I believe that PACS solved the initial problem that it was intended to solve: get rid of film. Whether it provided more value than that had a lot to do with the design of the PACS, and who was managing it.
But, the value of PACS has a lot more to do with how it is deployed, configured and managed. If a PACS owner fails to use informatics and operational best practices, they and their users will suffer. If they fail to invest in and manage the infrastructure—such as the networks, servers, and storage—they will suffer.
I have seen too many PACS operators with too heavy of a dependence on their PACS vendor. Radiology and IT too often lack staff that understand informatics, integration best practices (e.g. as defined by IHE), or how their system operates. I have seen two hospitals with the same software application doing very similar exam volumes, and one experienced high levels of user satisfaction and operational excellence, while the other had chronic issues.
I would argue that in today’s mature PACS market, it is not what you buy, but how you use it. Provider staff need skills and knowledge about best practices. They need to know more about PACS in general, and be less constrained to knowing only what their PACS vendor tells them. And one of the best places to develop these skills and broad knowledge is SIIM.
I’ll be at the SIIM meeting—stop and say ‘hi’ if you see me.