Evaluating the Implementation of Picture Archiving and Communication Systems in Newfoundland and Labrador—a Cost Benefit Analysis

Abstract

P icture archiving and communication systems (PACS) present an opportunity to radically change film-based radiology services both inside and outside the hospital setting. In the past, the usual medium for capturing, storing, retrieving, and viewing radiology images was hard copy film. The idea to replace film with digital images was first conceptualized in 1979. However, it was not until the early 1980s that advances in technology made introducing PACS into radiology departments feasible. PACS replaces the film environment with an electronic means to communicate and share radiology images and associated reports in a seamless manner between health professionals. During the period 1998–2002, the province of Newfoundland and Labrador (Canada) implemented PACS on a project basis across its eight regional health authorities. Following a reduction in health authorities from eight to four in 2003, implementations of PACS continued such that by early 2005, approximately 70% of Newfoundland and Labrador service delivery areas had PACS capability. However, with this expansion came increasing concerns with the quality and capacity of image storage, the long-term sustainability of these systems, and their disaster recovery capabilities. As well, many of these PACS sites had yet to achieve a 95% filmless state, which resulted in achieving less than maximum savings (e.g., elimination of film costs), and that because of these reduced savings, most sites were not able to offset the initial or ongoing maintenance costs of these earlier PACS. In the fall of 2005, Canada Health Infoway (Federal Government) and the Newfoundland and Labrador government (Provincial Government) partnered on a $23 million initiative to implement one of the first province-wide PACS in Canada. This initiative had two overall objectives: (1) to implement PACS in selected rural sites where no PACS currently existed and (2) to address gaps in those regions where PACS was currently operational. The provincial vision for PACS was one that would provide access to any patient, any image, any report, anywhere, and anytime. In realizing this vision, referring physicians and radiologists could view their patient’s images and/or reports in a hospital, their office, or even in their homes.