PACS & Profits

From imaging centers to community hospitals to large medical centers, clinicians tell first-hand how PACS is making a big impact on cost-cutting - facilitating significant cuts in film and operating budgets, file room, technologist and radiologist staffing and lost films - and improving workflow, radiologist and technologist productivity and speeding image and report turnaround to caregivers.

PACS ROI at Wyoming Valley Health Care SystemBy Chris Galanda, CIO

Northeastern, Pa.-based Wyoming Valley Health Care System (WVHCS) was founded in 1992 through the merger of Nesbitt Memorial Hospital and Wilkes-Barre General Hospital. A 420-bed acute care facility, Wyoming Valley has more than 3,000 employees, including 11 contracted radiologists who perform more than 175,000 imaging procedures per year.

With this many procedures, we were extremely interested in pursuing a picture archiving and communication system (PACS) to go with our existing Siemens NOVIUS radiology information system (RIS). After investigating various PACS options over the course of three years, WVHCS decided to implement Siemens SIENET PACS in late 2003. Our PACS implementation objectives were to:

• Integrate with our existing RIS
• Improve workflow
• Improve report turnaround times
• Decrease operational costs
• Increase patient referrals
• Increase patient and physician satisfaction
• Maintain HIPAA requirements

In particular, we sought to decrease imaging report turnaround time. We wanted to achieve a turnaround of about 18 hours from when the imaging order was first placed to the physician's final signoff on the report.

The Wyoming Valley RIS/PACS now seamlessly combines images, data and voice recognition capabilities using the Siemens Command Center, which integrates NOVIUS v. 26 with SIENET v. 42 PACS. Everything can be accessed using one keyboard and one mouse. And our physicians can access images and radiology reports from their offices or homes via the SIENET MagicWeb application. The reports and images are available to the referring physicians over this web-based distribution system just minutes after signoff by the radiologist.

With PACS, the total turnaround time for 100 percent of studies performed in WVHCS Imaging Services, from order to electronic signoff of the report, has been steadily reduced; in the third quarter of 2004, it was down to 19.3 hours. More specifically, from time of order to electronic signoff, 90.7 percent of our reports were distributed in 10.28 hours (i.e., just 7 hours from the time the test is completed).

The PACS cleaned up our backlogs of film waiting to be reviewed as well. In the past, there used to be 700 images waiting in the queue at any given time, but now that is down to 50. Film costs decreased by 65 percent, for annualized savings of $432,000, and we expect this number to further decrease as we continue to migrate equipment to the OR.

The average number of lost studies per month was reduced from 25 prior to the PACS implementation, to zero afterwards. The PACS administrator or her designee generates three data quality reports on a daily basis that are checked to confirm the integrity of our data.

WVHCS also has seen anywhere from a 35 percent to 126 percent increase in productivity (number of cases handled per month) for our radiologists. This percentage is dependent on the types of exams that they are reading. In addition, the number of staff radiologists has decreased from 14 to nine.

We also were able to reduce by six the number of full-time employees needed to maintain the film library (by moving these FTEs to open positions in comparable jobs such as scheduling and reception). The annual salary/benefit reduction in the film library to date has been $132,000.
 

PACS at Sacred Heart Hospital Reduces Costs, Staff and Boosts VolumeBy Belle Rodrigues RT(R), Director of Radiology and Nuclear Medicine, and Megan Turk RT(R), PACS Administrator

As part of ongoing service enhancement efforts, strategic investments have been made in technology, specifically in the high-volume diagnostic imaging department at Sacred Heart Hospital, a 243-bed Catholic medical center located in central Allentown, Pa.

The savings in cost and time management achieved with the PACS solution are indisputable. Misys Image Management, a web-based picture archiving and communication system (PACS) powered by eRad/
ImageMedical technology, has helped to streamline imaging processes, maximize staff productivity, reduce imaging space, nearly eliminate film costs and accelerate turnaround times.

One of the primary benefits of a PACS solution is the elimination of "lost films."  With digital imaging records, including prior studies, now immediately accessible via the internet, there is no longer the need to send a file clerk for hard copies to an off-site storage facility that once required a three-mile roundtrip.

Our PACS has provided tangible returns on investment that would please any hospital administrator. Sacred Heart Hospital reduced staff from six to four full-time and one part-time radiologist, while increasing its annual processing volume. Based on numbers supplied by salary.com, an independent source for compensation analysis, the hospital has saved $498,000 on those personnel adjustments alone.

The technology also has allowed for a 33 percent reduction in full-time technologists and has gone from 12 radiographers to eight, additionally dropping expenditures in diagnostic imaging by $152,000, based on similar data from salary.com.

With the addition of computed radiography and PACS, there is no longer a need for a darkroom. An additional estimated savings of $50,000 has been realized with the reduction of imaging rooms from nine to four.

Sacred Heart Hospital previously spent $200,000 annually on film; it currently spends approximately $20,000 - which represents a 90 percent reduction. A plan is currently underway to completely eliminate film costs by making all images available on CD-Rom.

Implementing PACS has improved Sacred Heart Hospital's bottom line in patient and physician satisfaction, though it's not a benefit that can be quantified in the line-item budget. For example, the turnaround time in the emergency room is critical. With the technology in place, ER physicians can do a wet read of the image almost immediately after it is processed.

"The PACS has proven to be a great system for the ER," says Scott Harris, MD, of the Emergency Department. "A process that used to take one to two hours now takes minutes. As soon as I see a patient is back in his or her bed, I know I can go to the workstation to view the images. In most cases, a preliminary reading from the radiologist is attached to the image."

With the installation of the Misys Radiology information system (RIS) and the Misys PACS Integration Module (Misys PIM), there will be a seamless exchange of information with the previously installed PACS. The Misys PIM, which complies with IHE guidelines, will serve as the gateway to convert RIS HL7 data into DICOM data, and is compatible with any PACS vendor solution. Upon completion of the RIS and PIM installation, Sacred Heart Hospital will further realize the benefits of the Misys RIS-PACS technology.

Building the Right PACS for Community-based Saints MemorialBy Susan Kalil, Manager, Diagnostic Imaging and Steve Walter, former Director, Diagnostic Imaging

Saints Memorial Medical Center (SMMC) is a 130-bed acute care facility located in Lowell, Mass. Two years ago, we were performing 90,000 exams a year with traditional film-based imaging. With the obvious clinical and operational limitations of film, it was readily apparent to us that a new technology was needed to remain competitive. Already, we had been utilizing Konica CR for a year in preparation for the jump into the PACS arena. However, as with many community hospitals, our biggest obstacle was funding. Capital dollars to fund a PACS installation simply weren't available.

As a result, we chose to look for an imaging company that could provide a complete turnkey model that would allow us to break even on our imaging costs. At the time, SmartPACS was the only imaging provider that included a non-capital and an operational break-even financial offering with its proposal. We signed a multi-year agreement with SmartPACS, and in a matter of weeks, Saints Memorial Medical Center had a full PACS installation.

Our hospital enjoyed the positive effects of switching to PACS almost immediately. Within three hours of system activation, we had reduced our film use by 70 percent. Within 10 days, our film use had been reduced by 95 percent. The standard monthly film order dropped from 23 cases to only one case per month.

It took less than 30 days for SMMC to realize a reduction in hard costs. And the soft costs associated with productivity and efficiency were quite evident as our hospital staff became proficient with the new technology. The most significant positive indicator was SMMC's increase in imaging volume, particularly in CT and ultrasound. For years prior to the PACS installation, our hospital had been unable to significantly grow volume in CT and ultrasound. However, with the implementation of PACS, we were able to increase our imaging volume in those modalities by double digits, increasing overall volume from 90,000 exams per year to just more than 100,000.

The use of PACS also greatly enhanced our medical facility's competitiveness in terms of attracting talented personnel. We had experienced difficulty in hiring a new radiologist due in part to our film-based imaging process. Within six months of the PACS installation, our hospital had recruited, not one, but two new radiologists.

Today, we process every exam digitally utilizing 13 native DICOM modalities. Each floor of the hospital is directly networked to the PACS server and has a clinical review workstation with flat-panel monitors accessible for doctors to view medical images at the point of care. These images are then stored on two hard drives located in different parts of the building and also backed up on tapes and saved in a vault. As a result, images can be viewed on demand - and unlike film - these images are rarely ever lost or misplaced.

Thanks to our PACS installation, what started as a community hospital's simple desire to upgrade technology, resulted in a more efficient, less costly and clinically enhanced method for providing healthcare imaging.

Susan Kalil is the manager of diagnostic imaging at Saints Memorial Medical Center. She has been associated with the hospital for 32 years and played a key role in the hospital's PACS installation. Steve Walter served as the director of diagnostic imaging at Saints Memorial Medical Center during the hospital's PACS installation. Currently, he is the director of imaging services at North Shore Medical Center, which is a part of Partners HealthCare System, Inc.

Boca Raton Community Hospital: Filmless & Fit
By Robin Hildwein, CIO

Let's face it. In healthcare, we spend a lot of time administering processes when we really want to spend that time administering care. At Boca Raton Community Hospital (BRCH), our primary IT goal is to shift the pendulum so that caregivers are empowered to focus on their patients. Reaching that goal would have been particularly problematic for us without the recent implementation of a picture archiving and communication system (PACS). Our digital medical imaging solution has not only improved the delivery of radiology services at our 394-bed hospital but, more importantly, going "filmless" has created efficiencies that enhance the overall clinical experience. By providing seamless access to information and streamlining workflow across our enterprise, the system allows us to cost-effectively improve decision-making and speed the response time of diagnostic results.

Challenge

Boca Raton Community Hospital is the largest hospital in southern Palm Beach County, Fla., and our challenges in the delivery of radiology services were not unlike those at any healthcare facility. We had a high volume of film and a lack of file room space. We experienced lost film and extraordinary delays in productivity and emergency department throughput. As a result, satisfaction among our radiologists, physicians, technologists and even patients was far from optimum. We knew we needed to provide a way to respond quickly to the need for medical images and the ability to view that film from multiple imaging centers. We formed a multidisciplinary steering committee to select the best PACS based on our criteria, and McKesson's Horizon Medical Imaging solution was the clear winner for us.

Results

Our initial expectations for the medical image management system, in terms of hard savings, were based on the processing and cost associated with the handling of film. Since going live in October 2003, our savings have far exceeded our projections. We've reduced 6.8 FTEs from our file room and reduced our cost for film by 85 percent in the first month and 31 percent annually based on a comparison to this time last year.

Our radiologists have been particularly outspoken about their satisfaction with PACS. They report enhanced productivity from functionality that allows them to improve dictation turnaround, assign workflow by specialization, conduct online study comparisons, manipulate images and review films remotely with other physicians while they share the viewing capabilities of the same image. And in the area of voice recognition dictation, the radiologists have found that the ability to remain focused has improved their self-editing efficiency by 16 percent, raising the threshold to 85 percent in August 2004.

The PACS solution also has increased productivity among our radiology technologists. The system allows for a quality review at the modality with the patient present, which reduces our error rate and the need for costly duplicative exams.

In terms of patient care, there is no question our service is improved. The electronic archive of images provides our radiologists and physicians with access to procedures the moment they are completed, supporting faster diagnostics, which has the potential to reduce errors and decrease length of stay. The turnaround time for STAT reports has been significantly reduced from an average of 90 minutes to less than 55 minutes. Our physicians are able to further improve decision-making capabilities by using McKesson's HorizonWP Physician Portal to access the real-time images in their offices and homes. The ease and familiarity of the Portal platform raised our physician satisfaction level with the retrieval, accuracy, and timeliness of electronic data to 99 percent post-PACS implementation.

At BRCH, we won't favor processes over people and with the PACS, we don't have to.

Turnaround Turns Around at Nassau Health Care Corp.
By Christopher Balbi, Administrative Director, Radiology

The Nassau Health Care Corp. (NHCC) is a 1,500-bed IDN, led by a 631-bed tertiary care teaching hospital, Nassau University Medical Center (Nassau, N.Y.), that annually performs more than 180,000 exams. NHCC operates the largest level 1 trauma center on Long Island.

NHCC chose AMICAS web-based PACS to catapult the organization's move from film-based radiology to PACS. The changes have been nothing short of dramatic, resulting in incredible returns to the institution, NHCC providers and the patients we serve.

Over two years ago, NHCC developed a strategic plan to enhance its healthcare provider status and perception of care by overhauling aging technology and act upon its commitment to client and patient service. NHCC, a local government-run and union-based institution, was spending about $500,000 annually on radiological film and chemicals (despite an 88 percent discount from list), and sought to cut film-related costs through the implementation of enterprise PACS.

When NHCC Chief Information Officer Christine Forman and I joined the hospital system, we sought to pay strict attention to budgetary concerns, technology infrastructure and customer service.  Additionally, we challenged staff to rise above the status quo, and to actively participate in the exciting clinical transformation. This was tough, but PACS provided the "spark" to invigorate staff, and sustain motivation for positive change.

Our PACS has played an integral role in our clinical and financial improvements. The simplicity of the web-based architecture has allowed us to implement quickly, and scale across our large enterprise without hesitation. In contrast to other hospitals forced to "phase-in" PACS, we implemented in one phase.

Our 35 radiologists gain access to PACS images from 15 workstations, and our clinicians access images and reports from hundreds of PCs. We've also connected radiology to our highest volume customers, the ED and ICU, using real-time worklists, to keep workflow synchronized 24/7. To our benefit, these elements have allowed us to focus our attention on achieving results, rather than struggle to rollout and keep the PACS in good technical health.

Live since February, the strength of our collective efforts have reaped significant tangible benefits. In one month, we reduced CT and nuclear medicine film usage by 85 percent, MR by 90 percent, and ultrasound by 95 percent. We will achieve even greater film reduction, beyond 90 percent, through recently rolled out high-volume CD burning
and remote, web-based image access via VPN. Consider these savings and improvements:

• The elimination of conventional film cassettes, jackets and stickers will save about $215,813 annually.
• Radiology clerical staff, mostly from the film file room, has decreased from 27.1 to 19.3 FTEs, saving more than $600,000 annually.
• Temporary staff budget decreased from $550,884 in 2003 to an estimated $215,000 for 2005 (requested budget).
• Off-site film storage is $121,959 per year, and will be reduced by 17 percent annually.
• Reduced lost films to <0.1 percent. Pre- PACS, lost film ratio was 25 percent.
• Improved report turnaround time from 20.5 to 4.8 hours within 6 months
• Improved image turnaround time to the ED from 40 minutes or greater to less than 5 minutes.
• Reduced MR backlog from 30 to 4 to 5 days.

Measured against any benchmark, our experiences are quite impressive. Together, we've leveraged enterprise PACS at every opportunity, and have truly transformed operations 360 degrees.



 

Austin Open MRI Speeds Reports to Caregivers and Cuts Film Costs
By Jeff Walker, Managing Partner

Austin Open MRI Center (AOMC) is a single-site imaging center that specializes in open and high field MRI and conducts 3,600 procedures annually. Since opening in 1997, the practice has built a solid reputation for providing excellent service and fast report turnaround.

There are eight radiologists who read for the imaging center. Prior to installing PACS in July 2003, we utilized a combination of manual and digital film, and we were spending a lot of time and money backing up images to CD-ROMs as well as printing films and delivering them to referring physicians' offices.
 
I knew it was time to transition AOMC towards a filmless environment, so I attended RSNA 2002 to research and evaluate PACS products and vendors. I found that the Merge eFilm solution more closely met my needs and was the best value in terms of solid functionality and price compared to the other systems. And thus we chose Merge eFilm's FUSION PACS.  

I was pleasantly surprised at the significant film cost savings related to a reduction in printing and distribution and incremental revenue opportunity we have experienced since installing PACS.



The practice has been able to cut its film delivery charges by $1,200 per month or $14,400 annually, as well as reduce film printing costs by 33 percent. FUSION PACS' integrated CD-ROM burner provided us with a competitive advantage, and has allowed the practice to generate incremental annual revenue of more than $18,000 from sales of images burned to CD-ROMs-approximately 60 percent of our patients take their images with them.

Our report turnaround time went from 48 to 24 hours and we can do STAT cases in 2 to 4 hours. It's a great service to be able to get stat cases to the referring physicians as soon as the patient is done with the exam. This has made our referring physicians very happy.

FUSION PACS met my expectations and the product is quickly evolving to be even more robust. Additionally, Merge eFilm service has been responsive and helpful with our support needs.

Bradford Regional Medical Center: Paying for PACS with Film Cost Savings
By Timothy Brown, Administrative Director, Imaging & Cardio-Pulmonary Services

Bradford Regional Medical Center (BRMC) in Bradford, Pa., is a 150-bed community hospital that performs about 62,000 procedures per year. The hospital borders New York State and is surrounded by the Allegany State forest.

The notion of PACS became interesting to me about four years ago when I worked in another facility in Buffalo, N.Y., but after investigating a number of options it was apparent that it just wasn't cost-effective. So I continued to monitor the technology waiting for the benefits of PACS to correlate with the cost.

About 17 months ago, I looked into a relatively new company in the U.S. market.  MTS/Delft was a large company in the Netherlands, however, it only had a handful of installations here in the U.S.

When looking at PACS, there were eight attributes I was concerned with:

• Must have seven years of exams on immediate retrieval
• Must be able to access studies via the web for physician offices
• Must be able to burn studies on CD for physician offices that don't have cable internet option
• Must be able to support exams via intranet
• Must be fully upgradeable
• Must be easy to learn and use
• Must be able to base cost only on film and chemicals
• Must be cost-effective based on 80 percent filmless operations

These key attributes were necessary to help assure a successful acceptance from a budget standpoint, not to mention from our radiologists and referring physicians.

These attributes were not prevalent on all PACS solutions and MTS/Delft met that criteria among other infrastructural criteria that is necessary on all PACS for basic functionality.

Three months after implementation, it became evident that our project was a success. We had already achieved a filmless rate of 83 percent and we still had a number of physicians to set up with our web software. This was especially encouraging since mammography was about 6 percent of our business. The graph at the bottom right supports our collection of data.

The cost of our processing chemicals went from an average of $2,230 per month to under $300 per month - and we have saved approximately $3,100 on our processor maintenance budget over the last five months.

Aside from cost savings, the implementation of PACS has dramatically changed our workflow. It was mentioned to me by one of the technologists that she felt it has been significantly slower and she was inquiring if I had any idea why. Although I knew the numbers that I have been seeing did not support her observation, I went back to check. The fact was we had taken on some new market areas and our numbers were not only strong, but also about 8 percent over budget.

For the immediate future, there is no thought for diminishing staff, but as long as exams continue to increase, I feel confident that we will have no need to hire additional staff. I believe this will represent a significant cost-savings going into the future.

In summation, our PACS project at Bradford Regional Medical Center has attained:

1. Instant image access for our radiologists and increasing the number of patient images they read per day.
2. Increasing patient throughput for exam totals through CR and direct capture devices.
3. Allowing any referral doctor anywhere the capability to access their patient's images.
4. Overall sense of pride for departmental staff in using the latest technology and making their jobs easier and more productive.

In my search for cost-cutting to afford our PACS project, I was pleasantly surprised with the increased production and profitability of my department.