A strategic PACS maturity approach

R. van de Wetering

    Research output: ThesisDoctoral thesis 1 (Research UU / Graduation UU)


    Finding the key determinants of Picture Archivingand Communication Systems (PACS)performance in hospitals has been a conundrumfor decades. This research provides a method toassess the strategic alignment of PACS in hospitalsin order to find these key determinants. PACS touches upon every single part of the imaging workflow chain and associated sub-steps that affects the quality of imaging services and clinical outcomes. Achieving the strategic alignment of PACS and pursuingits intended goals and objectives within hospitals seem to be an intricate and poorlyexamined process. We therefore highlight the value of a PACS evaluation and maturityframework that enables hospitals to reflect holistically on their PACS performance and supports the process of maturing PACS into hospital operations. This dissertation consists of three interrelated parts. The first part explores the impacts of PACS on hospital workflow using a holistic approach that provides fundamental features for assessing PACS from various perspectives.The second part synthesizes the PACS literature on maturity and evolvability in hospitals and defines the PACS Maturity Model (PMM). The PMM describes five levels of PACS maturity and the corresponding process focus. This is subsequently extended as a strategic planning method for PACS deployment, based on the elaboration of the strategic alignment concept and the maturity growth path concepts for the PACS domain.Finally, the third part develops a rigorous perspective and method that supports the process of situationally aligning PACS in hospitals. We develop such an integral model to assess empirically the maturity and organizational alignment of PACS and its impact upon PACS performances – defined as the multifactorial impacts and benefits produced by the application of PACS in terms of hospital efficiency and clinical effectiveness with respect to PACS workflow and patients’ clinical journeys – in hospitals. A key conclusion of this dissertation is that our conceptual model – validated through data from 64 hospitals within the Netherlands – shows a significant positive impact for the PACS alignment construct on perceived PACS performance.Thus, our expectation that the alignment of PACS had a significant impact on the multifactorial performance of PACS was confirmed. Based on various sources (case studies, conceptual design, meta-analyses and survey research)a PACS evaluation and maturity framework is developed that enables hospitals to reflect holistically on their PACS performance and likewise has predictive power to explain PACS performance within hospitals’ operations. The framework supports a strategic and systematic deployment of PACS to enhance its subsequent evolvability. Based on the outcomes of the various studies included in this dissertation, we believe that hospitals should follow a strategic PACS maturity planning perspective that drives a continuous process of change and adaptation as well as the co-evolvement and alignment of PACS. Adaptability and changeability should be integral properties, next to traditional and deliberate PACS strategic planning. This research extends the body of knowledge concerning PACS maturity and its evaluation from a business informatics perspective. This is important since the filmless facilities of PACS can be exploited much further, to achieve higher productivity levels and operational efficiency gains in hospitals.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • Utrecht University
    • Brinkkemper, Sjaak, Primary supervisor
    • Scheper, W.J., Supervisor, External person
    • Batenburg, R.S., Co-supervisor
    Award date14 Apr 2011
    Publication statusPublished - 14 Apr 2011


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