Who is the main stake holder for PACS, who pays for it, who manages it?

Resisting the temptation of cloudless skies and warm temperatures, SIIM 2008 attendees packed the ballroom of the Seattle convention center as key opinion leaders in the fields of radiology medicine and radiology information technology squared off in a PACS ownership bout made for prime time.

Crossing the threshold of acceptance years ago, PACS is essential to our daily practice. Now an enterprise wide proposition and investment the question is not when or how to purchase one, but who owns it once it is purchased. Managing and integrating a multi department PACS system for a large health care institution infrastructure can be challenging for an independent IT department. Are they up to the task or should IT ownership remain a domain based curriculum?

As the gloves came off, Moderator/Referee John Strauss from Fujifilm Medical systems had his work cut out for him.

IT is disingenuous, says Dr. Paul Chang from the University Of Chicago Pritzker School Of Medicine. "I hedge my bet," he adds, "this should not be looked at as 'Radiology vs. IT', it should be 'Radiology with IT'."

However, he states, infrastructural PACS components are already IT owned. "Viewing PACS and medical images are the multimedia component of health records. From a political point of view, it helps me with my job to be viewed as the IT guy instead of the radiologist," states Chang.

Work flow is extremely complex and IT needs constant access. On the other hand, to remain in the hands of the independent IT teams it will be critical for progressive IT support to value domain expertise.

Though it helps, radiology PACS support is not all about 'computer only knowledge'. Many medical imaging informatics professionals share a common trait that they are also practicing radiological technologists. Understanding the radiology department as a whole and the clinical workflow from within is the key component to radiology owned PACS management and radiology IT success. This on the other hand may be quite a challenge to own and fully support from the independent IT perspective. Radiology owned PACS often receives strong support from within and a team that is also dedicated to its department's long term goals and success.

So who should be awarded the title of PACS ownership? Perhaps the user community it serves.

[Dr. Channin makes his point to the assembled audience] "If you want radiology to adopt good IT practices it MUST remain in radiology", says Dr. David Channin from Northwestern University Feinberg School of Medicine. "If you don't have budget control, you have nothing", he adds. How many times have we approached budget controllers for upgrades only to be told to wait until pathology, cardiology, or other departments get theirs? "If we take the opportunity and manage IT well, other departments will follow," says Channin.

We in radiology best serve the radiology IT interface at our own pace and on our own terms. "To control our IT destiny radiology must be at the table defining their borders, IT must remain with radiology," adds Channin.

Leaving the room, many concurred it was now hotter inside than it was outside.

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