PACS: the second time around.

Conquest Hospital was a Picture Archiving and Communication Systems development site, designed to inform the specification of low cost systems and to provide information on benefits and drawbacks. The American College of Radiologists/National Electrical Manufacturers Association 2.0 protocol was used for image management. The Regional Health Authority sponsored the system, initially installed in mid 1992. It used a high-speed dedicated optical fibre distributed data interface network and for teleradiology an Integrated Services Digital Network solution. Image and other data were captured and archived satisfactorily. Image reporting folders were manually constructed and sent to reporting viewstations. Radiologists were able to directly request 'ad hoc' images from archive. The reporting function of the associated but unlinked radiology information system was satisfactory. Identification was made of data transfer, ergonomic, single point of failure and many other issues. These informed re-specification and the commercial approach for a Digital Images Communication in Medicine/Hyper Text Mark-up Language Picture Archiving and Communication System, the first stages of which have been whole hospital re-networking, Intranet introduction, installation of new Computed Radiography/Fluorography and Computed Tomography/Magnetic Resonance Imaging segments and a new Radiology Information System. The Picture Archiving and Communication System is now seen as part of a full Electronic Patient Record system. Networking and provision of high quality Personal Computer hardware for data review are seen as a corporate responsibility and a hospital overhead, no longer borne by individual projects. Our present work is synergistic with the procurement of a new Clinical Information System and the further development of the hospital Intranet.