A PICTURE ARCHIVING AND COMMUNICATION SYSTEMS (PACS) study was recently performed by KLAS,Footnote 1 a national market intelligence firm specializing in monitoring and reporting the performance of HealthCare’s Information Technology (HIT) vendors. Fifteen leading PACS vendors are included in the study, which provides a snapshot of today’s market performance and industry trends through the eyes of both users and vendors. KLAS interviewed clients from more than 275 sites and the study incorporates the opinions of over 345 PACS imaging managers, medical directors, radiologists, chief information officers (CIO), department directors, and vendor executives.

Measurements from 40 indicators (including system selection and implementation experiences), special questions, technical assessments, client win/loss, and pricing provide the basis of the provider experience. Vendor overviews with information regarding product history and development, move forward strategies, product strengths, market perception, Web, partnering, and HIPAA strategies rounded out the vendor “view.” Insight into industry trends are seen by comparing current survey results to 2001 and 2002 KLAS PACS Surveys1,2 and to the 2003 KLAS Radiology Information System (RIS) Survey.3

METHODS

KLAS, in concert with thousands of healthcare executives, CIOs, directors, managers, and clinicians has created a dynamic database of information on the performance of HIT vendors. The KLAS database represents the opinions of healthcare executives, managers, and clinicians from over 4,000 healthcare facilities on a total of 300+ vendors and 500+ different products. The data-gathering process is continual, with new performance evaluations and commentary reported daily (survey data more than 12 months old are archived and used for historical and trending purposes only).

The 2003 PACS study features ten vendors and is a follow-up from similar studies performed in 200l and 2002. The ten featured vendors include: Afga, DR Systems, eMed, Fuji, GE, Kodak, McKesson, Philips, Siemens, and Stentor. Five other vendors were in various stages of deployment and/or development and their information is reported accordingly. They include Amicas, Canon, Cerner, Emageon, and IDX. The PACS market and accessing a particular vendor’s market share within that market is difficult based upon each vendor’s definition of a full PACS implementation. Figure 1 represents the market share for the vendors included in the study, based on the number of live sites qualifying for the survey as reported to KLAS by the vendor and estimates from information KLAS has acquired over time and from other industry resources.

Figure 1
figure 1

PACS market share by vendor.

Full size image

Survey participants represented a broad cross section of PACS users. Figure 2 demonstrates the diversity of facility size among survey participants. Every vendor had a substantial number of interviewed clients reporting 100,000 to 300,000 studies annually, with 10% reporting over 300,000 studies. Led by DRSystems and Fuji (whose users performed the most studies through PACS), nine out of ten vendors had at least 75% of all studies being handled by their PACS solution.

Figure 2
figure 2

Facility size of participants.

Full size image

Performance monitoring was measured in three fundamental areas as listed in Figure 3: (1) Primary Indicators, which includes 14 key areas of general vendor performance as selected by CIOs/directors; (2) Detail Indicators, which includes 14 areas of specific performance (including more detail than primary indicators); and (3) Satisfaction Indicators, which provides an overall view of the system. Each of the customers was asked to rate, on a scale of 1 to 9 (low–high), their vendor on 28 aspects of performance, as well as answer 12 questions relating to customer satisfaction.

Figure 3
figure 3

Performance measurements.

Full size image

Special PACS survey questions were asked regarding study volumes (PACS and non-PACS), quantifiable benefits, interfaces, Web view product, and perceived top PACS vendors. In addition, analysis of client win/loss commentary provides insight into the vendor selection process and the reasons why a vendor is selected or not.

RESULTS

The result of the KLAS 2003 PACS Study4 identified a strong field of competitors as, together, the vendors score well (Fig 4) and average above the KLAS industry norm (the running 12 month average of all vendors and all products in the database). Although each vendor demonstrates its strengths, two vendor products, Stentor and McKesson Horizon Medical Imaging, set the scoring stage for performance monitoring in PACS.

Figure 4
figure 4

Overall vendor scores.

Full size image

The analysis of client win/loss commentary, as compared to previous years, indicates the prior relationship with a vendor and company size has less of an impact; whereas price, functionality, and technology have much more of an influence on vendor selection. Figure 5 indicates results of commentary analysis of “why a vendor was selected” and Figure 6 indicates “why a vendor was not selected.”

Figure 5
figure 5

Why a vendor was typically selected. The percentages may not add up to 100% because of multiple comments from the same respondent.

Full size image
Figure 6
figure 6

Why a vendor was typically not selected. The percentages may not add up to 100% because of multiple comments from the same respondent.

Full size image

“Vendors Considered” in the PACS selection process, by survey respondents, indicate that they are listed in order of frequency mentioned (highest to lowest) in Figure 7. The percentage refers to the number of times a vendor was specifically mentioned by a respondent. Previous years’ survey respondents clearly indicated an advantage to those vendors that were also providers of medical equipment and/or film, and while they are among the top still considered today, survey respondents indicate that they are focusing more on functionality, price, and technology for the final decision.

Figure 7
figure 7

Vendors considered.

Full size image

DISCUSSION

The KLAS 2003 PACS Study4 reflects a continued interest in and deployment of PACS by healthcare providers, suggesting a sincere and sustaining interest in such systems. Synergies are anticipated in complementary venues, such as cardiology and orthopedics, and at the same time the lines between PACS and RIS show evidence of merging as PACS begins to deploy “traditional” RIS functionality.

A true PACS should be able to support all diagnostic imaging modalities, and most sites surveyed are planning to include all modalities. Nine out of ten vendors had at least 75% of all studies being handled by their PACS solution. The most common benefits verbalized in this year’s study was cost savings on film and storage, increases in productivity/efficiency, and access and distribution of images (last year’s number one benefit stated). Also of note is that all vendors had clients that spoke to staff reductions.

Response to the questions concerning interfaces validated that the PACS clients have the same issues with integration and interfacing that other ancillary systems encounter. The goal of being 100% interfaced/integrated with every linked system has not been achieved. The most common PACS interfaces were RIS and Health Information System (HIS). Over 75% of the sites interviewed had an interface to their RIS, and 48% had an interface to their HIS. Only 2% reported they had an interface to their EMR system.

Accessibility by clinicians outside the image department is critical to success in sharing digital images for both patient care and productivity improvement. Clients this year spoke more frequently to the benefits of patient care, physician’s accessing images outside the department, and the impact of such access (improve patient care, increase in business, better collaboration with radiologist, and reduction of complaints).

The KLAS 2003 RIS Study4 indicates that, unlike their PACS counterparts, RIS vendors collectively score below the KLAS norm for overall performance. This suggests an opportunity and room for improvement. With the industry looking to an RIS to increase productivity and reduce medical errors and, with an opportunity for PACS and voice transcription investment and integration, RIS performance improvements are expected.

CONCLUSIONS

The KLAS 2003 PACS Study results show that vendor ratings seem to be “settling in” and that PACS vendors continue to perform, and together, PACS vendors average above the KLAS HIT industry norm. Key study findings include the following:

  • PACS market is growing, products are maturing, are more substantive and users are satisfied.

  • The lines between PACS and RIS are merging as PACS deploys more “traditional” RIS functionality.

  • Survey respondents are focusing more on functionality, price, and technology for the final PACS decision.

  • Quantifiable benefits are realized more quickly as the studies handled by PACS increases.

  • The most common benefits are cost savings from film and storage, increased productivity/efficiency, and immediate access to studies.

  • The most common PACS interfaces were with RIS and HIS.

  • Web or remote access is in wide use and contributes seriously to the benefits obtained.