Abstract
Background. Over the past four years, Steve Biko Academic Hospital has been in the process of implementing and refining the use of a picture archiving and communications system (PACS). As part of a post-implementation refining process, it is necessary to evaluate user-perceptions in order to improve on good system qualities and correct flaws.
 Aim. The aim of this study was to assess whether medical clinicians perceived PACS as a positive adjunct to training and teaching opportunities – specifically those opportunities related to radiological image viewing and interpretation as part of patient case discussions.
 Method. Standardised questionnaires with ‘free text’ and ‘option selection’ questions were distributed to clinicians who, as part of their training, rotated at Steve Biko Academic Hospital (where a PACS is in place) as well as other teaching hospitals without a PACS. Between February 2009 and May 2009, approximately 400 questionnaires were distributed. As a result of constant academic rotations, leave schedules of medical staff and posts vacated, questionnaires could not be distributed to the entire target population that was estimated to be in the region of 550 medical clinicians (comprising senior medical students, interns, medical officers, registrars and consultants). Of the 400 questionnaires distributed, 189 completed questionnaires were returned. Completion of the questionnaires was voluntary and anonymous.
 Results and conclusion. Although a PACS relates specifically to the archiving and retrieval of radiological images and reports, it became clear from the feedback received from medical clinicians (who are ward-based, theatre-based or clinic-based users of a digital system) that many other factors, such as lack of adequate hardware and sub-optimal personal IT proficiency, contributed to some of the negative PACS-related perceptions and ‘lost teaching opportunities’ reported. Negative comments specifically related to PACS as a training adjunct included the frustrations associated with PACS downtime (especially during the period in 2009 when many electrical power cuts were experienced nationwide, resulting in network interruptions) and slow image retrieval during peak work-flow times. The advantages of PACS as a positive training adjunct were highlighted in the areas of multi-site viewing and consultation, the possibility of image manipulation and measurement tools, and better overall image quality. Clinicians felt that their training experience was also enhanced because of better patient follow-up made possible by access to all previous radiological imaging of a particular patient. Of the clinicians who completed the questionnaires, 63.5% felt that the PACS at Steve Biko Academic Hospital contributed positively to their training by creating more overall learning opportunities than other training environments without a PACS.
Highlights
The implementation of fully digitised hospital imaging archiving systems is still in its infancy in the South African setting, advances in the expansion, assessment and refinement of digitised archiving systems in developed countries are at the forefront of current radiological and information technology research.Steve Biko Academic Hospital (SBAH) is a government-funded academic hospital with a fully digitised imaging archiving system in place
A picture archiving and communications system (PACS) relates to the archiving and retrieval of radiological images and reports, it became clear from the feedback received from medical clinicians that many other factors, such as lack of adequate hardware and sub-optimal personal IT proficiency, contributed to some of the negative PACS-related perceptions and ‘lost teaching opportunities’ reported
Of the clinicians who completed the questionnaires, 63.5% felt that the PACS at Steve Biko Academic Hospital contributed positively to their training by creating more overall learning opportunities than other training environments without a PACS
Summary
The implementation of fully digitised hospital imaging archiving systems is still in its infancy in the South African (and African) setting, advances in the expansion, assessment and refinement of digitised archiving systems in developed countries are at the forefront of current radiological and information technology research.Steve Biko Academic Hospital (SBAH) is a government-funded academic hospital with a fully digitised imaging archiving system in place. The implementation of fully digitised hospital imaging archiving systems is still in its infancy in the South African (and African) setting, advances in the expansion, assessment and refinement of digitised archiving systems in developed countries are at the forefront of current radiological and information technology research. The African status quo currently lags about 10 years behind our firstworld counterparts This is clear from early American and European post-PACS implementation quality assessment literature published from 1999 to 2002.1-6 Subsequently, as the development and refinement of those PACS systems proceeded, literature pertaining to the ‘added value’ aspects of PACS came to the forefront from around 2005 to 2007.7-10 Despite this time lag, our current experiences echo theirs. Over the past four years, Steve Biko Academic Hospital has been in the process of implementing and refining the use of a picture archiving and communications system (PACS). As part of a post-implementation refining process, it was necessary to evaluate user-perceptions in order to improve on good system qualities and correct flaws
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