At a time when the landscape of imaging management is shifting, it should be no surprise that perceptions of PACS, RIS, and other imaging management-related IT products should be in flux as well. And so they are, as Figures 1, 2, and 3 indicate. These are a few sample ratings of PACS and RIS vendor products as reported in the “Mid-Term Performance Review” published in June by Orem, Utah-based KLAS.
So why in particular should differences in satisfaction ratings be so broad, as shown in Figures 2 and 3? “There's a push right now for an enterprise solution for imaging; it's still relatively new as a concept, and there are a lot of different strategies out there,” says Kirk Ising, director of research for medical imaging and medical equipment at KLAS. What's more, Ising says, “One key thing is the drive toward making PACS products more or less interchangeable and creating a vendor-neutral archive, and that's important in understanding customers' perceptions, because customers don't want to be held hostage to PACS vendors.”
Industry experts on imaging management concur that the drive toward integration will shape perceptions of products and vendors going forward. “I think the integration piece is going to be the biggest issue,” says Joseph Marion, principal in the Waukesha, Wis.-based consulting firm Healthcare Integration Strategies. “And the concern there is building infrastructures that can manage an integrated set of information.”
Meanwhile, the largest vendors servicing the imaging field are retrenching and attempting to deepen their base at customer organizations, during a time when most of the spending-oriented focus is on HITECH-related EMR and CPOE, says Scott Grier, principal with Preferred Healthcare Consulting (Sarasota, Fla.). As a result, even at a time when customer needs for greater innovation around the enterprise-wide imaging management concept are growing, Grier doesn't see an intensification of vendor focus on it.
A countervailing factor, Grier says, is that, “Standalone imaging centers are having a very difficult time with reimbursement because of the DRA, and many are closing,” referring to the federal Deficit Reduction Act of 2005. “That has created a strong uptick in imaging volume at hospitals.” Physicians are also fleeing their reliance on troubled imaging centers in favor of allying more closely with hospitals. Smart CIOs, he says, will find ways to work this situation to their hospitals' advantage.
Most importantly, says Kim LaReau, vice president and CIO at the 443-bed Regions Hospital in St. Paul, Minn., CIOs must link their imaging strategy to their organization's clinical IT and business plans. “We are tied strongly into the organization's overall strategy as a whole - improving quality of care, the patient experience, and affordability,” says LaReau, who oversees imaging IT both at Regions Hospital itself and at two smaller satellite community hospitals.
LaReau and her colleagues began their planning for enterprise-wide imaging back in 2002. At that time, they had already implemented a core EMR on the outpatient side, and were about to roll it out on the inpatient side (Regions is an Epic customer). Along with that implementation, LaReau and her team moved forward with Epic's Radiant RIS system, and went live with a PACS product from Milwaukee, Wis.-based Merge Healthcare. It was logical to think systemically about imaging management in a multi-location environment, she says.
“The challenge for organizations,” LaReau says, “particularly now that we're mostly all capital-constrained, is really looking at resources. We wanted to maximize the care quality and efficiency we could provide.” Based on her experience, LaReau says she believes the most important task for CIOs is to really think through needs and priorities across the enterprise, before plunging into the upgrade of one of the components (PACS, RIS, modalities, EMR) in the architecture tied to imaging.
Wayne Andrews, practice lead of the Medical Imaging Group at Boston-based Beacon Partners, says serious analysis ahead of time is the answer. “The biggest single mistake organizations are making is not understanding where their current capabilities lie before they jump into trying to create a single central data repository,” he says. “First, you need to understand where you are. And so many organizations find out that they can't convert the data from three or four different PACS systems; and they've already earmarked monies for a solution that they won't be able to get to for some time.”
Policy Rears its Head
How might potential policy and reimbursement changes affect imaging and imaging IT?
On the one hand, President Barack Obama has called for an increased emphasis on preventive and primary care as part of overall federal healthcare reform legislation, which at press time was being debated in Congress. And that would mean, at the very least, a bolstering of reimbursement for such testing procedures as mammography and colonoscopy.
On the other hand, a draft healthcare reform plan being discussed in the Senate Finance Committee was said to propose Medicare reimbursement changes that would raise the assumed utilization rate for advanced imaging equipment to 90 percent (though with the potential for exemptions to that rate for rural and other disadvantaged providers).
As for the latter potentiality, industry experts agree that some form of utilization rate mandate may come via the Medicare program, regardless of whatever happens with broader healthcare reform initiatives.
The Department of Health and Human Services has had imaging modality utilization in its sights for some time now. And any such development could further spur the creation of software programs that prospectively analyze the clinical appropriateness of a particular imaging scan for a particular patient, or that retrospectively analyzes clinical outcomes, says Joseph Marion, principal in the Waukesha, Wis.-based consulting firm Healthcare Integration Strategies. CIOs will need to closely watch and track legislative or regulatory proposals that could shift reimbursement around imaging going forward, many agree.-M.H.
Centralization of images is becoming a best practice.
RIS, PACS and the EMR need to be linked.
Different types of physicians have distinct imaging needs.
PACS is becoming commoditized, while RIS is resisting.
Changes in reimbursement may significantly impact imaging demands.
Imaging is a ripe area to foster physician alignment.
Healthcare Informatics 2009 November;26(11):31-32