Challenges and opportunities for technology assessment in medical informatics. Case study: PACS.

In this paper the basic steps of cost-effectiveness analysis (CEA) are applied in the evaluation of picture archiving and communication systems (PACS). The exercise demonstrates that evaluations of PACS have been technology-orientated, rather than problem-orientated. Moreover, many of the potential benefits of the system have been insufficiently investigated. Assessment based on the analysis of the bottlenecks in the film-based system alone appears to be quite inaccurate, as shown by the diverging outcomes of early assessment results. The development of PACS has reached a state in which the first clinical experiences are being collected. This provides an opportunity to test postulated costs and benefits. Moreover it may provide a better insight into the future potential of the technology. Experimenting with PACS is expensive. Hence, we should work together in evaluation, in order to benefit as much as possible from each other's experiences.