Picture archiving and communications systems revolutionized medical imaging, digitizing examinations that used to be on film and archiving them in the PACS. But now many providers are moving from a PACS archive to an enterprise archive. That brings technical and political challenges as control of images moves from the radiology department to the hospital.

“I’m a radiologist and want to maintain control of our system,” says Alexander Towbin, M.D., a radiologist at Cincinnati Children’s Hospital Medical Center. “But it goes beyond radiology--should the radiology department have control over dermatology issues?” And beyond the hospital level is the delivery system level with technical and political questions of how to exchange images across other hospitals within and outside of a delivery system. For instance, how do you make sure every partner is identifying patients correctly? And whether hospitals want to or not, the electronic health records meaningful use program is pushing them toward accelerated health information exchange, including diagnostic images.

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