By Charles Bankhead

Electronic radiology systems save money and lead to a higher level of radiology service, according to a former healthcare CEO who says he would push even harder for automation if he had to do it all over again.

An "automated radiology practice" (ARP) cost more than $7 million to implement but produced a return on investment that far exceeded even the most conservative determinants of cost-effectiveness, said Dr. Leo Black, recently retired CEO of Mayo Clinic Jacksonville Medical Center in Jacksonville, FL.

"Within our institution, an 8% rate of return is considered cost-effective," Black said at an RSNA Refresher Course. "Our calculated rate of return [for the ARP] was 18% to 31%, depending how conservative the estimates were."

The system has brought with it many service benefits, he added. Identified benefits include improved telephone response to patients, decreased waiting time for imaging studies and reports, decreased patient correspondence time, and more prompt laboratory information. The time saved enabled outcome studies involving cost-effectiveness, distribution of radiology studies to physician exam rooms, and enhanced interaction between internists or surgeons and radiologists.

"I could go on and on about the benefits," Black said. "Everyone sees the benefits in their daily work."

The move toward an ARP at Mayo Clinic-Jacksonville began in 1992 with the idea of automated clinical practice. The idea was to develop an electronic network that would connect the medical center's hospital, four primary-care practices, and 235 clinical consultants. The extension to ARP occurred in 1994.

"We wanted the ability to send images to the hospital and clinics, so physicians and patients could look at them together," Black said.

The reasoning behind the move to an automated system was three-fold: the evolution of a new world of medicine; poor reimbursement levels, with the likelihood of further deterioration; and a need to cut expenses while maintaining or improving quality of care.

An electronic network seemed to offer a response to the challenge, Black said.

The automated clinical system went online in September 1996. The Jacksonville facility has been totally paperless since then. The ARP went online this year.

The ultimate goal is to expand the network to include individual homes and computers. "I believe the home is where more and more care is going to be provided in the future," Black said.

The move to an automated system involves convincing administrators that changes are needed. Selling the idea requires repetition, data, discussion, and patience.

Numerous key choices have to be made along the way. The institution must decide whether to start with the "big picture" and then develop individual programs, for example, or to start with individual programs and link them together at some point. One vendor can be used to reduce the number of disparate interfaces, or the institution can go with the "best of breed" for each type of need. The system can be developed as an isolated project, or as part of an institutional strategy, while looking for a positive return on investment early on, or making financial return a lower priority.

Of the last consideration, Black said, "In today's healthcare market, I think an institution will have to pursue a positive return fairly soon."

Key individuals within an institution must be carefully recruited to buy into the concept of an automated system and help in furthering the development of the system within the institution. A clear institutional vision for automation is essential, Black said. A business plan must be developed to justify the expense. Considerable effort has to be devoted to modification of behaviors that automation will affect. Ongoing evaluation of a system is a must after implementation.

"What is the importance of having an electronic practice environment?" Black asked in conclusion. "First, it saves money and leaves money to do other things to improve patient care. Secondly, it improves service to patients. Third, it positions an institution for what many of us think will be the new wave and the new way that medical care will be delivered in the next century."