What is the most common pitfall when users seek to determine PACS cost-effectiveness?

October 9, 2003

Hospitals around the world struggle with the issue of cutting costs while keeping up the quality of patient care. PACS experts from Europe provide insight on the cost-effectiveness of PACS implementation.Dr. Elmar KotterHead, imaging IT,

Hospitals around the world struggle with the issue of cutting costs while keeping up the quality of patient care. PACS experts from Europe provide insight on the cost-effectiveness of PACS implementation.

Dr. Elmar Kotter
Head, imaging IT, Freiburg
University Hospital, Germany

Determining cost-effectiveness is a very challenging task. To my knowledge, there is no standard methodology. It is essential to take into account more than the effects of RIS and PACS within the radiology department: In most cases the film cost and personnel savings will just be balanced by the cost of the PACS.

True cost-effectiveness of PACS exists only at the level of the entire hospital. An unpublished internal survey in our hospital showed that before the introduction of PACS, every doctor spent about 30 minutes per day searching for x-rays. We have nearly 1000 doctors in our hospital. Do the calculation yourself and consider that not only doctors search for x-rays.

A PACS is cost-effective only when combined with a digital image distribution system or, better, an electronic patient record, thus virtually eliminating the search for x-rays. When calculating the cost of your PACS, remember you will have to refinance your hardware every four years. Be aware that data production is growing quickly, and your digital archive has to grow.

Dr. Davide Caramella
Associate professor of radiology
University of Pisa, Italy


The most common pitfall is to calculate the costs and estimate the savings, taking into account solely the radiology department. Going digital entails additional costs, and very few direct savings are to be expected. Savings in film costs are not enough to justify the massive investments needed to implement a PACS from scratch. Try to determine the savings in terms of the increased overall efficiency that is achieved thanks to the implementation of the integrated digital management of all the clinical data (including images).

Dr. Frits Barneveld Binkhuysen
Radiologist, Hospital Eemland
Amersfoort, the Netherlands

The costs are relatively easy to calculate. The effectiveness of the cost savings is more difficult. Looking at the radiology department, the first item is often the cost of films, but also important are the so-called soft profits, which are more difficult to calculate. With PACS, you can optimize your workflow. You can (partly) outsource your work at night. You have easy access to second and expert opinions. PACS can improve the contribution of image information in the chain of the process of care as part of the electronic patient record. What is all this worth? Considering all of these together, PACS improves workflow management, your quality of life, and the quality of delivering healthcare.

Prof. Dimiter Tscholakoff
Professor of radiology
Rudolfstiftung Hospital, Vienna

The important step is to evaluate the number of people working in the radiology department and compare workflow aspects before and after introduction of PACS. Whenever workflow improvements result in higher patient throughput or potential for a decrease in the number of employees, cost-effectiveness will improve. The most common pitfall when trying to calculate the savings of going digital is to focus on film costs and film processing.

Prof. Walter Hruby
Chair of radiology
Danube Hospital, Vienna

The first rudimentary attempts to perform a profitability analysis of digital versus analog radiology proved to be deficient because they compared only the investment costs of PACS versus film costs. Later attempts included estimates of savings in personnel and archive space and were often subdivided into best-case/most likely and worst-case scenarios. Experience has shown us the qualitative value of digital radiology, such as patient and employee satisfaction as well as diagnostic and medical quality. It is not possible to measure and quantify these values, so invest the money for a profitability analysis into something more viable.

Dr. Raimund Vogl
Imaging information manager
Innsbruck Hospital, Austria

Before installing PACS, we did extensive calculations on cost-effectiveness. Because these calculations have to be based on the current technology and cost structure, and you have to project five years into the future, they are usually meaningless. Our film costs fell by a half over a few years, and archive media (magnetic tape instead of CD-ROM jukeboxes) and workstations (Windows NT instead of Unix) became a lot cheaper.

You have to do a cost-effectiveness analysis to justify such a big investment, but you should also be aware that things will probably develop differently. In our case, a lot of parameters changed, but the decision proved to be right and gave us a good infrastructure.