufacturers

INDEX OF FIGURES

• Figure 2.1: Total Spending on Healthcare in the U.S., 1960-2007
• Figure 2.2: International Per Capita Healthcare Spending by Country, 2006
• Figure 3.1: Representative PACS Architecture
• Figure 3.2: PACS Facilities Shown by Number of Exams/Procedures Performed Per Year
• Figure 3.3: Modalities Offered by PACS Facilities
• Figure 3.4: US Facilities with PACS
• Figure 3.5: PACS Installation Duration
• Figure 3.6: Number of Vendors Evaluated
• Figure 3.7 Ranking of PACS Evaluation Factors
• Figure 3.8 PACS Features Considered in Evaluating PACS
• Figure 3.9 PACS Vendor Aspects Considered in Evaluating PACS
• Figure 3.10: Number of Service Calls
• Figure 3.11: PACS Satisfaction
• Figure 3.12: Vendor's US Market Share
• Figure 4.1: IHE Technical Framework
• Figure 4.2: IHE Framework Organization
• Figure 5.1: Digital Dashboard
• Figure 5.2: PACSPulse Architecture
• Figure 5.3: The Usage and Performance Dashboard
• Figure 5.4: Paper Versus Paperless PACS Workflow
• Figure 5.5: PACS Workflow Example for a CT System

INDEX OF TABLES

• Table 2.1: U.S. Medical Imaging Market Size, 2001-2010
• Table 2.2: Global Medical Imaging Market Size, 2001-2010
• Table 2.3: U.S. User Expenditures for Medical Imaging Equipment and Related Products, 2000-2007
• Table 2.4: Total Number of Americans Over 65 Years of Age, 2000-2050
• Table 2.5: Hospital Survey
• Table 2.6: Percent Change in Volume of Examinations Per Imaging Modality between 1993 and 2004
• Table 2.7: Worldwide Market Share Medical Imaging Companies
• Table 2.8: Worldwide Imaging Procedures, 2001-2010
• Table 2.9: Penetration Rates of PACS in U.S. Hospitals, 2006-2012
• Table 3.1: List of Vendors
• Table 3.2: U.S. Market for PACS, 2004-2012
• Table 3.3: Worldwide and Regional Markets for PACS, 2004-2012
• Table 3.4: European PACS Expenditures, 2004-2012
• Table 3.5: ECRI Criteria for PACS Evaluation
• Table 3.6: Healthcare Leadership Council
• Table 3.7: Healthcare Leadership Council Summary of HIT Benefits
• Table 3.8: PACS Placements by Facility Type
• Table 3.9: Vendor's US Market Share
• Table 4.1: IHE Actors and Transactions
• Table 5.1: The Usage and Performance Dashboard