PACS technologies and reliability: are we making things better or worse?

Purpose: In the process of installing picture archiving and communications (PACS) and speech recognition equipment, upgrading it, and working with previously stored digital image information, the authors encountered a number of problems. Examination of these difficulties illustrated the complex nature of our existing systems and how difficult it is, in many cases, to predict the behavior of these systems. This was found to be true even for our relatively small number of interconnected systems. The purpose of this paper is to illustrate some of the principles of understanding complex system interaction through examples from our experience. Methods: The work for this paper grew out of a number of studies we had carried out on our PACS over several years. The complex nature of our systems was evaluated through comparison of our operations with known examples of systems in other industries. Results: Three scenarios: a network failure, a system software upgrade, and attempting to read media from an old archive showed that the major systems used in the radiology departments of many healthcare facilities (HIS, RIS, PACS, and speech recognition) are likely to interact in complex and often unpredictable ways. These interactions may be very difficult or impossible to predict, so that some plans should be made to overcome the negative aspects of the problems that result. Conclusion: Failures and problems, often unpredictable ones, are a likely side effect of having multiple information handling and processing systems interconnected and interoperating. Planning to avoid, or at least not be so vulnerable, to such difficulties is an important aspect of systems planning.