• E-mail
• Print
• PDF

Craft a cost-effective plan for PACS

Radiology Administrator's Compliance and Reimbursement Insider, February 1, 2007

Although some people believe that the whole world went digital some time ago, many community hospitals and freestanding facilities remain hesitant to purchase a PACS.

The product, process, and price still seem futuristic and complicated to many facilities.

Once upon a time, PACS represented an emerging technology, said Steven M. Walter, director of diagnostic imaging services for North Shore Medical Center in Salem, MA, during the 2006 American Healthcare Radiology Administrators meeting in Las Vegas.

“No on wanted to be standing on the point where the leading edge becomes the bleeding edge,” Walter remarked.

But purchasing a PACS system need not seem like an exploration into the mind of Jules Verne.

“It’s not rocket science anymore,” Walter said.

“PACS is a mature technology now. It is a competitive technology. It is affordable. There’s nothing freaky about it. You don’t need to be an expert. You can do this. You just need to trust yourself.”

Find the purpose for your PACS

First, decide what you expect to gain from the purchase of the PACS. Such a task may seem simple, but it requires a thorough and accurate assessment of your current systems.

“Find a vendor to meet your vision. Of course, that naturally implies that you’ve figured out what your vision is, but don’t be afraid,” said Walter.

Determine the effect of PACS implementation on the facility, business, patients, and staff.

Communicate for buy-in

No administrator advances any project without the support of both staff and superiors. For example, radiologists determined to continue reading film doom the PACS implementation process to failure.

“You have to have 100% buy-in from the radiologists,” Walter said.

Increase awareness from the CEO to the medical director and from referring physicians to radiologists, Walter said.

Walter suggested discussing the PACS during meetings and informing employees about PACS through a facility newsletter and company outreach.

For example, when the emergency department learns that images may be immediate, they also need to realize that does not necessarily mean that the radiologist’s interpretation will also be immediate.

It is all part of the learning curve, Walter said.

“They won’t come to you and ask you what you’re up to,” he said. “You have to hold it up for them. Offer individualized training and ongoing communication if you want medical staff on your side.”

For a successful program, create a PACS committee. Pull members from a variety of areas in your facility—radiology, technology, finance, and information technology (IT).

Allow the group to create its own mission as well as a vision for the system. And make sure that the committee maintains ownership and direction over the project.

Make IT part of the plan

Networking, integrations, patch management, storage, system monitoring, review-station support, disaster recovery, etc.—what does it all mean?

Ask your IT department. They know, so engage their assistance early and often.

“Most radiology staff aren’t trained in this stuff. A team effort with your IT department is necessary,” Walter said. “Collaboration is always challenging, but it is also always essential.”

Consider the facility’s current IT and radiology resources. Determine existing staff, experience, knowledge, and technology.

Many facilities typically divide operational responsibilities for the PACS system among radiology, IT, and the vendor.

Uncover the strengths and weaknesses of each. Then allocate tasks accordingly.

“If you have a strong IT department, make them responsible for IT planning. If not, keep the vendor in control. Either way, define whose responsibility it is in the PACS contract,” Walter said.

Ultimately, PACS remains a clinical tool, and the criteria for its purchase and use should be clinicallydriven, not solely IT-driven, Walter added. “You can’t do it without IT, but you can’t let them take over, either.”

Determine the right system and the right price

PACS, in and of itself, does nothing to generate revenue. It simply stores and retrieves data.

“How are you going to go to the [chief financial officer] and ask for money for a project that doesn’t generate any new revenue but costs $2–$5 million to implement?” Walter asked.

Some PACS vendors charge upwards of $12 per procedure, whereas others start financial packages at $4 per procedure, he said. For community hospitals, cost is crucial. In such environments, every dime counts toward the bottom line.

“It has to be affordable,” Walter said. “If it is not, then all other conversations are moot.”

Within the past year, Walter implemented his third break-even PACS program—each at a different community hospital in Massachusetts.

The annual PACS costs should be less than or equal to the current film-related costs, Walter said.

Determine the actual operating costs for your radiology facility or department, he added.

This will allow you to compare the future costs of your PACS against your current costs of film and related supplies.

“Be comprehensive and be real,” he said.

Pick the right vendor

Over the years, PACS technology developed somewhat generically, said Walter. Nevertheless, the market remains both competitive and diverse.

“They all may be ice cream, and we all like ice cream. But you may like strawberry, and I might favor chocolate . . . they’re all different flavors. It’s not one-vendor-fits-all,” he said.

Make sure that you complete a request for proposals (RFP). See related story in the December 2006 special report “Going Digital: Electronic imaging revolutionizes radiology,” available online at www.hcpro.com/content/64107.cfm.

Taylor the RFP to fit the specific needs of your institution in terms of size, IT resources, training needs, etc.

Make sure to include a mix of vendor types, Walter said. “Pick some vendors from both sides of that big-guy, small-guy fence.”

A small PACS vendor may be more flexible and better able to customize products to your needs, he said. However, larger companies generally maintain business stability over time.

Consider these factors when weighing your purchase choice. Take a careful look at vendors’ previous experience. Examine the systems they have installed based on the number of hospital beds, if appropriate, and the number of imaging studies per year.

With your proposals in hand, whittle down your choices based on your financial and other needs.

Measure the return on your investment

At facilities in which Walter implemented PACS, overall radiology productivity increased about 15%–40%, he said. Radiologists’ productivity increased even more.

“The bottom line remains clinical improvement,” said Walter. “Is the medicine better? Do we do a better job and provide a better service with PACS than with film? The answer is an unequivocal yes. It does work, it is amazing, and you can have it all.” n

Insider source

Steven M. Walter, director of imaging services, North Shore Medical Center, 81 Highland Ave., Salem, MA 01970, 978-354-4328; swalter@partners.org.

Keep workstation costs in the PACS package

To keep picture archiving and communication system costs low, vendors often trim some areas. Be aware of this when researching your PACS purchase.

Do not let vendors or your own penny pinching hamper a best practice, said Steven M. Walter, director of diagnostic imaging services for North Shore Medical Center in Salem, MA, during the 2006 American Healthcare Radiology Administrators meeting in Las Vegas. Make sure that you have enough workstations for all of your technologists.

“You need them,” said Walter. “Everyone needs them. Don’t let vendors shortchange you in an effort to reduce costs.”

Beware of PACS contracts that include the following: