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Image is Everything

March 27, 2007
by Mark Hagland
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No longer solely the domain of radiologists, imaging is taking hold throughout the hospital.

Q: When is the management of radiologic images no longer about the radiologists?

A: When a combination of technology advances, alterations in medical practice, the evolution of enterprise-wide clinical computing, and changes in the hospital strategic planning landscape redefines the question -- in other words, now.

In fact, industry experts agree, the whole notion of how and why hospitals and health systems should implement picture archiving and communications systems (PACS) is undergoing fundamental change these days, as they become one element in a far broader, more complex, and more strategic, buy/build/upgrade planning process.

Just take the example of 450-bed Regional Medical Center at Memphis, popularly known as "The Med" That hospital is currently going through a total PACS system replacement, which should go live by late spring.

"From my standpoint, second-generation PACS systems are a marketing tool for the hospital,"says James Leonard, the hospital's CIO. Leonard, who heads up a fully outsourced IT department that is staffed by Long Beach, Calif.-based First Consulting Group, says that while first-generation PACS systems were tools for radiologists, the second-generation systems being implemented now are, strategically speaking, for the referring physicians. "What you're trying to do is to put together a PACS system that's easier for a referring physician to use and view, so that he or she sends you more radiology studies than to the competition down the street. So it's all about ease of use for referring physicians."

Of course, such altered calculations mean that CIOs necessarily must engage clinician leaders in broader discussions around implementation -- not only among radiologists, but among all clinicians. The focus must be not only around images and data for radiology, but increasingly for cardiology as well (as cardiology PACS solutions come online) -- and soon for pathology. Down the road a bit, they will need to be for gastroenterology, dermatology and other clinical areas as well, say experts.

In this context, Leonard says bluntly, "If you buy a PACS system today for the radiologists, you're making a $2.5 million mistake. I want those neurologists and orthopods sending their studies to me, because they like the way my system works for them, versus the PACS across the street."Differentiating a hospital as superior in service and capabilities is the goal, he says, and it's a conversation CEOs and clinician leaders will understand.

Nationwide, a realization

The kinds of conclusions that The Med's Jim Leonard has come to are now being reached by CIOs nationwide, as they face multiple challenges, including:

  • integrating images and data from cardiology and other disciplines with the radiology images and data;

  • integrating the image-based systems with core electronic medical record (EMR) and hospital information systems;

  • coping with the explosion in radiologic images that is putting a strain on storage architectures nationwide;

  • expanding the availability of images and data to physicians everywhere; and

  • dealing with the need to upgrade or replace systems altogether, as hospitals move towards second-generation PACS systems.

Indeed, now is a time of intensive PACS implementation and upgrading, note those tracking industry trends. According to Mike Davis, executive vice president of HIMSS Analytics, Chicago, his group's latest research indicates that about 50 percent of hospitals nationwide have at least some of the components of PACS systems, while around 70 percent of 300-plus-bed hospitals have some version of PACS. In other words, in contrast to even five years ago, PACS capability has become the norm rather than the exception in the hospital world.

There is good and bad news in these statistics, industry analysts say. On the one hand, core PACS technology is rapidly becoming commoditized. On the other hand, the wait for the expertise to install hospital-based PACS systems and integrate them with EMRs is becoming longer.

Vincent Norlock, a Whitefish Bay, Wis.-based consultant with First Consulting Group and a specialist in PACS issues, says, "Smaller vendors in the PACS sphere are growing so quickly, some by 40 percent or more a year, that some of their installations are going beyond the three-to-four-month timeframe for their people even to show up."Tim zoph

A separate but ultimately more significant challenge for information executives, Norlock says, is the need for CIOs to plan strategically for the costs of implementing, maintaining, upgrading, and replacing these expensive systems. (Although individual situations vary widely, implementations are averaging about $1 million for smaller hospitals and $2-2.5 million for larger hospitals, he says.)

"At some point, you'll have to come to grips with the very large amounts of money needed to maintain these systems,"Norlock emphasizes. "The longer you wait to assess that scope and communicate it effectively out, the more weakened your credibility and perceived effectiveness will be."In other words, CIOs must develop strategic plans that CEOs and boards will understand and can endorse.

In fact, as they plan strategically, CIOs should think about the long-term efficiency gains that are a key part of the PACS promise, says consultant Scott Grier, president of Grier & Associates, an independent consultancy based in Sarasota, Fla.