This edition's cover story examines both emerging and established PACS installations in Europe with the purpose of highlighting some valuable lessons about what elements are needed for a successful project rollout. Two of the articles in particular give a comparative analysis of their nationally led solutions, one which failed to meet any of its desired requirements despite an enviable level of funding and one that has provided a successful nationally-integrated system to the benefit of all and particularly in a country with a relatively low population density and widely dispersed clinical facilities.
The planning and purchasing processes in each involved European country have had similar variations ranging from government sponsored and controlled procurement to local lease or purchase arrangements. As a result, the evidence of the risks and benefits of the different models is now more clearly understood and some key principles are now evident.
However, even the smartest of PACS is only efficient unless it is directly linked into the radiology and hospital information systems. Furthermore, what we have learned is that a unifying patient number should be a key goal. It is also important that the need to transfer reports and, if appropriate, images to primary care physicians who have referred the patients is taken into account when considering these linkages.
Patients often do not stick with a single healthcare establishment for their entire gamut of healthcare needs, and in areas where a number of hospitals are available to patients, either through patient choice or specialty and subspecialty care, it is essential that patient images and data are easily transferable and available for consultation between clinicians and radiologists at all relevant sites. It is therefore vital that compatibility is established at the procurement stage between different manufacturers bidding for a contract. This can be more easily established in a regional development providing the variety of users' requirements are considered and met. This leads to a further requirement that the users of the service, including radiologists, radiographers, clinicians and patients are all included in the process of developing the specifications and that standards are established prior to any implementation.
These are important lessons for all of us, as e-health remains the European Commission's highest priority, both for commerce and delivering healthcare to a burgeoning and aging population in the 'containment' mentality that exists presently regarding the exploding cost of healthcare and the reduced availability of trained personnel. It is vitally important that the legal framework of any of these developments is established, particularly where they involve cross-border healthcare and the transmission and reporting of examinations and data. Patient confidentiality, the standards of medical care and the qualifications of those involved must be legally protected and monitored to ensure compliance. It is also incumbent on all manufacturers to fully embrace the Integrated Healthcare Enterprise (IHE) initiative, to enable the provision of a high quality and efficient service to our patients.
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