10 years ago, many modality suppliers was selling a workstations with some storage space and image manipulation capabilities. Many hospitals had workstations--1 for MR, 1 for CT, 1 for NM, 1 for Fluroscopy, 1 for CR etc etc. Many vendors then started selling some server space alongwith workstations----MiniPACS. Radiologists had to move from workstation to workstations if they wanted to report on digital images. Film packets were the only way of providing a full imaging history in one place, as modality workstations created imaging data silos.

DICOM as a standard changed the digital imaging world. It is a vendor neutral standard. All radiology images from any modality supplier can be stored on PACS due to adherence of DICOM standards. For those modalities that did not support DICOM send or DMWL, intermediary boxes were put in. Nowadays no modality vendor can sell a modality with adherence to DICOM.

PACS integrated the imaging history, thus replacing the film packets and we moved filmless. For radiologists there was a remarkable change. We did not have to move from workstation to workstation to report. I can do all my reporting using PACS including 3D etc etc. From a commercial perspective, modality vendors must have seen a fall in sales for modality workstations and their small servers.

Modality, DICOM and PACS Analogy can be applied to Informations systems, XDS and EPR. Currently, Information systems (RIS, CIS, Ordercomms, Clinical letters system, Discahrge summary system, E-Prescribing etc) all hold digital information as data silos, due to lack of document standards. The only way clinicians can access full clinical history is by looking at paper notes, where the documents are printed and organised for a patient. XDS provides a document standard which will change the EPR world completely. Information systems (like X-ray modalities) will create the documents and send them off for staorage and display.

I think the next big change will be a PACS vendor who offers a "DICOM and XDS archive" and a "DICOM and XDS viewer"---Currently PACS vendors offer a DICOM archive and DICOM viewer. All major PACS vendors are aware of XDS. This leap of faith will offer customers an patient centric image and document viewing capabilities---an EPR!!!

Once suppliers are offering a system that stores both images and documents customers will prefer that over a system that only displays radiology images (analogy with a workstation that only displayed CT from a particular vendor).

Once XDS is realistically adopted, PACS will be a thing of the past (similar to modality workstations) and EPR will come about using XDS and DICOM as standards. Intermediary boxes will arrive to convert non-XDS information system to XDS.

The other big advantage will be that currently we struggle with old outdated information systems which are difficult to remove and replace. By adopting XDS standards, information systems will send all data to XDS repository and hence, one will find it as easy to replace an information system as it is to replace a CT scanner/MRI scanner.

Currently with a "connect all strategy" from the DOH/CFH, XDS provides a means of providing an EPR, and replacing the paper notes----in the same way that PACS replaced the film packet. XDS connects all information systems currently existing Information systems. This is my predictions of the future. We will see what 2013 brings. If we have a competitive market for PACS, a supplier proving "DICOM and XDS archive" with DICOM and XDS viewer will definately have an advantage over a "traditional" PACS.

By Dr. Neelam Dogur PACS & Teleradiology Group UK