Jess Dalehite, MD, is director of radiology, Medical Center Hospital (MCH), Odessa, Tex. He notes that phased-in deployment of a picture archiving and communications system (PACS) may be a wise way to proceed, but once the implementation has begun, a hospital must commit itself to becoming filmless, paperless, and totally integrated at the diagnostic workstation. "You can't stop halfway through and proclaim it good enough," he says. "If you buy PACS and you don't get rid of paper and you don't integrate it with voice and data, it's like buying a Ferrari and putting only one wheel on it. It will grossly underperform for you." He continues, "For PACS to be reasonably well accepted by radiologists and clinicians, it has to have all its wheels. Otherwise, people look at you and say, Hey, I thought this thing was really supposed to go.' The answer is that it will, but not as long as you continue to drive with less than all four wheels. In other words, it has to be fully integrated with the radiology information system and dictation."

For Dalehite, PACS represents a paradigm shift in radiology. This is why he favors a gradual deployment rather than an overnight, all-encompassing flip. "PACS truly revolutionizes the practice of radiology," he says. "It also solves the fundamental flaw of the way radiology has been practiced in the past. It used to be that you had to bring the radiologist to the image. PACS does the opposite: it brings the image to the radiologist."

Dalehite argues that there is really no shortage of radiologists, only a maldistribution of imaging, which PACS has the ability to rectify. "If we could ever overcome the issues of credentialing and licensing, there are enough radiologists out there right now to do all the work that is available," he says, provided the images are brought to the radiologists in a convenient way that suits their lifestyles. "It used to be that if you were away from the hospital, you couldn't do work. When a radiologist goes home or on a trip somewhere, there's a lot of lost productivity involved. Now, with PACS and the Internet, you can work away from the hospital. That represents the recapture of productivity. Here at MCH, we're far enough along in our deployment of PACS that we could, if needed, hire off-site radiologists as virtual staff, paid according to the number of images read, and have them up and running within 24 hours." He concludes that the potential value of PACS is so high that any time spent ensuring its proper deployment is worthwhile.