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Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users’ Work

Determining the Effect of the Picture Archiving and Communication System (PACS) on Different... Hindawi Radiology Research and Practice Volume 2022, Article ID 4306714, 7 pages https://doi.org/10.1155/2022/4306714 Research Article Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users’ Work Mahdieh Montazeri and Reza Khajouei Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran Correspondence should be addressed to Reza Khajouei; r.khajouei@yahoo.com Received 23 October 2021; Revised 22 January 2022; Accepted 4 February 2022; Published 28 February 2022 Academic Editor: Lorenzo Faggioni Copyright © 2022 Mahdieh Montazeri and Reza Khajouei. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. +e impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different di- mensions of the users’ work. +e objective of this study was to evaluate the impact of the PACS on different dimensions of users’ work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. +is study was performed on the PACS users (n � 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users’ work. Data were analyzed using descriptive statistics, ANOVA, and Pearson’s correlation coefficient statistical tests. +e mean of scores given by the PACS users was 4.31± 0.86 for external communication, 4.18± 0.96 for user intention to use the PACS, 3.91± 0.7 for service quality, 3.16± 0.56 for daily routine, and 3.08± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P< 0.01, CI � 95%). Factors such as user age (P< 0.01, CI � 95%), job (P< 0.001, CI � 95%), work experience (P< 0.001, CI � 95%), and PACS training method (P � 0.037, CI � 95%) were related to the impact of the PACS on different dimensions of users’ work. +is study showed that the PACS has a positive effect on different dimensions of users’ work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users’ work and to maintain and strengthen the capabilities and functions of radiology departments. workflow and increased the efficiency of healthcare pro- 1. Introduction viders [3]. PACS is a computerized system used to collect, Due to the large number of medical images captured by archive, process, communicate, and provide medical images and reports [4–6]. Studies have shown that this system different X-ray modalities, CT, MRI scanners, and sonog- raphy in health centers, storing and retrieving images are reduces costs, prevents duplication of radiological images, costly and time-consuming [1]. To address this problem, increases image quality, reduces access time, and improves over the past decades, significant changes have taken place in the quality of education, treatment, and security [7–10]. medical imaging technology worldwide, leading to the Studies have shown that younger radiologists are more digitalization of medical imaging devices [2]. +ese changes interested in information technology-based systems such as have led to the introduction and use of the picture archiving PACS and radiology information system (RIS), and these and communication system (PACS). PACS, along with other systems can help them boost their careers in various ways healthcare information systems, has changed hospitals’ [11]. A psychological study was conducted to assess the user 2 Radiology Research and Practice acceptance of the PACS in the radiology ward of hospitals 3. Results using the technology acceptance model (TAM). +is study Demographic information of the participants is presented in showed that the rate of technology acceptance was high [12]. Table 1. In this study, 78% of the participants were female, Although many studies have examined the challenges of the 47% had less than two years of experience with the PACS, PACS [3, 13–19] and the impact of this system on factors and 51% had a mean level of computer knowledge. Among such as cost reduction, improved access, image quality the users, 46% were physicians who worked with the PACS, [20, 21], and user workflow [11, 22], there is insufficient and 65% had received group training about the use of the evidence on the effect of the PACS on different dimensions PACS. of the users’ work. +e objective of this study was to evaluate Figure 1 shows the mean scores of the system impact per the impact of the PACS on different dimensions of users’ work (external communication, service quality, user in- the dimensions of users’ work. +e highest scores were assigned by the radiology staff (4.07± 0.39) and radiologists tention to use the PACS, daily routine, and complaints on (4.05± 0.56) and the lowest (3.48± 0.49) by the physicians to users) and to compare the opinions of different groups of the dimensions studied in this study. +e external com- users about the PACS. munication dimension had the highest score (4.31± 0.86), and the complaints on users’ dimension had the lowest 2. Materials and Methods score (3.08± 1.05). +e mean scores of all dimensions were above 3. 2.1. Research Setting. +e study population comprised all Among three factors in the external communication PACS users in two academic hospitals of Kerman University dimension, the highest score was related to the factor “the of Medical Sciences, including radiologists, radiology staff, impact of the PACS on accessibility and sharing of radiology ward heads, and physicians. In this study, two hospitals data with other wards” (4.48, ±0.88). +e mean score of all having different PACSs and medical specialties were in- factors in this dimension was above 4.2. +e highest score in cluded in the study. Afzalipour Hospital is known for its the service quality dimension was related to “the impact of internal medicine services and Shafa hospital for its car- the PACS on management for services of the radiology” diovascular services. At the time of this study, the PACSs had (4.06± 1.21). +e mean scores of the factors related to this already been implemented in these two hospitals and are dimension were between 3.7 and 4.1. In the dimension of available in all clinical wards of these two hospitals. +e user intention to use the PACS, the highest score was related PACS in Shafa has been implemented since 2017 and was to the factor “I intend to use the PACS as much as possible” purchased from MARCO, an Iranian company. +e PACS in (4.45± 0.9). In the daily routine dimension, the highest score Afzalipour has been implemented since 2016 by Infinity, a was related to the factor “the impact of the PACS on job Korean company. satisfaction” (3.77± 1.07), and the lowest was related to “the impact of the PACS on the responsibilities and work re- quests of radiologists and radiology staff” (2.47± 1.06). +e 2.2. Data Collection. +e data collection tool was a ques- mean scores of all factors in this dimension were below 4. tionnaire developed based on the previous studies in this +e highest score in the complaints on users’ dimension was field [23–25] and was completed by 72 participants. +e related to the factors “increasing the cooperation of the ICT questionnaire had two parts. +e first part included eight department with the radiology department after the questions about user characteristics and demographic in- implementation of the PACS,” and the lowest score in this formation of the participants, and the second part included dimension was related to the factor “physicians and other 25 questions concerning the five following dimensions: clinical staff are less appreciative towards the PACS” external communication (questions 9 to 11), service quality (2.37± 1.41). Except for one factor, “physicians and other (questions 12 to 17), user intention to use the PACS clinical staff are less appreciative towards the PACS,” the (questions 18 and 19), daily routine (questions 20 to 26), and mean score of all factors in this dimension was higher than 3. complaints on users (questions 27 to 33). A 5-point Likert Table 1 shows the results of the ANOVA test to examine scale (from very high to very low) was used to answer the the relationship between user demographics and the impact questions of the second part. of the PACS. +e study variables had significant relation- ships with user age, work experience, occupation, and type of 2.3. Data Analysis. Data were analyzed by SPSS version 24. PACS training (P< 0.05, CI � 95%). According to this test result, the highest scores were given by users under 30 years To analyze the data, question items were scored from 5 (very high) to 1 (very low). Analysis of variance (ANOVA) was old and the lowest score by users of 40 to 49 years old. By increasing the users’ age and work experience, the mean of used to assess the relationship between individual charac- the score given to the effects of the PACS decreased. +e teristics and the five dimensions of external communication, highest score was given by the users having work experiences service quality, user intention to use the PACS, daily between 11 and 15 years and the lowest by the users with routine, and complaints on users. Pearson’s correlation work experiences of 5–10 years. Individuals who received coefficient was used to measure the correlation between PACS training individually gave the highest scores, and these dimensions. +is study was approved by the Ethics those who received e-learning gave the lowest scores. Also, Committee of Kerman University of Medical Sciences the scores of the service quality, user intention to use the (code: IR.KMU.REC.1399.042). Radiology Research and Practice 3 Table 1: Participants’ demographics and their relationship with the impact of the PACS. Demographic information Frequency (%) Mean SD p Female 56 (77.8) 3.79 0.53 Gender 0.177 Male 15 (2.08) 3.51 0.50 Under 30 24 (33.8) 3.92 0.52 30–39 26 (36.6) 3.84 0.46 Age (years) 0.001 40–49 16 (22.5) 3.33 0.50 50 or older 5 (7) 3.41 0.27 Novice 4 (5.6) 3.28 0.34 Average 37 (51.4) 3.85 0.38 Computer knowledge 0.11 Advanced 25 (34.7) 3.63 0.70 Expert 6 (8.3) 3.66 0.42 Group training 47 (65.3) 3.80 0.54 Individual training 14 (19.4) 3.82 0.42 Training PACS 0.037 Web-based tutorial training 4 (5.6) 3.21 0.11 No training 7 (9.7) 3.37 0.55 Less than five 23 (31.9) 4.00 0.48 5–10 2 (2.8) 3.57 0.51 Work experience (years) 0.001 11–15 4 (5.6) 4.07 0.49 More than 15 13 (18.1) 3.83 0.42 Less than 2 34 (47.2) 3.78 0.45 2–5 26 (36.6) 3.81 0.59 Experience using the PACS (years) 0.058 6–10 8 (11.3) 3.42 0.50 More than ten 3 (4.2) 3.13 0.40 Radiologist 9 (12.5) 4.05 0.56 Radiology staff 16 (22.2) 4.07 0.39 Job <0.001 Physician 33 (45.8) 3.48 0.49 Ward’s head 14 (19.4) 3.71 0.44 External Service quality User intention Daily routine Complaints on communication to use PACS users Dimensions of users′ work Radiologists Physicians Radiology staff Ward heads Figure 1: Mean scores of PACS impact per the dimensions of users’ work. PACS, daily routine, and complaints on users’ dimensions computer knowledge was also related to the external were significantly related to the user age, work experience, communication dimension so that the mean of scores given and type of training (P< 0.05, CI � 95%) so that, by in- by the users having an average knowledge or greater was creasing the age and work experience, the mean of scores almost twice as high as the mean of scores given by the given to the mentioned dimensions declined. +e users’ beginners. Users with a work experience of lower than five Mean 4 Radiology Research and Practice Table 2: Pearson’s correlation between study dimensions. External External communication communication r � 0.631 Service Service quality P< 0.001 quality User intention to use the r � −0.88 r � 0.104 User intention to use the PACS P � 0.462 P � 0.383 PACS r � 0.36 r � 0.265 r � 0.203 Daily Daily routine P � 0.002 P � 0.025 P � 0.088 routine r � 0.021 r � 0.98 r � 0.166 r � 0.403 Complaints on Complaints on users P � 0.841 P � 0.414 P � 0.164 P< 0.001 users years had the most, and people with work experiences be- technology acceptance studies in medical settings, the use of the PACS depends on its usefulness and ease of use [32–34]. tween 11 and 15 years had the lowest desire to work with the PACS. It seems that embedding various tools and features in today’s Pearson’s correlation coefficient test was used to measure PACS interface has made this system useful and easy to use. the correlation between the dimensions of external com- +e existence of multiple features in the system can meet munication, service quality, user intention to use the PACS, users’ expectations and result in service quality and user daily routine, and complaints on users, the results of which intention to use the PACS. However, other PACSs can have are shown in Table 2. According to these results, the highest different results depending on their characteristics. correlation was between the two dimensions of external Consistent with the results of previous studies [26, 31], communication and service quality (r � 0.631, P< 0.05) and the results of our study showed that the implementation of the lowest correlation between the two dimensions of daily the PACS improves service quality. +is improvement can routine and service quality (r � 0.265, P � 0.02). result from better management of radiology services and provision of better information for decision-making, by improving access to information, after the implementation 4. Discussion of the PACS. In particular, according to the results of previous studies, PACS supports physicians’ decision- 4.1. Principal Findings. +is study showed that the PACS has making [21] and diagnosis [35] due to greater access to a positive effect on different dimensions of users’ work, so the images and reports. Nevertheless, the results of a study participants gave a score of higher than 2.5 to all the di- conducted by Watkins [36] showed that the PACS can in- mensions on the 5-point Likert scale. Based on the results, crease access to images but does not affect clinical decision- PACS improves external communication, increases user in- making. +is difference could be related to the qualitative tention to use the PACS, enhances service quality, streamlines methodology with fewer participants used in this study. daily routine, and reduces user complaints, respectively. +e +is study showed that more than half of the users believed participants gave a mean score of approximately 4 out of 5 to that the implementation of the PACS had supported the users in the three dimensions of external communication, user in- performing their daily routine. Congruent with our findings, tention to use the PACS, and service quality. Ayal and Seidman [37] showed that the PACS reduces the time required for daily routine and increases user satisfaction. It 4.2. Comparison with the Results of Other Studies. +e pos- provides ubiquitous access to images, reduces the time of image itive effect of the PACS on different dimensions of users’ work recovery and clinical reports, enables effective planning to use that was shown in this study was in line with the results of radiology devices, facilitates teleconsultation, and provides previous studies [23, 26, 27]. +e present study found that assistive devices to support image recognition and improve more than two-thirds of users believed that the PACS had hospital workflow. Another study [39] showed that the PACS improved external communication. Consistent with our improves daily routine by reducing image searching and in- findings, Hains et al. [28] examined the effect of the PACS on terpretation time and speeding up the diagnoses. the physicians’ work in the ICU and concluded that the Consistent with the results of a previous study [26], our implementation of the PACS improves physicians’ efficiency findings showed that, after PACS implementation, com- and communication between the ICU and the radiology plaints on users in the radiology department were decreased. department. +e reason is that electronic communication Also, Trumm et al. [38] reported that replacing analog and processes have changed the image viewing patterns and re- film-based systems with the PACS reduced the problems of duced physicians’ visits to the radiology department to view the radiology department and ultimately increased user radiology images [28]. Implementation of the PACS also satisfaction and reduced complaints on radiology staff. improves communication between physicians and radiolo- gists by facilitating joint decision-making [11, 29]. +is study showed that the majority of the participants 4.3. Relationship between the Impacts of the PACS and De- mographic Information of the Participants. +e results of our were inclined to use the PACS. +is tendency could be due to the ease of use of the system [30, 31]. As stated in the study showed that factors such as user age, job, work Radiology Research and Practice 5 trained and untrained users had a favorable opinion about experience, and PACS training method are related to the impact of the PACS on different dimensions of users’ work. the impact of the PACS on various dimensions of their work. In this study, the highest correlation was between the two According to the results, PACS had a positive effect on the work dimensions of all groups of PACS users. A previous dimensions of external communication and service quality. study [39] showed that physicians believe that the PACS is Previous studies [45, 46] also showed the positive effect of more reliable than the analog system due to various features external communication on service quality. It is suggested such as editing functionalities and the ability to make dif- that the authorities of medical centers that have no PACS put ferent changes in images and to compare previous and new the hospital-wide implementation of the PACS on their images of the same patient. Physicians believed that the agendas to increase service quality. PACS improves the efficiency of the patient’s follow-up process because of the ability to access images from multiple 4.4. Limitations. +e present study had three limitations. locations and easy consultation among different wards. +is study was conducted only on two types of PACSs According to the results of our study, the type of users’ job implemented in two hospitals. Future studies can address affects their perception about the PACS. Among the main other types of PACSs in several geographical areas and on a users of the system, radiologists and radiology staff had a larger number of participants. Second, this study examined more positive opinion about the PACS than other clinicians the impact of the PACS only on the five dimensions of users’ such as physicians. +is may be due to the novelty of the work (external communication, user intention to use the PACS for physicians compared to radiologists and their PACS, service quality, daily routine, and complaints on unfamiliarity with this system. Consistent with this finding, users). +e effect of the PACS on other dimensions of users’ Alalawi et al. [23] concluded that radiologists pay much at- work may have been missed in this study. +is effect can also tention to the strengths of the system than physicists and believe be influenced by other issues such as the extent of daily that the PACS improves their efficiency. Also, Buabbas et al. PACS use and the quality of the PACS and user interface. [31] showed that more than three-quarters of the radiologists Subsequent studies can work specifically on each of these found the PACS user-friendly and were positive about it. issues. +ird, in this study, we evaluated the impact of the By increasing the age and experience of participants in PACS from the perspective of users. Since individuals’ this study, their perspectives about service quality were more perspectives can be subjective, subsequent studies can use positive, and their intention to use the PACS decreased. +is more objective methods, such as observation. may be because users with a lower work experience used the PACS for most of their work period and could easily adapt to 5. Conclusion the system. Still, people with a higher work experience are resistant to using the PACS due to the long-term use of the +e results of this study showed that the PACS had a positive previous system and need time to change their habits. effect on the work dimensions of users. +is system has the Various studies have shown that users who had more ex- greatest impact on improving external communication, perience with the PACS had a more positive view of the increasing user intention to use the system, and increasing system [26, 40]. Previous studies have also shown that young service quality. In this study, we did not only measure the people are more inclined to use information technology and impact of the PACS on the positive aspects of users’ work, applications [41, 42]. However, various studies have shown such as increasing service quality, but also on the negative that improving the user interface and addressing system ease aspects such as complaints and pressure on the radiology of use can increase the willingness of older adults to use these department. For example, our results showed that radiology systems [43, 44]. staff received more calls requesting information regarding One of the reasons that users in this study were positive PACS functions and services. Although different PACSs may about the PACS was that most of them were trained in the have common advantages, several studies need to be done to use of the PACS. In line with our results, other studies have identify the negative impacts of the PACS. However, in this shown that user training can contribute to the successful study, radiologists have a greater understanding of the implementation of the PACS [19, 39]. Despite the usefulness benefits of the PACS than physicians, results showed that the of training, Bramblz et al. showed that this training does not PACS has benefits for all user groups, and the users believe always exist. For example, study participants expressed that that this system has a positive impact on various dimensions “image contrast is not controllable” and “changing the of their work. +is study evaluated the impact of the PACS darkness or brightness of the images is impossible,” while from the users’ point of view and showed that this system these features were present in the system, but users had not can positively affect five dimensions of users’ work (external received training about them [21]. According to the findings communication, service quality, daily routine, personal of this study, PACS had the greatest impact on the work intention to use the PACS, and complaints on users). Other dimensions of users who received individual system train- studies can consider other issues such as the extent of daily ing. Another study [39] showed the greater impact of in- PACS use and the quality of the PACS and user interface. dividual training compared to other methods (group training, training through manuals, and electronic files) on Data Availability user learning, use of system capabilities, and its successful implementation. Although training can help to identify a +e data used in this study are available from the corre- system’s capabilities, the results of this study showed that all sponding author upon request. 6 Radiology Research and Practice practice,” Journal of Digital Imaging, vol. 20, no. 4, Ethical Approval pp. 411–421, 2007. [12] B. 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Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users’ Work

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Hindawi Radiology Research and Practice Volume 2022, Article ID 4306714, 7 pages https://doi.org/10.1155/2022/4306714 Research Article Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users’ Work Mahdieh Montazeri and Reza Khajouei Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran Correspondence should be addressed to Reza Khajouei; r.khajouei@yahoo.com Received 23 October 2021; Revised 22 January 2022; Accepted 4 February 2022; Published 28 February 2022 Academic Editor: Lorenzo Faggioni Copyright © 2022 Mahdieh Montazeri and Reza Khajouei. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. +e impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different di- mensions of the users’ work. +e objective of this study was to evaluate the impact of the PACS on different dimensions of users’ work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. +is study was performed on the PACS users (n � 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users’ work. Data were analyzed using descriptive statistics, ANOVA, and Pearson’s correlation coefficient statistical tests. +e mean of scores given by the PACS users was 4.31± 0.86 for external communication, 4.18± 0.96 for user intention to use the PACS, 3.91± 0.7 for service quality, 3.16± 0.56 for daily routine, and 3.08± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P< 0.01, CI � 95%). Factors such as user age (P< 0.01, CI � 95%), job (P< 0.001, CI � 95%), work experience (P< 0.001, CI � 95%), and PACS training method (P � 0.037, CI � 95%) were related to the impact of the PACS on different dimensions of users’ work. +is study showed that the PACS has a positive effect on different dimensions of users’ work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users’ work and to maintain and strengthen the capabilities and functions of radiology departments. workflow and increased the efficiency of healthcare pro- 1. Introduction viders [3]. PACS is a computerized system used to collect, Due to the large number of medical images captured by archive, process, communicate, and provide medical images and reports [4–6]. Studies have shown that this system different X-ray modalities, CT, MRI scanners, and sonog- raphy in health centers, storing and retrieving images are reduces costs, prevents duplication of radiological images, costly and time-consuming [1]. To address this problem, increases image quality, reduces access time, and improves over the past decades, significant changes have taken place in the quality of education, treatment, and security [7–10]. medical imaging technology worldwide, leading to the Studies have shown that younger radiologists are more digitalization of medical imaging devices [2]. +ese changes interested in information technology-based systems such as have led to the introduction and use of the picture archiving PACS and radiology information system (RIS), and these and communication system (PACS). PACS, along with other systems can help them boost their careers in various ways healthcare information systems, has changed hospitals’ [11]. A psychological study was conducted to assess the user 2 Radiology Research and Practice acceptance of the PACS in the radiology ward of hospitals 3. Results using the technology acceptance model (TAM). +is study Demographic information of the participants is presented in showed that the rate of technology acceptance was high [12]. Table 1. In this study, 78% of the participants were female, Although many studies have examined the challenges of the 47% had less than two years of experience with the PACS, PACS [3, 13–19] and the impact of this system on factors and 51% had a mean level of computer knowledge. Among such as cost reduction, improved access, image quality the users, 46% were physicians who worked with the PACS, [20, 21], and user workflow [11, 22], there is insufficient and 65% had received group training about the use of the evidence on the effect of the PACS on different dimensions PACS. of the users’ work. +e objective of this study was to evaluate Figure 1 shows the mean scores of the system impact per the impact of the PACS on different dimensions of users’ work (external communication, service quality, user in- the dimensions of users’ work. +e highest scores were assigned by the radiology staff (4.07± 0.39) and radiologists tention to use the PACS, daily routine, and complaints on (4.05± 0.56) and the lowest (3.48± 0.49) by the physicians to users) and to compare the opinions of different groups of the dimensions studied in this study. +e external com- users about the PACS. munication dimension had the highest score (4.31± 0.86), and the complaints on users’ dimension had the lowest 2. Materials and Methods score (3.08± 1.05). +e mean scores of all dimensions were above 3. 2.1. Research Setting. +e study population comprised all Among three factors in the external communication PACS users in two academic hospitals of Kerman University dimension, the highest score was related to the factor “the of Medical Sciences, including radiologists, radiology staff, impact of the PACS on accessibility and sharing of radiology ward heads, and physicians. In this study, two hospitals data with other wards” (4.48, ±0.88). +e mean score of all having different PACSs and medical specialties were in- factors in this dimension was above 4.2. +e highest score in cluded in the study. Afzalipour Hospital is known for its the service quality dimension was related to “the impact of internal medicine services and Shafa hospital for its car- the PACS on management for services of the radiology” diovascular services. At the time of this study, the PACSs had (4.06± 1.21). +e mean scores of the factors related to this already been implemented in these two hospitals and are dimension were between 3.7 and 4.1. In the dimension of available in all clinical wards of these two hospitals. +e user intention to use the PACS, the highest score was related PACS in Shafa has been implemented since 2017 and was to the factor “I intend to use the PACS as much as possible” purchased from MARCO, an Iranian company. +e PACS in (4.45± 0.9). In the daily routine dimension, the highest score Afzalipour has been implemented since 2016 by Infinity, a was related to the factor “the impact of the PACS on job Korean company. satisfaction” (3.77± 1.07), and the lowest was related to “the impact of the PACS on the responsibilities and work re- quests of radiologists and radiology staff” (2.47± 1.06). +e 2.2. Data Collection. +e data collection tool was a ques- mean scores of all factors in this dimension were below 4. tionnaire developed based on the previous studies in this +e highest score in the complaints on users’ dimension was field [23–25] and was completed by 72 participants. +e related to the factors “increasing the cooperation of the ICT questionnaire had two parts. +e first part included eight department with the radiology department after the questions about user characteristics and demographic in- implementation of the PACS,” and the lowest score in this formation of the participants, and the second part included dimension was related to the factor “physicians and other 25 questions concerning the five following dimensions: clinical staff are less appreciative towards the PACS” external communication (questions 9 to 11), service quality (2.37± 1.41). Except for one factor, “physicians and other (questions 12 to 17), user intention to use the PACS clinical staff are less appreciative towards the PACS,” the (questions 18 and 19), daily routine (questions 20 to 26), and mean score of all factors in this dimension was higher than 3. complaints on users (questions 27 to 33). A 5-point Likert Table 1 shows the results of the ANOVA test to examine scale (from very high to very low) was used to answer the the relationship between user demographics and the impact questions of the second part. of the PACS. +e study variables had significant relation- ships with user age, work experience, occupation, and type of 2.3. Data Analysis. Data were analyzed by SPSS version 24. PACS training (P< 0.05, CI � 95%). According to this test result, the highest scores were given by users under 30 years To analyze the data, question items were scored from 5 (very high) to 1 (very low). Analysis of variance (ANOVA) was old and the lowest score by users of 40 to 49 years old. By increasing the users’ age and work experience, the mean of used to assess the relationship between individual charac- the score given to the effects of the PACS decreased. +e teristics and the five dimensions of external communication, highest score was given by the users having work experiences service quality, user intention to use the PACS, daily between 11 and 15 years and the lowest by the users with routine, and complaints on users. Pearson’s correlation work experiences of 5–10 years. Individuals who received coefficient was used to measure the correlation between PACS training individually gave the highest scores, and these dimensions. +is study was approved by the Ethics those who received e-learning gave the lowest scores. Also, Committee of Kerman University of Medical Sciences the scores of the service quality, user intention to use the (code: IR.KMU.REC.1399.042). Radiology Research and Practice 3 Table 1: Participants’ demographics and their relationship with the impact of the PACS. Demographic information Frequency (%) Mean SD p Female 56 (77.8) 3.79 0.53 Gender 0.177 Male 15 (2.08) 3.51 0.50 Under 30 24 (33.8) 3.92 0.52 30–39 26 (36.6) 3.84 0.46 Age (years) 0.001 40–49 16 (22.5) 3.33 0.50 50 or older 5 (7) 3.41 0.27 Novice 4 (5.6) 3.28 0.34 Average 37 (51.4) 3.85 0.38 Computer knowledge 0.11 Advanced 25 (34.7) 3.63 0.70 Expert 6 (8.3) 3.66 0.42 Group training 47 (65.3) 3.80 0.54 Individual training 14 (19.4) 3.82 0.42 Training PACS 0.037 Web-based tutorial training 4 (5.6) 3.21 0.11 No training 7 (9.7) 3.37 0.55 Less than five 23 (31.9) 4.00 0.48 5–10 2 (2.8) 3.57 0.51 Work experience (years) 0.001 11–15 4 (5.6) 4.07 0.49 More than 15 13 (18.1) 3.83 0.42 Less than 2 34 (47.2) 3.78 0.45 2–5 26 (36.6) 3.81 0.59 Experience using the PACS (years) 0.058 6–10 8 (11.3) 3.42 0.50 More than ten 3 (4.2) 3.13 0.40 Radiologist 9 (12.5) 4.05 0.56 Radiology staff 16 (22.2) 4.07 0.39 Job <0.001 Physician 33 (45.8) 3.48 0.49 Ward’s head 14 (19.4) 3.71 0.44 External Service quality User intention Daily routine Complaints on communication to use PACS users Dimensions of users′ work Radiologists Physicians Radiology staff Ward heads Figure 1: Mean scores of PACS impact per the dimensions of users’ work. PACS, daily routine, and complaints on users’ dimensions computer knowledge was also related to the external were significantly related to the user age, work experience, communication dimension so that the mean of scores given and type of training (P< 0.05, CI � 95%) so that, by in- by the users having an average knowledge or greater was creasing the age and work experience, the mean of scores almost twice as high as the mean of scores given by the given to the mentioned dimensions declined. +e users’ beginners. Users with a work experience of lower than five Mean 4 Radiology Research and Practice Table 2: Pearson’s correlation between study dimensions. External External communication communication r � 0.631 Service Service quality P< 0.001 quality User intention to use the r � −0.88 r � 0.104 User intention to use the PACS P � 0.462 P � 0.383 PACS r � 0.36 r � 0.265 r � 0.203 Daily Daily routine P � 0.002 P � 0.025 P � 0.088 routine r � 0.021 r � 0.98 r � 0.166 r � 0.403 Complaints on Complaints on users P � 0.841 P � 0.414 P � 0.164 P< 0.001 users years had the most, and people with work experiences be- technology acceptance studies in medical settings, the use of the PACS depends on its usefulness and ease of use [32–34]. tween 11 and 15 years had the lowest desire to work with the PACS. It seems that embedding various tools and features in today’s Pearson’s correlation coefficient test was used to measure PACS interface has made this system useful and easy to use. the correlation between the dimensions of external com- +e existence of multiple features in the system can meet munication, service quality, user intention to use the PACS, users’ expectations and result in service quality and user daily routine, and complaints on users, the results of which intention to use the PACS. However, other PACSs can have are shown in Table 2. According to these results, the highest different results depending on their characteristics. correlation was between the two dimensions of external Consistent with the results of previous studies [26, 31], communication and service quality (r � 0.631, P< 0.05) and the results of our study showed that the implementation of the lowest correlation between the two dimensions of daily the PACS improves service quality. +is improvement can routine and service quality (r � 0.265, P � 0.02). result from better management of radiology services and provision of better information for decision-making, by improving access to information, after the implementation 4. Discussion of the PACS. In particular, according to the results of previous studies, PACS supports physicians’ decision- 4.1. Principal Findings. +is study showed that the PACS has making [21] and diagnosis [35] due to greater access to a positive effect on different dimensions of users’ work, so the images and reports. Nevertheless, the results of a study participants gave a score of higher than 2.5 to all the di- conducted by Watkins [36] showed that the PACS can in- mensions on the 5-point Likert scale. Based on the results, crease access to images but does not affect clinical decision- PACS improves external communication, increases user in- making. +is difference could be related to the qualitative tention to use the PACS, enhances service quality, streamlines methodology with fewer participants used in this study. daily routine, and reduces user complaints, respectively. +e +is study showed that more than half of the users believed participants gave a mean score of approximately 4 out of 5 to that the implementation of the PACS had supported the users in the three dimensions of external communication, user in- performing their daily routine. Congruent with our findings, tention to use the PACS, and service quality. Ayal and Seidman [37] showed that the PACS reduces the time required for daily routine and increases user satisfaction. It 4.2. Comparison with the Results of Other Studies. +e pos- provides ubiquitous access to images, reduces the time of image itive effect of the PACS on different dimensions of users’ work recovery and clinical reports, enables effective planning to use that was shown in this study was in line with the results of radiology devices, facilitates teleconsultation, and provides previous studies [23, 26, 27]. +e present study found that assistive devices to support image recognition and improve more than two-thirds of users believed that the PACS had hospital workflow. Another study [39] showed that the PACS improved external communication. Consistent with our improves daily routine by reducing image searching and in- findings, Hains et al. [28] examined the effect of the PACS on terpretation time and speeding up the diagnoses. the physicians’ work in the ICU and concluded that the Consistent with the results of a previous study [26], our implementation of the PACS improves physicians’ efficiency findings showed that, after PACS implementation, com- and communication between the ICU and the radiology plaints on users in the radiology department were decreased. department. +e reason is that electronic communication Also, Trumm et al. [38] reported that replacing analog and processes have changed the image viewing patterns and re- film-based systems with the PACS reduced the problems of duced physicians’ visits to the radiology department to view the radiology department and ultimately increased user radiology images [28]. Implementation of the PACS also satisfaction and reduced complaints on radiology staff. improves communication between physicians and radiolo- gists by facilitating joint decision-making [11, 29]. +is study showed that the majority of the participants 4.3. Relationship between the Impacts of the PACS and De- mographic Information of the Participants. +e results of our were inclined to use the PACS. +is tendency could be due to the ease of use of the system [30, 31]. As stated in the study showed that factors such as user age, job, work Radiology Research and Practice 5 trained and untrained users had a favorable opinion about experience, and PACS training method are related to the impact of the PACS on different dimensions of users’ work. the impact of the PACS on various dimensions of their work. In this study, the highest correlation was between the two According to the results, PACS had a positive effect on the work dimensions of all groups of PACS users. A previous dimensions of external communication and service quality. study [39] showed that physicians believe that the PACS is Previous studies [45, 46] also showed the positive effect of more reliable than the analog system due to various features external communication on service quality. It is suggested such as editing functionalities and the ability to make dif- that the authorities of medical centers that have no PACS put ferent changes in images and to compare previous and new the hospital-wide implementation of the PACS on their images of the same patient. Physicians believed that the agendas to increase service quality. PACS improves the efficiency of the patient’s follow-up process because of the ability to access images from multiple 4.4. Limitations. +e present study had three limitations. locations and easy consultation among different wards. +is study was conducted only on two types of PACSs According to the results of our study, the type of users’ job implemented in two hospitals. Future studies can address affects their perception about the PACS. Among the main other types of PACSs in several geographical areas and on a users of the system, radiologists and radiology staff had a larger number of participants. Second, this study examined more positive opinion about the PACS than other clinicians the impact of the PACS only on the five dimensions of users’ such as physicians. +is may be due to the novelty of the work (external communication, user intention to use the PACS for physicians compared to radiologists and their PACS, service quality, daily routine, and complaints on unfamiliarity with this system. Consistent with this finding, users). +e effect of the PACS on other dimensions of users’ Alalawi et al. [23] concluded that radiologists pay much at- work may have been missed in this study. +is effect can also tention to the strengths of the system than physicists and believe be influenced by other issues such as the extent of daily that the PACS improves their efficiency. Also, Buabbas et al. PACS use and the quality of the PACS and user interface. [31] showed that more than three-quarters of the radiologists Subsequent studies can work specifically on each of these found the PACS user-friendly and were positive about it. issues. +ird, in this study, we evaluated the impact of the By increasing the age and experience of participants in PACS from the perspective of users. Since individuals’ this study, their perspectives about service quality were more perspectives can be subjective, subsequent studies can use positive, and their intention to use the PACS decreased. +is more objective methods, such as observation. may be because users with a lower work experience used the PACS for most of their work period and could easily adapt to 5. Conclusion the system. Still, people with a higher work experience are resistant to using the PACS due to the long-term use of the +e results of this study showed that the PACS had a positive previous system and need time to change their habits. effect on the work dimensions of users. +is system has the Various studies have shown that users who had more ex- greatest impact on improving external communication, perience with the PACS had a more positive view of the increasing user intention to use the system, and increasing system [26, 40]. Previous studies have also shown that young service quality. In this study, we did not only measure the people are more inclined to use information technology and impact of the PACS on the positive aspects of users’ work, applications [41, 42]. However, various studies have shown such as increasing service quality, but also on the negative that improving the user interface and addressing system ease aspects such as complaints and pressure on the radiology of use can increase the willingness of older adults to use these department. For example, our results showed that radiology systems [43, 44]. staff received more calls requesting information regarding One of the reasons that users in this study were positive PACS functions and services. Although different PACSs may about the PACS was that most of them were trained in the have common advantages, several studies need to be done to use of the PACS. In line with our results, other studies have identify the negative impacts of the PACS. However, in this shown that user training can contribute to the successful study, radiologists have a greater understanding of the implementation of the PACS [19, 39]. Despite the usefulness benefits of the PACS than physicians, results showed that the of training, Bramblz et al. showed that this training does not PACS has benefits for all user groups, and the users believe always exist. For example, study participants expressed that that this system has a positive impact on various dimensions “image contrast is not controllable” and “changing the of their work. +is study evaluated the impact of the PACS darkness or brightness of the images is impossible,” while from the users’ point of view and showed that this system these features were present in the system, but users had not can positively affect five dimensions of users’ work (external received training about them [21]. According to the findings communication, service quality, daily routine, personal of this study, PACS had the greatest impact on the work intention to use the PACS, and complaints on users). Other dimensions of users who received individual system train- studies can consider other issues such as the extent of daily ing. Another study [39] showed the greater impact of in- PACS use and the quality of the PACS and user interface. dividual training compared to other methods (group training, training through manuals, and electronic files) on Data Availability user learning, use of system capabilities, and its successful implementation. Although training can help to identify a +e data used in this study are available from the corre- system’s capabilities, the results of this study showed that all sponding author upon request. 6 Radiology Research and Practice practice,” Journal of Digital Imaging, vol. 20, no. 4, Ethical Approval pp. 411–421, 2007. [12] B. Aldosari, “User acceptance of a picture archiving and +is study was approved by the Ethics Committee communication system (PACS) in a Saudi Arabian hospital of Kerman University of Medical Sciences (code: radiology department,” BMC Medical Informatics and Deci- IR.KMU.REC.1399.042). sion Making, vol. 12, no. 1, p. 44, 2012. [13] A. Kalyanpur, J. Singh, and R. Bedi, “Practical issues in picture Conflicts of Interest archiving and communication system and networking,” In- dian Journal of Radiology and Imaging, vol. 20, no. 1, pp. 2–5, +e authors declare there are no conflicts of interest. [14] M.-N. Rohaya, “Medical imaging trends and implementation: Authors’ Contributions issues and challenges for developing countries,” Journal of Health Informatics in Developing Countries, vol. 5, no. 1, 2011. MM was the major contributor in writing the manuscript. [15] S. Tolle, H. Primo, T. Harris, and J. Morgan, “Overcoming RKh was the research supervisor and final editor. 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Radiology Research and PracticeHindawi Publishing Corporation

Published: Feb 28, 2022

References