Healthc Inform Res.  2019 Oct;25(4):324-331. 10.4258/hir.2019.25.4.324.

PACS Implementation Challenges in a Public Healthcare Institution: A South African Vendor Perspective

  • 1Department of Telehealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.


Conventional radiological processes have been replaced by digital images and information technology systems within South Africa and other developing countries. Picture Archiving and Communication Systems (PACS) technology offers many benefits to institutions, medical personnel and patients; however, the implementation of such systems can be a challenging task. It has been documented that South Africa has been using PACS for more than a decade in public hospitals with moderate success. The aim of this study was to identify and describe the PACS challenges endured by PACS vendors during implementation in the South African public healthcare sector.
This was achieved by engaging in a methodological approach that was qualitative in nature collecting data through semi structured interviews from 10 PACS experts/participants which were later analysed qualitatively.
The findings show that PACS vendors have countless challenges, some of which include space, insufficient infrastructure, image storage capacity, system maturity and vendor related concerns. It was clear that the PACS experts readily offered contextually appropriate descriptions of their encounters during PACS implementations in South African public healthcare institutions.
PACS vendors anticipate these challenges when facing a public healthcare institution and it is recommended that the hospital management and potential PACS stakeholders be made aware of these challenges to mitigate their effects and aid in a successful implementation.


Radiology Information Systems; Medical Informatics; Medical Informatics Computing; Information Storage and Retrieval; Radiography

MeSH Terms

Delivery of Health Care*
Developing Countries
Health Care Sector
Hospitals, Public
Information Storage and Retrieval
Medical Informatics
Medical Informatics Computing
Radiology Information Systems
South Africa


  • Figure 1 A Picture Archiving and Communication Systems (PACS)-based workflow.


1. Liu Y, Wang J. PACS and digital medicine: essential principles and modern practice. Boca Raton (FL): CRC Press;2011.
2. Pare G, Trudel MC. Knowledge barriers to PACS adoption and implementation in hospitals. Int J Med Inform. 2007; 76(1):22–33.
3. Bui AA, Taira RK. Medical imaging informatics. New York (NY): Springer Science & Business Media;2010.
4. Mulla FA. The experiences of radiographers working with PACS and RIS in Gauteng [dissertation]. Johannesburg, South Africa: University of Johannesburg;2012.
5. Department of Health. Minister of Health calls for national telemedicine strategy [Internet]. Gauteng, South Africa: Sabinet;2010. cited at 2019 Oct 25. Available from:
6. Triegaardt M. Picture Archiving and Communication Systems in the South African public healthcare environment: a suitable structure and guidelines to assist implementation and optimisation [dissertation]. Stellenbosch, South Africa: Stellenbosch University;2013.
7. Jorritsma W, Cnossen F, van Ooijen PM. Merits of usability testing for PACS selection. Int J Med Inform. 2014; 83(1):27–36.
8. Abdullah ZS. Hospital information systems implementation framework: critical success factors for Malaysian public hospitals [dissertation]. Perth, Australia: Curtin University;2013.
9. Ammenwerth E, Iller C, Mahler C. IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study. BMC Med Inform Decis Mak. 2006; 6:3.
10. Reddy AS, Loh S, Kane RA. Budget variance analysis of a departmentwide implementation of a PACS at a major academic medical center. J Digit Imaging. 2006; 19(1):66–77.
11. Aldosari B. User acceptance of a picture archiving and communication system (PACS) in a Saudi Arabian hospital radiology department. BMC Med Inform Decis Mak. 2012; 12:44.
12. Carlin L, Smith H, Henwood F, Flowers S, Jones A, Prentice R, et al. Double vision: an exploration of radiologists' and general practitioners' views on using picture archiving and communication systems (PACS). Health Informatics J. 2010; 16(2):75–86.
13. Inamura K, Kim JH. History of PACS in Asia. Eur J Radiol. 2011; 78(2):184–189.
14. Wynekoop JL, Russo NL. Studying system development methodologies: an examination of research methods. Inf Syst J. 1997; 7(1):47–65.
15. Manyisa ZM, van Aswegen EJ. Factors affecting working conditions in public hospitals: a literature review. Int J Afr Nurs Sci. 2017; 6:28–38.
16. Health Systems Trust. Evaluation of hospital information system in the Northern Province in South Africa [Internet]. Durban, South Africa: Health Systems Trust;2002. cited at 2019 Oct 20. Available from:
17. Benatar SR. Health care reform and the crisis of HIV and AIDS in South Africa. N Engl J Med. 2004; 351(1):81–92.
18. Health Information and Management Systems Society. Enabling healthcare reform using information technology. Chicago (IL): Health Information and Management Systems Society;2008. cited at 2019 Oct 20. Available from:
19. Sukums F, Mensah N, Mpembeni R, Kaltschmidt J, Haefeli WE, Blank A. Health workers' knowledge of and attitudes towards computer applications in rural African health facilities. Glob Health Action. 2014; 7:24534.
20. Lorenzi NM, Riley RT. Organizational issues = change. Int J Med Inform. 2003; 69(2-3):197–203.
Full Text Links
  • HIR
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: