PACS-related technologist productivity gains can help justify investment

April 9, 2003

Even today, PACS still competes with other technology investments for scarce medical IT dollars. Demonstrating how a PACS can improve technologist productivity can help make the case that the investment is justified. PACS is proving itself to be as

Even today, PACS still competes with other technology investments for scarce medical IT dollars. Demonstrating how a PACS can improve technologist productivity can help make the case that the investment is justified.


PACS is proving itself to be as technologically necessary to an efficient radiology department as a RIS. Software-only solutions and decreasing memory costs continue to make PACS more affordable for even the smallest hospital-based radiology practices. Yet the decision to purchase a PACS is often postponed.

One of the most common reasons for delaying the PACS purchase is that many other projects in the enterprise compete for limited capital funds. The chief financial officer typically needs to see a return on investment (ROI) that makes the PACS financially attractive relative to other projects. The CEO and COO want the project to contribute to fulfilling the mission of the hospital, solve service-related issues, and increase the productivity of employees and the competitiveness of the hospital. It is imperative that PACS advocates communicate its potential benefits to the decision-makers in the most articulate and quantifiable way possible.

Illustrating the impact of PACS on radiology workflow by modeling productivity improvements, cost avoidance, new capacity and revenue opportunities is an effective means of communicating some of the benefits of a PACS.This article outlines the principals for quantifying PACS-related benefits that can be achieved through improvements in technologist workflow.

METHODS

Methods for articulating and quantifying the benefits of a PACS may be elicited from the technologists during the interview process or through more rigorous observation and measurement. A combination of both methods typically yields the most information about opportunities for productivity and other improvements that will accrue from a successful PACS implementation.

Technologists from each modality should be included in the interview and observation process to define the PACS-related productivity improvements specific to their modalities and to your institution. Familiarity with business process reengineering and industrial engineering techniques is helpful for synthesizing the information into models that are meaningful and convincing to key decision-makers.

PRODUCTIVITY OPPORTUNITIES

The objective of the productivity analysis is to determine whether technologists will be able to perform more exams in less time with a PACS. Film processing, handling, and transport activities may be quantified on a per exam or per patient basis. For example, if it takes five minutes per exam to process film, match a prior, and prepare the jacket for the radiologists, then the number of annual exams multiplied by five minutes will yield the productivity opportunity, in terms of minutes for that particular modality. Another simple example is the potential savings of two to five minutes per patient by eliminating manually entered patient demographic and exam information at the modality by deploying DICOM Worklist Management.

Each modality within your institution will have unique opportunities for improving productivity as a result of implementing a PACS. Many smaller community hospitals, for example, use older teleradiology systems for after-hours interpretations. Many of these systems transmit exams one image at a time. Technologists may need to spend 20 minutes or more just to transmit a full set of CT images.

Another example is the amount of time that can be saved by eliminating the need to refilm lost images. It may be more reasonable to calculate the total time saved based on the number of occurrences per week. Overall productivity gains can be significant. Studies conducted at the Baltimore VA, for example, documented a 40% increase in technologist productivity for general radiography in a filmless PACS environment.

CAPACITY OPPORTUNITIES

Additional exam capacity can be calculated by dividing the total technologist time saved from elimination of film activities by the average patient turnaround time without film-related activities. The patient turnaround time without film-related activities is equal to the total current patient turnaround time minus the time required for the film-related activities.

Caveats and assumptions should be clearly stated for any calculation. A two-technologist staffing model per resource, for example, will limit the productivity gains since scanning can continue while one technologist processes and handles film. Productivity improvements due to reduced film handling and processing in MRI will be minimized because these activities are usually performed while patients are being scanned.

REVENUE OPPORTUNITIES

Capacity opportunities can be used to estimate potential increases in revenue. Additional revenue estimates for each modality are calculated by multiplying the average collection rates based on payer mix by the increased exam capacity and average charge per exam. Only revenue for outpatients should be included in the calculation.

Several assumptions and caveats need to be included with any projected revenue calculations. If there is a high degree of appointment availability, for example, it may not be reasonable to predict an increase in volume commensurate with the productivity opportunities. In short, revenue opportunities are only valid to the extent that there is unmet demand for radiology services.

COST AVOIDANCE

Capacity gained through improved technologist productivity can be used to illustrate how much of the future demand for radiology services can be met using existing human and capital resources. Estimated productivity improvements should be used to justify cost avoidance in hiring additional technologists who might otherwise be needed to meet future demand. This point needs to be emphasized since the first reaction of many senior administrators is to view the potential gains as a reason to reduce labor.

The results can be modeled in terms of total salary and benefits avoided or in terms of labor cost per exam. If the latter, then the projected labor cost per exam should be compared with what the cost would have been had a PACS not been purchased. Further, if current equipment is near 100% utilization and estimates for future demand for radiology services are high, arguments can be crafted to illustrate that fewer pieces of equipment may be needed in the future to meet the projected demand.

SUMMARY

Institutions that rely heavily on agency technologists can make a stronger argument for reducing or avoiding future personnel costs by improving the productivity of technologists. Institutions that use non-technical personnel such as film librarians for many of the film handling tasks will have less opportunity for improving technologist's productivity through a PACS implementation. The decision whether to include quantified benefits from increased technologist productivity in the PACS ROI will depend on how well the arguments are modeled and articulated to the key decision-makers.

Mr. Levine is senior business systems consultant for The Radiology Consulting Group and senior project manager in informatics in the radiology department at Massachusetts General Hospital. He can be reached by e-mail at llevine@partners.org.