The digital hospital/PACS – an impact assessment

In order to make rational decisons for further Pacs-implementations in Vienniese community hospitals a (neutral) assessment of the SMZO-Project was launched by the Vienniese community hospital financing body (Wiener Krankenanstaltenverbund)


An interdisciplinary team of three researchers - using the methods of participatory observation, interviewing and data-collection - stayed at the hospital for 3 months. The centre of interest was the work-organisation, practical application and application behaviour, perceptions of radiologists as well as clinicians of the benfits and disadvantages in the daily use PACS, realism of economic expectations, technical aspects, etc.


  • Integration of clinical information and interface-problems: The installation of PACS is only the "logical consequence" of the introduction of information technologies in many different fields in medicine. It is one (important) step on the way to a digitised hospital and an electronic medical patient document. PACS has to be looked at and assessed in this context of integration of the many "languages" spoken in a hospital. Other Systems such as HIS and RIS have the potential to hinder PACS from showing its benefits and to being accepted and considered as useful, even in the "clinical periphery": Problems with the interfaces (between HIS-RIS-PACS) are the biggest hurdles to be overcome.
  • Dependence on the supplier: The elements of dependence on the supplier of PACS (in a contract) have to be carefully evaluated. A system-administrator looking at the functionality of PACS in the wider hospital-context and in the interest of the hospital might solve constantly arising problems more satisfactorily.
  • Maturity of the system: The implementation phase up to the moment of "maturity" takes longer than expected. There are still (many) problems to be solved: Automatic pre-fetching and autorouting are functions that are to be implemented in the early phase of implementation.
  • The hospital-wide distribution of images is problematical in itself: Since the clinicians expect to receive the radiological pictures as quickly as possible (even before reporting) the professional role of the radiologist is queried and changes from "first reporter" to "image consultant".
  • Efficiency and demand for radiological services: As yet there is no proof, other than in archiving and reduction in film-costs, that PACS works economically: no fewer personnel, no reduction in the number of radiological examinations, the correlation with length of hospital stay is plausible, but not proven.
  • Quality of care: PACS has, on the other hand, a strong impact on some aspects in the improvement of the quality of care (reduction of dose radiation, quality of reporting because of post-processing possibilities, interdisciplinarity, widespread use of radiological examinations for educational purposes and in research, documentation).



  • Wild, C. (1999). HTA in Austria: PACS and ESWT. Medical And Biological Engineering & Computing. Supplement.
  • Peissl, W. (1999). Telemedizin, Radio1476. Retrieved from
  • Wild, C., Peissl, W., & Tellioglu, H. (1998). An Assessment of PACS: The Case Study of the SMZO Project. International Journal Of Technology Assessment In Health Care, 573-582.
  • Wild, C., & Peissl, W. (1997). Digitale Radiologie, Radio1476. Retrieved from
  • Peissl, W., Tellioglu, H., Wild, C., & Nentwich, M. (1997). Das digitale Krankenhaus – Eine Technikfolgen-Abschätzung moderner Telekommunikationstechnologien im Krankenhaus am Beispiel des Donauspitals/SMZO , Institut für Technikfolgen-Abschätzung, Wien. doi:/10.1553/ITA-pb-b9
  • Nentwich, M. (1997). Digitalisierung der Medizin – Zur Klärung einiger rechtlicher Fragen der Telemedizin. Recht Der Medizin, 175-181.
  • Peissl, W., & Wild, C. (1996). Patientenkarten: Eine Technikfolgen-Abschätzung einer Anwendung der Informationstechnologie im Gesundheitsbereich. In Tichy, G. (Hg.), Technikfolgen-Abschätzung in Österreich – Entscheidungshilfe in einer komplexen Welt, Beispiele aus der Praxis. Wien.
  • 1



  • 12/10/2004
    Walter Peissl: 
    Telemedizin – Sozio-ökonomische Perspektiven
    Seminar Telemedizin, Wien
    Other Lecture
  • 15/09/1999
    Walter Peissl: 
    Telemedizin – Chancen und Gefahren der Digitalisierung der Medizin
    Seminar gem. mit Wolfgang Mazal und 23.4. Wien
    Other Lecture
  • 13/05/1998
    Walter Peissl: 
    The Digital Hospital a Technology Assessment of modern telecommunications technologies in hospitals: the case of Donauspital/SMZO presented to the Workshop: "Parliamentary Technology Assessment between Science and Politics – Delivering Good Quality." Schi
    Parliamentary Technology Assessment between Science and Politics – Delivering Good Quality, Schiermonnikoog/NL 13.-15.5
    Other Lecture
  • 23/04/1998
    Claudia Wild: 
    PACS: das digitale Krankenhaus – ein Assessment der sozio-ökonomischen Auswirkungen (Poster)
    2. Österr. Public Health Tagung „Wie steuerbar ist das Gesundheitswesen ?“, 23.-24. April, Linz
    Other Lecture
  • 08/09/1997
    Walter Peissl: 
    Vernetzungsprojekte im Krankenhaus: sozio-ökonomische Dimensionen am Beispiel PACS: IIR-Fachkonferenz "Zukünftige Informationsverarbeitung im Krankenhaus"
    8.-9.9., Wien
    Other Lecture
  • 06/06/1997
    Walter Peissl,  Claudia Wild: 
    Die digitale Radiologie – eine Technikfolgen-Abschätzung: 4
    Jahrestagung "EDV im Krankenhaus" 6.-7.6., Pörtschach
    Other Lecture
  • 1


01/1996 - 12/1997