10 Steps to Strategically Build and Implement your Enterprise Imaging System: HIMSS-SIIM Collaborative White Paper

An enterprise imaging (EI) strategy is an organized plan to optimize the electronic health record (EHR) so that healthcare providers have intuitive and immediate access to all patient clinical images and their associated documentation, regardless of source. We describe ten steps recommended to achieve the goal of implementing EI for an institution. The first step is to define and access all images used for medical decision-making. Next, demonstrate how EI is a powerful strategy for enhancing patient and caregiver experience, improving population health, and reducing cost. Then, it is recommended that one must understand the specialties and their clinical workflow challenges as related to imaging. Step four is to create a strategy to improve quality of care and patient safety with EI. Step five demonstrates how EI can reduce costs. Then, show how EI can help enhance the patient experience. Step seven suggests how EI can enhance the work life of caregivers and step eight describes how to develop EI governance. Step nine describes the plan to implement an EI project, and finally, step 10, to understand cybersecurity from a patient safety perspective and to protect images from accidental and malicious intrusion.

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program. Final rule

This major final rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies such as changes to the Medicare Shared Savings Program, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. In addition, this final rule includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model.

Radiological image data migration: Practical experience and comparison of the costs of work

Purpose: To identify costs deriving from data migration of obsolete digital archives by measuring the workload, and to analyse migration-associated problems.

Material and Methods: Two digital archives were used (DTL and MOD) and the capacity of these archives could no longer support the needs of the Medical Imaging Centre. The entire content of the DLT archive and selected data from the MOD archive were transferred to the current higher capacity (17 TB) tape archive. The running time of work processes was measured by self-reporting, and the cost of work was calculated.

Results: The transfer of 43,096 studies required 314 working hours over the course of 15 months in total. The work was partly manual, partly automatic. The percentage of non-retrievable MOD images was 35. Less than 0.2% of the DLT image transfers failed due to incorrect patient or image data. The MOD - DLT transfer cost was six times higher per study than the DLT - DLT transmission cost.

Conclusion: At present, data migration may be inevitable as the amount of data increases and technology advances. The data transfer proved to be labour intensive, with high fault sensitivity regarding the MOD archive. The cost of work of data migration was 0.4% of estimated digital archiving total yearly cost. Automated data migration is preferable.

Organizational centralization in radiology

Traditionally, hospitals have a radiology department, where images are taken and interpretation occurs. Teleradiology makes it possible to capture images in one location and transmit them elsewhere for interpretation. Organizational centralization of radiology interpretations is therefore of interest. Empirical data have been collected in qualitative interviews of 26 resource persons with substantial experience with picture archiving and communication systems and teleradiology, from 12 departments of radiology in Norway. The response rate was 90%. A total of 21 theoretically possible types of centralization of image interpretation were identified, representing combinations of three categories of geographical centralization, and seven categories of centralization according to function. Various advantages and disadvantages of centralization were identified. Organizational changes may be decisive for the future of teleradiology, but it may be wise to plan for change in small steps, since we know little about how broad future organizational changes based on teleradiology will be, or what will decide how far particular organizations will go.

[The dilemma of data flood - reducing costs and increasing quality control]

Digitization is found everywhere in sonography. Printing of ultrasound images using the videoprinter with special paper will be done in single cases. The documentation of sonography procedures is more and more done by saving image sequences instead of still frames. Echocardiography is routinely recorded in between with so called R-R-loops. Doing contrast enhanced ultrasound recording of sequences is necessary to get a deep impression of the vascular structure of interest. Working with this data flood in daily practice a specialized software is required. Comparison in follow up of stored and recent images/sequences is very helpful. Nevertheless quality control of the ultrasound system and the transducers is simple and safe - using a phantom for detail resolution and general image quality the stored images/sequences are comparable over the life cycle of the system. The comparison in follow up is showing decreased image quality and transducer defects immediately.

Storing radiology images in the reform era: what CFOs need to know

Vendor-neutral archives (VNAs) normalize PACS images and make image exchange possible, even when multiple divergent PACS or radiology departments are involved. These systems, onsite or cloud-based, allow for strategic and long-term growth regardless of the PACS used. Radiologists continue to operate with their system/vendor of choice, further strengthening productivity, satisfaction, and organizational loyalty. Finance executives shave costs, avoid future PACS expenses, and gain greater leverage with PACS vendors.

Has the Picture Archiving and Communication System (PACS) become a commodity?

The Picture Archiving and Communication System (PACS) market has been transformed by disruptive innovations from the information technology industry. The cost of storage alone has dropped by a factor of 100 within the past 10 years. Improvements in display, processing, and networking have likewise enabled PACS to be a capable replacement for film. The maturity of PACS has permeated the US healthcare industry from large academic hospitals to small outpatient imaging centers. Can PACS continue to be a platform for innovation or has it become a commodity?

Crunch time. CIOs balance cost and flexibility to plan for storing large volumes of diagnostic imaging data

Faced with skyrocketing imaging data storage costs, CIOs at three healthcare facilities found alternatives that have enabled them to slash expenditures, monitor their storage requirements, and provide more cost-effective backup solutions.

Parsing the PACS market. Evaluating a PACS upgrade or replacement decision is all about understanding need

* The current PACS vendor market is particularly unstable right now, because of the global economic recession, much of the industry's attention focusing on EMRs because of the passage of federal healthcare IT stimulus funding for core-clinical IT implementation, and vendor downsizing. * In theory, ClOs should be able to obtain particularly good "deals" with vendors at this time; but the complex economic situation makes deal-making more challenging than it might appear at first glance. * ClOs and industry experts agree that CIOs need to strategize carefully with regard to PACS purchasing and especially PACS replacement purchasing, in the current market.

Indicators to estimate radiographic film savings due to a PACS in a Mexican health institute

The scope of this paper is to evaluate the impact of PACS implementation in radiographic film (RF) savings at the Imaging Department at the National Institute of Respiratory Diseases in Mexico City, considering both Computed Tomography (CT) and Computed Radiography (CR) modalities. The PACS at the INER was installed in 2006, and the CT and CR have been operating entirely digitally since then. Therefore, the document evaluate three different periods, before the arriving of the PACS (2005), during the PACS installation (2006) and after PACS (2007). A set of indicators were designed to measure and visualize the impact of the PACS in the RF savings. Two templates are provided to define and to apply each one of the indicators proposed.

Sustainable IT budgeting: a method to determine not to exceed values for annual infrastructure purchases

Picture-archiving and communication systems are complex entities, but at core they consist of compute processors that are networked together to store and retrieve objects. Therein lay fundamental aspects of both performance benchmarking and predicting future costs, provided one can accurately predict trends in both exam volumes and sizes. Hence, determining the correct amount of capital to reserve annually for the information technology infrastructure can be a difficult process for the administrator of a medical center. Both exam volumes and sizes tend to increase over time. In addition, users demand more compute-intensive applications and expect exam delivery to the desktop to be ever timelier despite the increase in size. Against this, storage, compute, and networking costs tend to decrease over time for the same performance level. At the end of the day, the question of whether to budget more or less capital for next year's infrastructure is not trivial. This paper develops a methodology that uses current baseline data to predict the "ampleness" of a budget to meet future needs.

DicomWorks: software for reviewing DICOM studies and promoting low-cost teleradiology

DicomWorks is freeware software for reading and working on medical images [digital imaging and communication in medicine (DICOM)]. It was jointly developed by two research laboratories, with the feedback of more than 35,000 registered users throughout the world who provided information to guide its development. We detail their occupations (50% radiologists, 20% engineers, 9% medical physicists, 7% cardiologists, 6% neurologists, and 8% others), geographic origins, and main interests in the software. The viewer's interface is similar to that of a picture archiving and communication system viewing station. It provides basic but efficient tools for opening DICOM images and reviewing and exporting them to teaching files or digital presentations. E-mail, FTP, or DICOM protocols are supported for transmitting images through a local network or the Internet. Thanks to its wide compatibility, a localized (15 languages) and user-friendly interface, and its opened architecture, DicomWorks helps quick development of non proprietary, low-cost image review or teleradiology solutions in developed and emerging countries.

Évaluation médico-économique d’un système capteur-plan grand champ en radiopédiatrie

PURPOSE

To evaluate the impact of a completely automated digital radiography (DR) unit in a pediatric radiology department on productivity. Materials and methods. Comparative evaluation of DR and computerized radiography (CR) units on 193 patients imaged in a pediatric radiology department. The time to complete each step of all examinations was recorded. Half of the exams were performed using CR and the other half was performed using DR.

RESULTS

There was a 52% time gain for simple projection exams using DR and a 51% time gain for dual projection exams using DR (p<0.001). A workflow study performed a 9 month period showed that DR could absorb 84% of work previously performed on two conventional radiography units.

CONCLUSION

DR is necessary for digital imaging departments to increase productivity, while providing added ergonomic comfort and flexibility. It is particularly well suited for pediatric imaging departments.

Financial assessment of a picture archiving and communication system implemented all at once

The objective of this study was to determine the differential cost between film-based radiology and a hospital-wide picture archiving and communication system (PACS) implemented all at once. The cash flow and running costs of PACS and film-based operation were measured over an 8-year time horizon. When the hospital-wide PACS was implemented over a short period, there was instant conversion into digital film and archives. The net present value (NPV) for PACS operation is US $1,598,698, whereas the NPV for film-based operation is US $2,083,856, indicating a net saving of US $485,157. The payback period is 4 years. The costs of computed radiography and image plates account for 40% of the initial capital expenditure in PACS implementation, followed by computer hardware (30%) and software (9%) costs. Our experience shows that implementation of hospital-wide PACS all at once can produce cost savings. For hospitals intending to go filmless, this study offers a model for financial evaluation of PACS to help in decision making.

Budget variance analysis of a departmentwide implementation of a PACS at a major academic medical center

In this study, the costs and cost savings associated with departmentwide implementation of a picture archiving and communication system (PACS) as compared to the projected budget at the time of inception were evaluated. An average of $214,460 was saved each year with a total savings of $1,072,300 from 1999 to 2003, which is significantly less than the $2,943,750 projected savings. This discrepancy can be attributed to four different factors: (1) overexpenditures, (2) insufficient cost savings, (3) unanticipated costs, and (4) project management issues. Although the implementation of PACS leads to cost savings, actual savings will be much lower than expected unless extraordinary care is taken when devising the budget.

Experiences with a prototype tracking and verification system implemented within an imaging center

RATIONALE AND OBJECTIVES

Most health care facilities currently struggle with protecting medical data privacy, misidentification of patients, and long patient waiting times. This article demonstrates a novel system for a clinical environment using wireless tracking and facial biometric technologies to automatically monitor and identify staff and patients to address these problems.

MATERIALS AND METHODS

The design of the location tracking and verification system (LTVS) was based on a workflow study which was performed to observe the physical location and movement of patient and staff at the Healthcare Consultation Center II (HCC II) running hospital information systems, radiology information systems, picture archive and communication systems, and a voice recognition system. Based on the results from this workflow study, the LTVS was designed using a wireless real-time location system and a facial biometric system integrated with the radiology information system. The LTVS was tested for its functionality in a laboratory environment, then evaluated at HCC II.

RESULTS

Experimental results in the laboratory and clinical environments demonstrated that patient and staff real-time location information and identity verification can be obtained from LTVS. Warning messages can immediately be sent to alert staff when patient's waiting time is over a predefined limit, and unauthorized access to a security area can be audited. Additionally, patient misidentification can be prevented during the course of examinations.

CONCLUSIONS

The system enabled health care providers to streamline the patient workflow, protect against erroneous examinations and create a security zone to prevent, and audit unauthorized access to patient health care data required by the Health Insurance Portability and Accountability Act mandate.

Space jam. Are digital imaging systems straining your storage resources?

The growth in digital imaging is a boon for quality of care, but storage systems are bursting at the seams, creating complications both technological and financial.

Cost-effective handling of digital medical images in the telemedicine environment

BACKGROUND

This paper concentrates on strategies for less costly handling of medical images. Aspects of digitization using conventional digital cameras, lossy compression with good diagnostic quality, and visualization through less costly monitors are discussed.

METHOD

For digitization of film-based media, subjective evaluation of the suitability of digital cameras as an alternative to the digitizer was undertaken. To save on storage, bandwidth and transmission time, the acceptable degree of compression with diagnostically no loss of important data was studied through randomized double-blind tests of the subjective image quality when compression noise was kept lower than the inherent noise. A diagnostic experiment was undertaken to evaluate normal low cost computer monitors as viable viewing displays for clinicians.

RESULTS

The results show that conventional digital camera images of X-ray images were diagnostically similar to the expensive digitizer. Lossy compression, when used moderately with the imaging noise to compression noise ratio (ICR) greater than four, can bring about image improvement with better diagnostic quality than the original image. Statistical analysis shows that there is no diagnostic difference between expensive high quality monitors and conventional computer monitors.

CONCLUSION

The results presented show good potential in implementing the proposed strategies to promote widespread cost-effective telemedicine and digital medical environments.

Detection rates in pediatric diagnostic imaging: A picture archive and communication system compared with a web-based imaging system

OBJECTIVE

This prospective study assesses whether there are differences in accuracy of interpretation of diagnostic images among users of a picture archive and communication system (PACS) diagnostic workstation, compared with a less costly Web-based imaging system on a personal computer (PC) with a high-resolution monitor.

METHODS

One hundred consecutive pediatric chest or abdomen and skeletal X-rays were selected from hospital inpatient and outpatient studies over a 5-month interval. They were classified as normal (n = 32), obviously abnormal (n = 33), or having subtle abnormal findings (n = 35) by 2 senior radiologists who reached a consensus for each individual case. Subsequently, 5 raters with varying degrees of experience independently viewed and interpreted the cases as normal or abnormal. Raters viewed each image 1 month apart on a PACS and on the Web-based PC imaging system. McNemar tests were used to compare accuracy of interpretation across both imaging systems. Confidence intervals (CIs) were calculated for differences in the proportion assessed incorrectly on the PACS, compared with the Web-based PC imaging system.

RESULTS

There was no relation between accuracy of detection and the system used to evaluate X-ray images (P = 0.92). The total percentage of incorrect interpretations on the Web-based PC imaging system was 23.2%, compared with 23.6% on the PACS (P = 0.92). For all raters combined, the overall difference in proportion assessed incorrectly on the PACS, compared with the PC system, was not significant at 0.4% (95%CI, -3.5% to 4.3%).

CONCLUSION

The high-resolution Web-based imaging system via PC is an adequate alternative to a PACS clinical workstation. Accordingly, the provision of a more extensive network of workstations throughout the hospital setting could have potentially significant cost savings.

Cardiovascular PACS: recent KLAS findings

To assist in providers' need for knowledge in this important area, KLAS conducted a study focusing on uses, benefits and challenges with Cardiovascular PACS (CPACS)--as reported by providers themselves. The report focuses on several considerations, including: quantifiable benefits; functional strength of remote cardiac image management; and advice for choosing and implementing a CPACS system.

Developing a radiology information system and picture archiving and communications system (RIS/PACS) for a Kenyan hospital

RIS/PACS systems can greatly improve patient care and physician education. However, these features come at a high cost not attainable in most developing countries. Our goal was to explore low-cost options for basic RIS/PACS. We were able to design and implement a low cost RIS/PACS solution that was used for thousands of studies. Future work will expand on the functionality and reliability of this low-cost solution.

Database application of digital medical X-rays and labs: computerization, storage, retrieval, interpretation, and distribution

Stenter lets the health care worker order an X-ray that is produced as a computer image rather than on flat film. The health care provider can be in any location with the correct equipment, and view the digital image. The dimensions of this discussion are extensive. The cost savings because of reduced media and storage cost is substantial. Health care quality can be improved because of the ability to obtain consultation via telemedicine and the enhanced ability to track medical problems over time via trends. The major downside is the limited cost imbursement system to pay for technology. Unfortunately, this may impact on the improved quality of care. In simple terms someone needs to pay for the technology and the quality of health care needs to be maintained or improved. The real cost to the health care systems needs to be correctly calculated and inappropriate charging kept to a minimum. Specific costs need to be kept in mind and the first is the cost for new staff or staff training. The number of health care providers that are able to read the X-ray can be enlarged remembering that only American Board Certified Radiologists are allowed to give the final recommendation. How do we view the cost of missing something? It could be argued that this risk will be reduced because of improved technology for obtaining the digital X-ray and improved enhancement software. One way to view this situation is to include technology, management, and organization. The cost and benefits occur through the interplay of all three dimensions. The development of digital imaging hardware and artificial intelligence software will demand change in the management and organization. The organization will require changes in its design to accommodate the technology as to support and resources. Management will evolve to include methods for control and monitoring this technology. Business processes and standard operating procedures will change to integrate the technology into the organization in the most effective and efficient manner.

Purchasing a PACS: from planning to procurement

Picture archiving and communication systems (PACS) are highly versatile data storage and retrieval systems that facilitate the transfer of digital images and patient data throughout a healthcare enterprise. They process images from diagnostic modalities and are interfaced to radiology information systems and hospital information systems to improve workflow. Ensuring that you select a PACS that is optimal for your facility requires planning and judgment. It also requires that you define your needs based on optimal workflow, clearly convey those needs to prospective suppliers, and organize responses for easy comparison. In this article, we outline the steps needed to prepare for a PACS purchase: (1) defining the scope of your PACS, (2) analyzing your workflow requirements so that you can plan workstation deployment, (3) ensuring adequate integration, (4) planning for your image-storage needs, (5) ensuring security, and (6) putting together an effective request for proposal.

[DRG and OPS-301: effects on the acquisition performance in radiology]

Reimbursement for inpatient services rendered based on comparable daily care rates, case-based flat rates, and special fees as practiced until now has been replaced by the system of diagnosis-related groups. Up until 2004, operation and procedure system (OPS 301) codes could be processed completely automatically by appropriate adaptation of the radiology information system (RIS). Because of further differentiation of OPS codes in the 2005 version, it is no longer possible to unambiguously determine OPS codes automatically. Our goal was to fulfill these additional requirements with as little extra effort as possible. In 36 of 2138 procedures during an observation period of 12 days, i.e., 4/day, manual input on the part of the radiology technical assistant and quality assurance by the diagnosing physician were necessary. This is only needed in complicated procedures for which the minor added effort is negligible in comparison to the entire effort expended for the procedure. We were thus able to achieve the goal of near automation of ascertaining OPS codes.

The socioeconomic aspects of information technology for health care with emphasis on radiology

RATIONALE AND OBJECTIVES

Information technology is the key to cost effective and error free medical care in the United States and the only problem is that there is not enough of it yet. During the past 15 years, billions of dollars have been spent on information technology for health care with very little benefit but significant adverse effects on patients, physicians, and nurses. The truth about health care information technology (HIT) probably lies somewhere between these extreme statements, representing technophile and skeptical views, respectively.

MATERIALS AND METHODS

There is no doubt that computer and communication hardware has reached a state of sophistication and availability in which any and all necessary information can be generated, stored, and distributed to health care workers in support of their patient care tasks. The barriers to rapid and widespread development and diffusion of cost effective and practically useful HIT are exclusively related to human factors.

RESULTS

This article explores some of the organizational, cultural, cognitive, and economic forces that interact to influence success of HIT initiatives in health care organizations. A key point to be recognized is that the intrinsically handcrafted nature of health care work combined with high degrees of complexity and contingency make it impossible to "computerize" with the same ease and completeness of other industries. The major thrust of the argument is that designers of information systems and health care informatics managers must meet needs of patients and care providers. The software they create and implement should promote, support, and enhance the existing processes of health care rather than seeking to dictate how direct care providers should do their work.

CONCLUSIONS

Instead of looking for "buy in" from physicians and nurses, the informatics community must return the authority over functional specification of patient care information systems to them--where it belonged in the first place. This same lesson about computer technology and organizational politics is also being learned in the business community, where executives are reclaiming responsibility for mission critical informatics decisions.

Supporting growth of digital imaging

Today's digital imaging industry has come very far for hospitals. The basic technology is ready, and hospitals are now acquiring, viewing, and storing more and more of their images digitally. The problem is--all of this is still only happening inside the radiology room. What's needed now for digital imaging to realise its full potential--both in cost savings and in improved patient care--is a supporting infrastructure of hardware, software and service options that extends image viewing outside of the radiology room and into the rest of the hospital. In fact, two of the most critical components for the widespread distribution of images are firstly, the availability of viewing hardware (especially DICOM-calibrated displays) whose cost and features are tailored to each user environment, and secondly, the ability for hospitals to manage this distributed hardware and provide quality assurance from one centralised location.

Planning for PACS: A comprehensive guide to nontechnical considerations

A complete picture archiving and communication system (PACS) installation is one of the largest projects a radiology department will undertake. Although technology issues are important, they often draw focus away from many other significant issues This paper describes in detail all of these other necessary components that need to be addressed if a PACS installation is to be relatively trouble free, provides guidelines for successful PACS implementation, and details pitfalls to be avoided.

Financing a large-scale picture archival and communication system

RATIONALE AND OBJECTIVES

An attempt to finance a large-scale multi-hospital picture archival and communication system (PACS) solely based on cost savings from current film operations is reported.

MATERIALS AND METHODS

A modified Request for Proposal described the technical requirements, PACS architecture, and performance targets. The Request for Proposal was complemented by a set of desired financial goals-the main one being the ability to use film savings to pay for the implementation and operation of the PACS.

RESULTS

Financing of the enterprise-wide PACS was completed through an operating lease agreement including all PACS equipment, implementation, service, and support for an 8-year term, much like a complete outsourcing. Equipment refreshes, both hardware and software, are included. Our agreement also linked the management of the digital imaging operation (PACS) and the traditional film printing, shifting the operational risks of continued printing and costs related to implementation delays to the PACS vendor. An additional optimization step provided the elimination of the negative film budget variances in the beginning of the project when PACS costs tend to be higher than film and film-related expenses.

CONCLUSION

An enterprise-wide PACS has been adopted to achieve clinical workflow improvements and cost savings. PACS financing was solely based on film savings, which included the entire digital solution (PACS) and any residual film printing. These goals were achieved with simultaneous elimination of any over-budget scenarios providing a non-negative cash flow in each year of an 8-year term.

Picture archiving and communication system--part 2 cost-benefit considerations for picture archiving and communication system

Picture archiving and communication system (PACS) has become an important component of many radiology departments. PACS is expected to make the departments more efficient, reduce operating costs, and improve the communication between the radiologist and the referring physician. Even if the cost-savings are not substantial because of the capital expense of PACS, cost justification is very important in demonstrating the substantial advantages of PACS at either little or no additional expense. Some cost-benefit considerations for PACS are discussed in relation to a hospital-wide implementation.

Establishing benchmarks for creation of a pro-forma economic model to evaluate filmless PACS operation

The purpose of this study was to establish data points (benchmarks) to incorporate into a pro-forma cost analysis model, comparing film-based and filmless modes of operation. Prospective data were collected over a 6-year period at the Baltimore VA Medical Center (BVAMC) immediately before and after implementation of a hospital-wide PACS. These data were in turn compared with local and national VA centers during comparable time periods, to establish reference data between manual film-based (without PACS) and filmless operations (using PACS). Benchmarks utilized for the study fell into 2 broad categories: operational costs and revenues generated. Factors contributing to operational costs include space requirements, equipment, supplies, personnel, and maintenance. Factors contributing to revenues generated included examination volume, modality mix, and reimbursement rates. Collectively, these data points were incorporated into a pro-forma model that allows prospective PACS customers to compare total cost of ownership for film-based and filmless operations dependent on the unique variables of the respective institution.

[Is teleradiology service in primary health care cost-effective?]

BACKGROUND

Not many analyses have been performed of the cost-effectiveness of telemedicine services. A teleradiology service linking a general practice in rural Norway up with the local hospital in the nearest town was established in 1998.

METHODS

Savings on traveling expenditure were registered for all patients who underwent elective examinations in Otta during the first year of service. Over a four-month period in 2002, records were made of whether patients undergoing emergency examinations were taken in to the local general practice or referred to the hospital. These data are key factors in the evaluation of cost-effectiveness. The method employed is a cost-minimisation analysis in which the costs of teleradiology are compared to the costs incurred when patients go to hospital for a radiological examination.

RESULTS

On the basis of data for 3006 patients, an estimated annual NOK 1.4 million (USD 200,000) were saved on travelling expenditures and by patients or their employers because of working hours not lost. Annual costs of NOK 50,000 were avoided because radiological examinations in the surgical out-patient clinic are no longer necessary. Annual costs of NOK 400,000 include investments in equipment, lease of a broadband connection, and less efficient utilization of equipment and surgeries. Examinations done twice incurred estimated annual costs of NOK 40,000. The cost-minimization analysis shows that on an annual basis the service saves costs of NOK 1 million (USD 160,000).

INTERPRETATION

This study shows that telemedicine is most likely to be cost-effective when annual patient load and travel costs are high, together with relatively low investment costs.

Use of a clinical pathway to manage unsuspected radiographic findings

STUDY OBJECTIVES

To describe our 5-year experience with a clinical pathway used to ensure the timely communication and evaluation of unsuspected radiologic findings (URFs) noted on clinically requested chest imaging.

DESIGN

Prospective data collection on clinical practice.

SETTING

Academically affiliated Veterans Affairs medical center.

PARTICIPANTS

Pulmonary physicians, nurses, and radiologists.

RESULTS

Over a period of 5 years, 1,629 URFs were referred to the pathway (from chest radiographs, 1,359 [83.4%]; from CT scans, 270 [16.6%]). Most URFs (78%) were nodules, with a specific diagnosis made in one third of URFs, and with a specific diagnosis thought to be clinically significant in another one third of URFs. The most common diagnosis was neoplasm, with over two thirds of these diagnoses being lung cancer. One third of lung cancers detected were either stage 1 or 2, with 1 in 17 of all URFs being stage IA lung cancer. The cost of the pathway was estimated at 28,600 dollars per year.

CONCLUSIONS

URFs noted on chest imaging are frequently clinically significant, and a systematic approach to managing URFs, such as a clinical pathway, can significantly improve care in a large teaching hospital.

ASP archiving solution of regional HUSpacs

The application service provider (ASP) model is not novel, but widely used in several non-health care-related business areas. In this article, ASP is described as a potential solution for long-term and back-up archiving of the picture archiving and communication system (PACS) of the Hospital District of Helsinki and Uusimaa (HUS). HUSpacs is a regional PACS for 21 HUS hospitals serving altogether 1.4 million citizens. The ultimate goal of this study was to define the specifications for the ASP archiving service and to compare different commercial options for archiving solutions (costs derived by unofficial requests for proposal): in-house PACS components, the regional ASP concept and the hospital-based ASP concept. In conclusion, the large scale of the HUS installation enables a cost-effective regional ASP archiving, resulting in a four to five times more economical solution than hospital-based ASP.