Currently many PACS commercial models have depended on storage as the main source of revenue. The more data we store, the more they earn in revenue. This has led to a reluctance by PACS suppliers to implement a rules/algorithm-based data image culling. In the old "film packet" world, storage space was limited, finding more space was expensive, hence most hospitals had policies for rules-based culling of film packets.
Dr. Neelam Dugar is a consultant radiologist at Doncaster Royal Infirmary, U.K., and chair of the Royal College of Radiologists' Imaging Informatics Group.Despite the claim that storage hardware is cheap these days, clinical/patient data storage remains fairly expensive. One cannot just store the data and forget about it. Patient data need to be stored safely and must be accessible within three seconds, otherwise it is likely the doctor will be unable to use the data to support patient care. Most of us expect to view our emails within three seconds of a click, so the same applies here. But to keep data within a "three-second display window" remains a challenge.
Patient data must be kept in managed storage where storage software and hardware systems are kept up-to-date -- we cannot carelessly lose patient data. Whilst storage, server, and network technology keeps improving by leaps and bounds, in the same way image quality also keeps improving with an increase in image size for each exam. Today's multidetector CT scans are now producing gigabytes of data, rather than the traditional megabytes from plain films. Hence, the three-second display standard for clinical image data will remain a challenge for any emerging storage technology -- cloud storage, storage virtualization, etc.
It is time for reflection of PACS image data. Can we keep the data forever? Is there any proven benefit of keeping data forever? Is there any clinical evidence to support that routinely keeping everything forever actually is statistically significant for improving patient management? What did we do in the past with film packets? Could we have kept them forever? What were the policies in place for culling film packets? Can we apply those same policies to digital data?
In the U.K., the film packet culling was based on rules (normally film packets were culled eight years after the last visit to the radiology department, with the ability to manually extend the date for medicolegal, oncology, research etc.). Why can we not apply the same rules and algorithms to digital data? Traditionally, the PACS vendors have been reluctant to allow any culling of data; sales executives could be scaremongers about possible accidental deletion of data. Why cannot there be a rule that prevents any data to be deleted before eight years? Could the commercial interests to increase storage be responsible?
As customers become intelligent, they will demand a PACS commercial model that is based on a service model, rather than a storage model. They will also demand that the PACS is able to follow an algorithm for data deletion. This will ensure that the data storage remains fairly controlled -- similar to film packets. Intelligent PACS customers are likely to drive this direction for PACS development.
Dr. Neelam Dugar is consultant radiologist at Doncaster Royal Infirmary, U.K., and chair of the Royal College of Radiologists' Imaging Informatics Group.
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