DR. LEMKE is a professor of computer graphics and computer-assisted medicine at Technical University in Berlin, Germany.

Communication systems based on local area networks with ring topology were first developed in Europe in the early 1970s, led by the University of Cambridge with a 10-Mbit/sec prototype system. Telecommunication companies and research institutions first made use of these systems for nonmedical applications. During the late '70s, attempts were also made at the Technical University of Berlin and elsewhere1 to use LANs for medical image communication, but these first system concepts never reached the stage of implementation in a clinical setting.

The first real clinical PACS implementations took place in the U.S. in the early '80s at the University of Pennsylvania, University of California, Los Angeles, and University of Kansas. Some more or less successful PACS developments also took place in Europe in the 1980s, particularly in the Netherlands, Belgium, France, Austria, the U.K., Italy, and Germany. Most systems could be characterized by their focus on a single clinical department, such as radiology or nuclear medicine. European hospital-wide PACS with high visibility evolved in the early '90s in London (Hammersmith Hospital) and Vienna (SMZO). These were followed in the late '90s by 10 to 20 PACS installations in each of the major industrialized countries in Europe.

During this early development phase of PACS, its implementation was mainly a matter of the radiology department. This is changing rapidly, and PACS planning is increasingly seen in the context of a hospital-wide or regional approach. With increased networking among healthcare institutions and the growing relevance of teleradiology scenarios, PACS strategies must take not only local but also regional and global factors into consideration.

SAXTELEMED PROJECT

PACS in Europe is moving toward a more strategic, rather than situational solution-seeking approach. This is best exemplified by a reference project in Saxony, Germany, called SaxTeleMed. The project was initiated by the Ministry of Social Welfare, Health, Youth and Family of the Free State of Saxony. It covers seven regional projects distributed throughout Saxony. Each regional project is organized around so-called lead hospitals, which network with other cooperating hospitals and medical practices. The regional reference projects are designed to be largely independent, although in some instances, a network connection between them is also considered. Altogether, 39 hospitals and medical centers are involved.

The aim of this program is to test the technical, organizational, legal, and economic problems in digitization and networking within Saxony. The knowledge gained from this project is expected to improve future PACS investment decisions in healthcare and, above all, to implement secure systems.