van de Wetering Rogier, Batenburg Ronald
Department of Information and Computing Sciences, Faculty of Sciences, Utrecht University, Fruinplantsoen 77, 3571 PT, Utrecht, The Netherlands,
J Digit Imaging. 2014 Jun;27(3):337-50. doi: 10.1007/s10278-013-9671-y.
Owing to large financial investments that go along with the picture archiving and communication system (PACS) deployments and inconsistent PACS performance evaluations, there is a pressing need for a better understanding of the implications of PACS deployment in hospitals. We claim that there is a gap in the research field, both theoretically and empirically, to explain the success of the PACS deployment and maturity in hospitals. Theoretical principles are relevant to the PACS performance; maturity and alignment are reviewed from a system and complexity perspective. A conceptual model to explain the PACS performance and a set of testable hypotheses are then developed. Then, structural equation modeling (SEM), i.e. causal modeling, is applied to validate the model and hypotheses based on a research sample of 64 hospitals that use PACS, i.e. 70 % of all hospitals in the Netherlands. Outcomes of the SEM analyses substantiate that the measurements of all constructs are reliable and valid. The PACS alignment-modeled as a higher-order construct of five complementary organizational dimensions and maturity levels-has a significant positive impact on the PACS performance. This result is robust and stable for various sub-samples and segments. This paper presents a conceptual model that explains how alignment in deploying PACS in hospitals is positively related to the perceived performance of PACS. The conceptual model is extended with tools as checklists to systematically identify the improvement areas for hospitals in the PACS domain. The holistic approach towards PACS alignment and maturity provides a framework for clinical practice.
由于图像存档与通信系统（PACS）部署需要大量资金投入，且PACS性能评估不一致，因此迫切需要更好地了解医院中PACS部署的影响。我们认为，在研究领域，无论是从理论上还是实证上，都存在差距，无法解释PACS在医院部署的成功与成熟度。理论原则与PACS性能相关；从系统和复杂性角度对成熟度和一致性进行了综述。然后开发了一个解释PACS性能的概念模型和一组可检验的假设。接着，应用结构方程模型（SEM），即因果建模，基于64家使用PACS的医院（占荷兰所有医院的70%）的研究样本对模型和假设进行验证。SEM分析结果证实，所有构念的测量都是可靠且有效的。PACS一致性——被建模为五个互补组织维度和成熟度水平的高阶构念——对PACS性能有显著的正向影响。这一结果在不同子样本和细分群体中都稳健且稳定。本文提出了一个概念模型，解释了医院中PACS部署的一致性如何与PACS的感知性能呈正相关。该概念模型通过清单等工具进行扩展，以系统地识别医院在PACS领域的改进领域。对PACS一致性和成熟度的整体方法为临床实践提供了一个框架。
