Investing in Picture Archiving and Communication Systems PACS

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Investing in Picture Archiving and Communication
Systems (PACS)

• MEDITECH CIO Technology Workshop
• 6/17/2004

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Technology is dominated by two types of people
those who understand what they do not manage, and
those who manage what they do not understand.
Putt's Law
If the automobile had followed the same
development cycle as the computer, a Rolls-Royce
would today cost 100, get a million miles per
gallon, and explode once a year, killing everyone
inside.
Robert X. Cringely, InfoWorld magazine
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PACS Stats
Over 40 of Meditech clients are in the process
of planning and selecting a PACS system
Dorenfest - 2004
43 of all respondents have identified PACS as
one of the most important applications to
implement over the next two years
HIMSS 2004 Leadership Survey
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Why? Because PACS Has Proven.

• To Protect and Increase Market Share through
  Better Service to Referring Physicians
  Specialists
• To Reduce Costs and Consolidate Services
• To Increase Productivity
• To Increase Revenues
• To Improve Quality Patient Safety

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PACS Mandate

• No longer a question of whether to acquire
  PACS, It is only a question of When and How.

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PACS 101

• P The power to view images, transfer and receive
  data at diagnostic, reporting, consultation and
  remote workstations. 

A The ability to archive to magnetic or other
optional media for short or long term storage.
C LAN or WAN connectivity as well as
communication capability.
S System integration that includes modality
interfaces and gateway connectivity to healthcare
and departmental information system using one
integrated system.
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Benefits Over Lightbox Technology

• Image Manipulation with Software
• Contrast Brightness Control
• Image can be flipped or rotated
• Edges can be enhanced
• Areas of Interest can be enlarged
• Old images retrieved and compared
• Viewed in more than one place
• Cannot be borrowed or lost

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History of PACS
History is the version of past events that
people have decided to agree upon.
Napoleon Bonaparte (1769 - 1821)
There is no reason for any individual to have a
computer in his home.
Ken Olsen (1926 - ), President, Digital
Equipment, 1977
Computers make it easier to do a lot of things,
but most of the things they make it easier to do
don't need to be done.
Andy Rooney (1919 - )
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History of PACS

• 1983 US Army
• 1985 Univ of Washington Georgetown Univ.
• 1985 National Cancer Institute
• Radiology Only
• Focus was on Film-less

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Today - PACS Ripple Effect
Due to the Ripple Effect integration to the
Electronic Medical Record is key. Meditech is
uniquely positioned.
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PACS Improves Quality

• Reduce of Repeat Exams (poor technique)
• Reduce Number of Retakes (lost film)
• Eliminate Redundant Data Entry
• Improve the Availability to ED, OR, ICUs, and
  Offsite Locations
• Shorten Report Turnaround Times
• Reduce Patient Waiting Times
• Reduce Backlog of Scheduled Exams
• Address Lost Charges (exam completed but not read)

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Overall Benefits of PACSBerkshires Goals

• Eliminate Film and Film Related Costs (800K/year
  at BHS)
• Archive Images Digitally to Reduce Storage Costs
• Improve Access to Images and Patient Data by
  integrating with Meditech EMR
• Improve Communications to Clinicians and
  Referring Physicians
• Improve Patient Access to Radiology Services

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Case StudyBaltimore VA Medical Center

• 59 steps to 5 for order, obtain, filing,
  retrieving, and reporting a chest x-ray
• Reduction of exam times by 60
• 50 increase in Radiologist productivity
• 5 increase in interpretation accuracy
• 50-60mins per day savings for Clinicians
• Rad consultations dropped from 7 per day to 2
• Lost Films (unread) dropped from 8 to .30

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Case StudyBaltimore VA Medical Center

• Retakes dropped from 5 to .7
• Non-stat exams interpretations dropped from 12-24
  hrs to 20 minutes
• Reporting turnaround dropped from 24-48 hrs to 2
  hrs from time of exam
• Outpatient Utilization increased by 21
• Enhanced recruitment of residents, interns and
  med students

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Getting Started
When you come to a fork in the road, take it.
Yogi Berra (1925 - )
There are risks and costs to a program of
action. But they are far less than the long-range
risks and costs of comfortable inaction.
John F. Kennedy (1917 - 1963)
I have an existential map. It has 'You are here'
written all over it.
Steven Wright
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Sample Methodology
About one-third of all people evaluating PACS
want PACS to do things that PACS simply cant do.
Another third expect PACS to work properly
without obtaining required information transfer
from other clinical systems. Michael Cannavo,
Imaging Economics
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Sample Methodology
Understand what PACS can and cannot do
Get Political Support
Get Financial Support
Process Reengineering Study
Needs Assessment Project Plan
RFP
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What PACS can do!

• Increase technologist and radiologist
  productivity
• Serve as a catalyst for a department-wide process
  reengineering evaluation
• Increase primary care physician (PCP)
  satisfaction levels with the hospital services
• Virtually eliminate film use
• Reduce all environmental issues relating to film
  use including silver recovery, and chemical
  disposal
• Reduce retrieval time of prior images
• Reduce exposure-related retake rates
• Reduce storage requirements over a long term
  period (gt10 years)
• Reduction in file room clerical ftes
• Decrease cost per admission
• Reduction in lost film

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What PACS cannot do!

• Have a dramatic impact on FTE budget
• Impact storage space in the near term (lt 5 years)
• Impact overall length of stay
• Decrease transcription costs without using
  bar-coding of normal reports in the RIS or using
  voice to text conversion
• Increase revenue without active marketing of the
  facilities services to take advantage of the time
  savings generated by PACS

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Get Political Support

• Hospital Administration
• Nursing
• Radiologists
• Specialists
• Primary Care
• Eventually the Board

This is no time to make new enemies.
Voltaire (1694 - 1778), when asked on his
deathbed to forswear Satan.
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Get Financial Support

• Develop Solid Cost Model (5 yrs)
• Include ROI
• Phased Approach if Necessary
• Make sure it is realistic
• Computer Radiography (CR)
• Digital or Direct Radiology (DR)

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Sample Cost Model
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Sample Cost Model
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Sample Cost Model
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Process Reengineering
By failing to prepare, you are preparing to
fail.
Ben Franklin
You can observe a lot just by watching.
Yogi Berra
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Process Reengineering Study

• Workflow, Volume, FTE utilization, Existing
  Planned Equipment
• What Problems are you looking to solve?
• What is required to solve the problems?
• What benefits will be obtained?

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Needs Assessment Project Plan

• Build on the cost model and reengineering study
• Hospital-wide imaging strategies
• Radiology specific strategies
• Competitive environment
• Cost of Implementation
• Purchase Options

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Purchasing Options500k - 8M

• Image Equipment Suppliers
• GE, Siemens, Phillips
• Film Suppliers
• AGFA, Fuji, Kodak
• Information Systems Suppliers
• Cerner
• Specialty Suppliers
• DR Systems, Amicas
• ASPs (per procedure)
• Emageon, Stentor

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PACS RFP

• Draft the Project Team
• Description of Facility
• What it requires
• How system will be used
• When its needed
• Specific requirements
• Background info on Imaging Modalities
• Native Dicom
• Complete procedural volumes
• PACS Interfaces
• Service
• Documentation Training
• Project Plan
• Response Format

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PACS RFP

• System Description
• How system is expected to work
• Solve what problems
• DICOM Support
• Performance specs
• Existing Proposed Network
• Vendor vs Hospital Responsibilities
• Advanced Software (3D)
• Install specs responsibility
• Insurance Subcontracting clauses
• Acceptance Criteria
• Warranty, Response Time, Uptime
• HIPAA

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RFP Scoring

• Relationship
• Implementation
• Integration
• Functionality
• Technology
• Cost
• Support

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Sample Scoring
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Use of Consultants
If the world should blow itself up, the last
audible voice would be that of an expert saying
it can't be done.
Peter Ustinov (1921 - 2004)
A consultant is an expert who will know tomorrow
why the things he predicted yesterday didn't
happen today.
Laurence J. Peter (1919 - 1988)
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Use of Consultants

• Develop Cost Model
• Process Reengineering
• Needs Assessment
• RFP Process
• Contract Negotiations
• Implement Workflow

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Barriers to Success

• Physician Resistance to reading soft copy
• Decrease in Physician Productivity
• System Reliability (Business Continuity)
• Implementation of Workflow Changes
• System Sizing to Capacity
• Overstated ROI

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Future
Where a calculator on the ENIAC is equipped with
18,000 vacuum tubes and weighs 30 tons, computers
in the future may have only 1,000 vacuum tubes
and perhaps weigh 1.5 tons.
unknown, Popular Mechanics, March 1949
The future, according to some scientists, will
be exactly like the past, only far more
expensive.
John Sladek
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Physician Preferences
Which exam would you order?
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Beyond PACSHow Good are Your Ologies

• Cardiology

• Neurology

• Oncology

As long as acquisition of image is DICOM
compliant they can be link to PACS and displayed
using the MEDITECH EMR!
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PACS The ORs

• Image Accessibility Seen As Greatest Advantage of
  PACS by Surgeons Orthopods
• Workstation Tools (orthopedic surgeon)
• Digital Arteriography (vascular surgeon)
• Image-Guided Surgery (neurosurgeon)
• Computer-Aided Detection Systems

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Final Thought
Be enthusiastic because..
If you aren't fired with enthusiasm, you will be
fired with enthusiasm.
Vince Lombardi