Our cover story on picture archiving and communications systems (PACS) began life as a history and quickly evolved into a tribute to those early academics who invested their time and mental capital in the dream of PACS. My writer George Wiley flatly refused to do the timeline I requested: Everyone hedged on dates and I couldn't pin anyone down, he said. Attempting to nail down the birth of PACS was like trying to isolate a quark in a bottle.

So instead of a linear history, Wiley listened to the stories told by some of these early pioneers and related them back in a fascinating tale of the genesis of the digital age in radiology, something so many of us take for granted. In tracking some of the names on the list of PACS pioneers, I discovered that some continue to work in radiology and to press the boundaries of what is possible in digital communications. Others have moved on to other callings and other fields in academia and even other countries. For a few, the trail went cold. Certain names came up again and again in researching this story, but because those pioneers worked for vendors, our editorial policy prohibits naming them. We want to extend our apologies for slighting you in this way. If there is someone out there whose early contributions have not received the recognition they deserve, please help correct the record and send me an e-mail.

Many other people who continue to contribute to the evolution of PACS were not recognized: they include both the academics and the vendors who helped move PACS from an expensive, thick-client, radiology-centric system that was essentially an electronic version of the film library to an expensive enterprise-wide communications system based on interoperability and leveraging web technology to leap walls and buildings. There are many people out beating the drum right now for interoperability among information systems; our cover story is a tribute to radiology's early role in this endeavor. PACS truly is an accomplishment that has and will continue to benefit all of medicine.

In his keynote to the recent meeting of the Healthcare Information and Management Systems Society, David Brailer, MD, national coordinator for health information technology, underscored several hurdles that continue to stand in the way of interoperability, including the adoption gap between large and small practices, which also has been true of institutions and PACS. Finding a place in the capital or operational budget for PACS is critical to the viability of every health care organization. In the latest administrative debacle from the Los Angeles-based King Drew Medical Center reported by the Los Angeles Times , a sole locum tenens radiologist was paid $1.3 million for round-the-clock coverage of a troubled trauma center. A web-based PACS may have enabled the eight full-time staff and six contracted radiologists to find another way.

PACS is clearly a story that is ongoing, a work still in progress. A single-screen sign-on for all applications continues to elude us, but we are close. And health care organizations are just beginning to experiment with exchanging information across institutional lines. But one thing is certain: PACS will continue to evolve until it disappears into the broader fabric of an EHR, or vice versa. A new generation of visionaries will see to that.

Cheryl Proval