The early adoption in the 1990s of a standard for the organization, storage, and communication of medical information fueled a revolution in medical informatics in the last two decades of the 20th century. Now in the 21st century, a new revolution seems to be near…

Since the early 1980s, there have been multiple efforts to define storage schemes for images and medical information, initially in the academic and research context. In those years, there were still no storage standards and less communication standards, so each manufacturer found a solution that met their marketing requirements. Thus, each start-up of a medical information storage solution was a titanic task in terms of effort and cost.

Already at the beginning of the 1990s, the first version of the Digital Imaging and Communication in Medicine Standard (DICOM) was released, and it quickly began to be adopted by the main manufacturers in the medical informatics industry. This is how the DICOM standard becomes an international healthcare data standard and communication protocol for exchanging medical images and related data in just a few years. It was the first time in the history of the health industry that each hardware and software manufacturer unified criteria to interoperate and share information. This revolution boosted supply and demand, since it was becoming easier to implement technology in the health care context and each medical center could decide which manufacturer best suited their needs without having to deal with the challenge of technological change.

After the adoption of the DICOM standard, the term picture archiving and communication system (PACS) was officially introduced to refer exclusively to that technological component responsible for storing medical images and their respective communication protocol to access them. These systems were strongly linked to the DICOM standard, which allowed an apparent standardization in the way healthcare data were stored, transmitted, and shared. Years later, PACS systems received another new technological boost, the consolidation of computer networking technologies and the reduction in storage costs. This new milestone promoted the inclusion of these technologies in smaller health centers, which further increased their adoption throughout the world.

At the beginning of the year 2000, PACS systems began to include new functionalities outside of their initial definition and it formal definition became more diffuse. Thus, many PACS manufacturers included functionalities such as DICOM image viewing, DICOM modality management, modalities worklist management, etc. Thus, for those who are restricted to the initial definition of PACS systems, a PACS is only responsible for storage, organization, and communication scheme, while for others a PACS must manage the visualization and even the prioritization of cases.

In the last decade, legacy on-site systems have been replaced by cloud-based systems. Around 90% of new PACS system implementations are estimated to be cloud-based. Some fundamental benefits are highlighted for cloud-based systems: greater scalability, higher availability, improved security, regulatory compliance, and efficient access to technical support. It seems that the current scenario for PACS systems is the most adequate possible. However, the growing need for interoperability outside the DICOM standard has again raised the need for standardization of nonDICOM management, fundamentally in contexts other than general radiology. Although this is not a recent problem, we have returned to the scenario where each manufacturer determines its best solution to the aforementioned challenge. Today, we talk about vendor-neutral archive (VNA) systems, to refer to the second generation of PACS systems decoupled from the impositions set by manufacturers and with extended support for non-DICOM sources. In the next installment of this series, we will talk a bit more about the modern concept of VNAs.

Jorge Rudas, Ph.D. in Biotechnology,
Head of the Innovation Team in IMEXHS
Research on computational modeling of biological system group at the National University of Colombia.
jorge.rudas@imexhs.com