PACS Americana: The U.S. radiology IT market is saturated and stable, but change is on the way

"PACS replacement is a costly thing," says HIMSS Analytics' John Hoyt. For the time being, "There may be consolidation as opposed to replacement."

The first thing one notices, when looking at HIMSS Analytics' tallies of picture archiving and communication systems (PACS) adoption in hospitals, is how high they are. Unlike CPOE, e-prescribing or even EHRs, the market penetration for PACS systems is pretty robust.

In 2007, some 70 percent of hospitals had at least one radiology PACS modality up and running. As of this year, nearly 91 percent of 5,309 hospitals surveyed can say the same.

"If you've been a [PACS] salesperson, you've had some good years," jokes John Hoyt, executive vice president of HIMSS Analytics.

That said, not all modalities are created equal. While radiology PACS  -  for CT, ultrasound, MRI, even digital fluoroscopy  -  are in place in three-quarters of hospitals or more, other specialties have seen slower adoption.

"We make a distinction between radiology PACS and cardiology PACS, and the reason we do that is that there really are different market penetrations," says Hoyt. 

When it comes to cardiology, PACS prevalence is below 40 percent.

"Small hospitals"  -  those with fewer than 100 or 150 beds, say  -  "are not going to have cardiology PACS because they don't have dedicated cardiologists who are doing interventional exams," says Hoyt.

Of course, adds Jennifer Horowitz, HIMSS' senior director of research, "That trend is true in the radiology market in general: Smaller hospitals don't have radiology PACS either. That's where the penetration rates lag."

When hospitals do spend money on PACS, though, "They generally go across the board of modalities," says Hoyt. "They get all of their machines to write to PACS. Any analog machine that writes to film, they either have to throw it out or have a major renovation of the machine, so it makes a digital file that is then sent to PACS which then can turn it into a digital image on the monitor."

"Going to PACS is not just a matter of getting a PACS system up, but also may mean some of your older equipment has to be renovated or retrofitted or replaced," he adds.

That's a big and expensive undertaking, which explains why the PACS market, as relatively mature and saturated as it is, is nowhere near as dynamic as in some other areas of health IT. 

A September Frost & Sullivan report highlighted how that saturation  -  combined with long replacement cycles and, especially, a focus of capital and manpower on electronic health records  -  has led to a lackluster market at the moment.