"I still do not understand how all of the advantages that Brad describes are gained via a Web based PACS. Whether the PACS is web or not, a system can still be brokerless, flexible, inexpensive, easy to deploy, easy to upgrade, etc. A web based PACS still requires somewhat complex servers and configurations, etc. The advantage for me, and the only one, of a web based system is the ability to 'launch' the application from the web. This opens up opportunities that are endless. Now granted, that is a huge advantage, but I just dont think that people are conveying the advantages of web based PACS very well, and espescially not in this tidbit by Brad. I would love to see data on whether web based PACS perform better, are more reliable, are more secure, etc. And for those requests, I would love to see real examples, and not any high level, marketing focused, buzz word based responses."
I can't answer this question as well as, say, Brad Levin might, but I'll try. As you probably know by now, I have Agfa Impax 4.5 at one hospital, and Amicas LightBeam at another. The former is arguably at the pinnacle of development of a non-web-based system, the latter is typical of the modern breed of web-based architecture. What are the differences to me, the end-user?
If you discount differences in the clients themselves (and I could wax poetic about that for hours and hours), there is no obvious difference in the two approaches (again, from my point of view) whilst working within the hospital. I open the studies and read them. Rocket science here, right? I should add, however, that the Amicas system checks the software on my station upon each sign-on, and allows the installation of any available upgrade (that is already on the server) before the reading session begins. Could this be done with Impax? I suppose it could, but it isn't at the moment.
The real difference to me is how the system works when I am outside the hospital. Deployment of a client is much easier with a web-based system, and there is no discrepancy in the software I use at home, in the hospital, or in Timbuktu (or in the North Woods of Wisconsin if I should happen to be there.) Again, could this be accomplished with Impax? Maybe, but Agfa chooses instead to add another box, the Web1000, as an entirely separate server and client. The later versions of Web1000 look a little more like Impax, but they remain two very separate programs. At 3AM, it is a lot easier to use what you have been using all day than adjust to something different, trust me. Moreover, being able to sit at any computer in the world with broadband Internet access (well, any Windows computer anyway) and be up and running with minimal effort is truly mind-boggling when you think about it.
I'm not well-enough versed in the underlying architecture (or I haven't had enough Versed) to discuss the relative merits of each approach. My rather simplistic view is this: The 'net was designed for rapid, error-proof, interruption-resistant transmission of data. That's what we need for PACS, yes? So why reinvent the wheel?
I think we would all love to hear from experts on both sides of this issue.