Imaging center PACS: ASP and ye shall receive

PACS involves difficult decisions for even the largest hospitals, but smaller outpatient imaging centers often find dealing with PACS purchasing questions even more perplexing.

Problems faced by stand-alone imaging center administrators differ from those of hospital administrators and require unique solutions. These issues were detailed in a recent paper (Radiol Manage 2003;25:36-41).

"Typically, most information about PACS concentrates on solutions and requirements for hospital radiology facilities," said T.J. Farnsworth, vice president of marketing and strategic development at RadVault in Hayward, CA. "For imaging centers, the financial justification for PACS may be less immediate than for hospitals."

Once the justification is made for the financial viability of PACS in an imaging center, the next question is how to finance PACS acquisition.

"This decision will depend largely on how you cost-justify your PACS, as well as the shape of your business model," Farnsworth said, "It will usually come to a decision between capital purchase or contracting with an application service provider."

In the hospital-dominated marketplace, PACS has traditionally been treated as a capital acquisition.

"For most imaging centers, however, owning a PACS is more of a problem than a benefit," Farnsworth said.

ASPs increasingly represent a successful financial alternative for imaging centers.

One of the largest considerations with PACS is how to store the digital images. There are currently three options:
? onsite
? offsite ASP
? onsite ASP: hybrid option in which an ASP vendor installs and manages onsite storage archives based on a per-procedure fee

The onsite ASP concept enables healthcare facilities to have an onsite image archive without having to make a costly initial investment in archive hardware. This strategy overcomes the main objection some radiologists have in relinquishing control of images to remotely hosted ASPs.

It allows the facility to acquire its own onsite archive, while spreading the ownership costs out over a longer period of time. Like the offsite ASP contractors, onsite ASPs usually take responsibility for implementation, maintenance, and upgrading of the archive.

Another issue is physician resistance to change. Whereas hospitals have the ability to dictate to their internal referring physicians that imaging studies are henceforth to be delivered digitally to desktop PCs rather than on film by sneaker net, the roles are likely to be reversed in a private imaging center environment.

Imaging centers often find dealing with cultural resistance to digital imaging among their client physicians a more delicate matter.