Sharing of a single picture archiving and communications system among disparate institutions: barriers to success.

There has been a great deal of interest in sharing picture archiving and communications system (PACS) technology. Much of the discussion to this point has involved macro business/technical issues, such as cost for service, bandwidth, and storage technologies. In our own effort to share the Maine Medical Center PACS with other providers, we have found that the micro issues are just as important, including trust, cooperation, persistence, and dedication to fundamental change. It is not impossible to share a PACS, but a number of barriers must be overcome if the overall effort is to be successful. In this paper we present our experience with shared PACS technology by describing the impediments to sharing PACS among disparate institutions; explaining our early attempts to integrate "outside" images into our institutional PACS and the impediments that led to the failure of those early attempts; and suggesting a semi-quantitative means for calculating Likelihood of Success, based on lessons learned thus far. We also describe a new, multilevel effort at sharing our PACS, hoping to stimulate discussion of the barriers to success and to solicit input from PACS vendors and from fellow SCAR members.