PACS planning, execution demand realistic outlook

While the cost of PACS has declined in the last decade, the system is still a major investment that requires careful planning, implementation, and follow-up. A number of metrics can measure the performance of a PACS, including cost savings, increased revenue, improved test turnaround times, and physician and patient satisfaction. It's especially important to document expected gains.

"Document your current environment and be prepared for surprises. Customers are almost always stunned to see the breadth of applications and the lack of their interoperability," said James Oakes, a principal with Health Care Information Consultants in Baltimore, at the 2007 Society for Imaging Informatics in Medicine meeting.

It's not unusual to underestimate expenses and cost savings when implementing a PACS, said George H. Bowers, a colleague of Oakes'. It's important to include in the planning the annual PACS maintenance fee, for example, which can add up to 25%. The hiring of PACS administrators and any reconfiguration of the facility needed to accommodate the installation are other lurking expenses.

The cost savings from a reduction in film and chemicals are usually less than expected, because it's difficult to totally eliminate film, Bowers said. But real savings can come from the use of fewer film librarians, although those benefits tend to accumulate slowly.

Productivity is easier to measure. Studies have shown that technologists' productivity increases up to 30% with the implementation of computed radiography and PACS and up to 70% with digital radiography and PACS. Radiologists' productivity also increases.

PACS can yield a positive return on investment, but only if it is one component in an overall strategy that addresses workflow, imaging equipment, and the facility.

As an example, Bowers presented a case study of a very busy medical office complex built in the 1970s. Over time, it had added CT, mammography, and MRI, essentially chopping up the existing footprint. Because poorly designed workflow resulted in two-hour waits for x-rays, in-house physicians began to send patients to an outside center. Before long, they also sent CT and MRI patients outside.

The solution involved creating three new dressing rooms adjacent to the waiting room, hiring two technologist aides to help patients, and implementing a PACS with a DICOM modality work list.

While the volume of the center increased by 15%, total wait time dropped to under 15 minutes. Radiologists no longer had to check the films immediately, as they could assess them later from the PACS workstation. One full-time equivalent technologist was eliminated.

In another case study, officials realized at their first audit five years after PACS installation that their projected savings of $2.9 million had been overestimated. They wanted to know why. Planners had not anticipated the cost of additional IT staff and equipment, and the cost savings from using less film and chemicals were not realized quickly enough. The real lesson, Bowers said, is don't wait five years for the first audit.