Spanish hospital sees PACS as key to efficient operation

June 1, 1999

Spanish hospital sees PACS as key to efficient operationNew institution serves 230,000 via capitated payment modelHealthcare institutions around the world are facing a strategic imperative to operate more efficiently. In this economic

Spanish hospital sees PACS as key to efficient operation

New institution serves 230,000 via capitated payment model

Healthcare institutions around the world are facing a strategic imperative to operate more efficiently. In this economic environment, hospitals are increasingly turning to digital image management to achieve higher levels of productivity and efficiency.

One purchaser of PACS technology that is reporting success with its installation is Hospital de la Ribera, a new Spanish hospital in the province of Valencia. Healthcare in Spain has historically been under government control, but the government's healthcare agency has faced increasing costs and operating deficits in recent years.

In a new business model for the country, the Valencia Public Administration (the regional government) has contracted with an affiliate of the Spanish insurance company Adeslas to provide healthcare to 230,000 citizens of Valencia. Other private enterprises have been providing healthcare services to two million civil servants in Spain, and based on the success of those ventures, the government decided to embark on a similar venture for the general public.

The 250-bed hospital, Ribera Salud UTE, is a joint venture between Adeslas, three regional banks, and two civil engineering firms. Adeslas holds 51%, while the banks and engineering companies own 45% and 4%, respectively.

The Valencia Public Administration has committed to pay Ribera Salud $266 per patient per year, a reimbursement level considerably lower than the average cost of care of $366 per citizen per year. With that in mind, the company recognized that its hospital would have to operate at a high level of efficiency in order to be profitable. The acquisition of a PACS network was seen as an important element in that effort.

PACS equipment
The company purchased a PACS network from Data General and its PACS software provider MarkCare Medical Systems. The purchase, which includes training and five years of service and support, cost $2.5 million and comprised a package of servers, storage, and workstations. Six dual-monitor, 2.5K x 2K workstations and seven single-monitor 1K x 1K workstations were installed in the radiology department. Two digitizers were installed to handle mammography studies and films from outside the hospital.

Two dry printers and one laser printer were implemented, as were two FCR 5000 computed radiography systems from Fuji Medical Systems USA of Stamford, CT. Software licenses for radiologists and clinicians were included. Integration of the PACS with the HIS/RIS was also part of the deal.

A digital linear tape (DLT) archive is employed for long-term archiving, while a 90-gigabyte RAID array is used for short-term storage. DICOM-compliant lossless JPEG compression is performed on archived images.

Although it was not included in the $2.5 million figure, an Ethernet and fiber-optic network was installed. Networking was provided by a local company affiliated with one of the hospital's owners, although Data General collaborated on the design.

Additional servers and clinical workstations costing $700,000 were supplied by Data General; included in this purchase were 400 workstations for use by clinicians. Of the 400, 130 are PACS workstations. In addition to offering image-review capability, the workstations provide services such as Web access, e-mail, and electronic patient record capabilities.

The hospital, which opened on Jan. 1, is filmless with the exception of mammography, which is read on films. The hospital plans to soon launch a study evaluating the use of digital mammography.

Education
Digital image management has achieved only minimal implementation in Spain. One obstacle that had to be overcome at Ribera Salud was the lack of experience many clinicians and radiologists had with PACS and with viewing medical images on a workstation, said Dr. Julia Camps, a radiologist at the hospital.

To meet this educational need, vendor representatives provided teaching sessions and set up a help desk to answer questions and address problems with the PACS network. If the hospital were going through the process again, it would allow more time for system testing and training, Camps said. Varying levels of DICOM compliance among modality vendors was also a challenge in the early stages of the project.

Once radiologists became acclimated to the PACS network, they reported an overall favorable experience with soft-copy viewing. In particular, they have found chest x-rays much easier to diagnose off workstations. In addition, the number of retakes is low with the system, Camps said.

"This is the next revolution in radiology. PACS is expensive, but in the long run, the possibility of retrieving any film at any moment and deriving precious information from it is a tremendous benefit," she said.

Hospital de la Ribera

Radiology Department
Carretera Alzira-Corbera, KM 1
Alzira 46600
Valencia, Spain
(34) 96-245-81-00
fax: (34) 96-245-81-56

www.hospital-ribera.com

Key personnel
Alberto de Rosa, general manager

Antonio Burgeueno Jerez, marketing manager

Enrique Esteban, chief radiologist

Maria Casal, radiologist consultant

Vendors
Data General (systems integration); MarkCare Medical Systems (PACS software)

Implementation type
Large-scale PACS

Rationale for purchase
Efficiency and technological capabilities of digital image management.