One way that a picture archiving and communications system (PACS) facilitates growth is by enabling users to reach beyond the walls of their practices, instantaneously passing images to consulting radiologists at universities and specialized care centers all over the world. Next Generation Radiology of Great Neck, NY, understood that potential when it acquired a PACS in 1998. David Katz, MD, president and managing partner, says, "Our hope was to be able to use the expertise of outside radiologists to make our services more comprehensive, and of even higher quality."

Looking back with the benefit of hindsight, this goal was not entirely met. "Definitely, it was a mixed bag," Katz says. "What we've learned about remote PACS reading is that the human factor is still the bottom line. The reading we get back is only as good as the time and effort that the radiologist on the other end is willing to put into it. Here's what I mean: if I send a case off to a university center and whoever gets it is in a hurry to go home because it's the end of the day, that person might forget to look at the old films from 3 months ago or might not take the time necessary to ensure the highest possible quality of work. This can also happen if the university center regards work from the outside as somehow less important than its own in-house work." Under such circumstances, remote reading is of no real help. Unfortunately, Katz has little control over who will be reading his submitted cases at those universities. His only recourse, in the event of dissatisfaction with the work done there, is to take his business elsewhere, which is exactly what Katz has done.

"I've sought to form relationships only with those institutions where I'm assured of getting back a quality reading," he says, noting that the two outside entities he most extensively uses are New York's Hospital for Special Surgery and Ohio's Cleveland Clinic Foundation. "If we send a very difficult wrist MRI to experts at a place like the Hospital for Special Surgery, where all they do all day is orthopedic radiology and where we know that, no matter what, they're going to be methodical and diligent (and even have familiarity with the previous surgical technique that may have been used on the patient), then we're going to get back a quality reading. The same is true if we send a case to the Cleveland Clinic Foundation, where PACS and remote work are truly integrated into their work flow so that they can give the cases we submit the care and attention they deserve."