Next-generation PACS appliance helps reduce the impact of the DRA.

The Deficit Reduction Act (DRA) of 2005 and its resulting cuts in radiology service reimbursements have cast a long shadow not only on the exciting technological advancements in medical imaging, but also on the financial viability of many imaging practices. Amid all the fallout, however, a number of savvy imaging practices are able to thrive by taking full advantage of next-generation technology offering significant cost savings that can eventually translate into new revenue-generating opportunities.

In the face of current DRA challenges, today’s imaging practices must demonstrate a willingness to seek and invest in new technologies—such as the new class of PACS appliances—to improve productivity and efficiency and streamline operations. In addition to cost-cutting, the financial impact of the DRA demands that imaging practices invest in new modalities to expand their existing service lines to generate incremental revenue.

Jacinto Medical Center, Baytown, Tex, faced the challenge of managing its ever-increasing volume of digital medical images and health care data that many other imaging centers share. Offering comprehensive radiology/fluoroscopy services, including open MRI, CT, ultrasound, nuclear medicine for Cardiolite studies (screening for blockage in heart arteries), and ECG stress procedures, Jacinto operates a busy and demanding imaging practice that required a reliable, feature-rich, and, most important, cost-effective digital image management solution.

To meet the latest challenges brought on by the DRA, the practice adopted the latest next-generation picture archiving and communications system (PACS) technology, most notably the Candelis ImageGrid PACS appliance, which has proven to be instrumental to its success at a time when most imaging practices are operating at historically low margins with reimbursement cuts affecting almost every facet of the business.

Digital Image Management Challenges

For years, Jacinto searched for a reliable, feature-rich, cost-effective PACS solution. The prohibitively high up-front and operational costs of many solutions meant that the practice would have to sacrifice, or at least reconsider, future plans for investing in new imaging modalities that could expand current service offerings. The practice also considered adopting an off-site image archive service; however, recurring monthly costs and the lack of immediate access to priors quickly eliminated this option.

Jacinto Medical Group initially attempted to manage its growing volume of digital data with a CD-based digital image archival and retrieval system. The digital image archive, which consisted of an extensive library of CDs—approximately 100 CDs used per month, and 1,200 CDs archived per year—required significant manual intervention for proper maintenance and updating. This option also lacked the scalability required for the practice to keep pace with its rapid growth and expansion plans. In addition, Jacinto’s need to replicate all medical images and studies for remote storage, as required by the Health Insurance Portability and Accountability Act (HIPAA), became a highly labor-intensive process resulting in significant additional costs.

In practice, Jacinto radiologists required faster access to studies and priors than what some of the PACS solutions could provide. The technologists were dedicating more and more time to retrieving prior studies from the CD-ROMs or burning new studies on CDs or DVDs to provide to the network of referring physicians. It became increasingly challenging for the practice to find the time to replicate the images, and dedicate the on-site storage space required for its CD library. With the ultimate goal of adding new modalities and expanding the practice, it realized that it wasn’t as efficient as it needed to be, and also needed assistance with improving communication with its physician partners.

It was clear that Jacinto required a unique PACS solution that would streamline its operating efficiency, reduce image archive and management costs, and improve communication in the face of DRA-mandated cuts in reimbursements.

Next-generation PACS Appliance

An alternative to conventional PACS, a PACS appliance consists of a suite of sophisticated software capabilities closely integrated with state-of-the-art hardware. An appliance operating system, optimized internal data path, embedded database, and extensive DICOM services, integrated with industry-standard CPU and RAID, comprise the major elements of the system. Using Serial ATA disks in the main chassis and expansion units, a PACS appliance’s storage capacity can be configured from 1 terabyte to tens of terabytes.

Many of the most popular features of more expensive PACS can be found in a PACS appliance. However, because it is designed as a fully integrated solution on a single storage server hardware platform, a PACS appliance is significantly easier to install and administer than PACS. In comparison, from a hardware perspective, a traditional PACS solution consists of multiple general purpose servers that have been integrated with a storage system. In addition, a PACS appliance’s optimized architecture accelerates image access and simplifies operation and management, while protecting patient images in a highly reliable, HIPAA-compliant storage and archival environment.

When fully implemented, a PACS appliance simplifies usage, communication, and management of digital medical images by making the underlying image management and archiving infrastructure transparent to the user. By adhering to established and widely adopted DICOM standards and not generating proprietary DICOM tags, the PACS appliance ensures DICOM inoperability across any modality and streamlines the archiving, management, and automated rule-based routing of digital images over a network without significant administration.

Adapting for the DRA

After carefully considering several options and realizing that a conventional PACS implementation would be priced prohibitively high to meet current financial requirements, Jacinto deployed the Candelis ImageGrid PACS appliance and realized instantaneous benefits. Its appliance architecture meant that a six-terabyte system could be installed in just 4 hours with no interruptions to daily operations. The PACS appliance system can also be easily expanded to the tens of terabytes to accommodate the practice’s anticipated future growth.

Today, all five imaging modalities at Jacinto send images directly to the new PACS appliance system for immediate viewing by radiologists. As a DICOM-compliant storage server, the PACS appliance is compatible with any DICOM viewing software, including the practice’s existing GE Centricity workstation. As a bonus, the practice has not been burdened with traditional costs related to connecting new modalities or workstations.

The PACS appliance also provides a Web-based DICOM viewer and advanced teleradiology capabilities that enabled the practice to keep pace with referring physicians’ demand for immediate viewing of patient studies and reports. The addition of an Information Lifecycle Management (ILM) software module helped Jacinto comply with HIPAA requirements by allowing for automated backup of imaging studies and data to an integrated tape library.

By providing DICOM encapsulation, the PACS appliance is also able to attach non-DICOM files to studies. These files can be in any type of format, such as PDF, TIFF, JPEG, Microsoft Word, Excel, or PowerPoint. This feature allows the practice to further reduce costs by digitally storing the entire patient file with imaging studies in an entirely paperless operation.

Additional features, such as the Order Entry module, allow the Jacinto front office to capture patient demographic information as well as specific study details. This data is used to generate a Modality Worklist that eliminates the time-consuming task of inputting data at the acquisition workstation by the modality technologists.

The Results: Lower Costs and New Revenue Opportunities

With its PACS appliance implementation, Jacinto Medical Group has been able to improve productivity among its radiologists by offering them immediate and always-online access to its entire image library, as well as the routing of images to off-site users and its network of referring physicians.

The new system’s compatibility with all existing DICOM-standard modalities has lowered the practice’s overall image management costs by eliminating the labor-intensive CD-based system. Equally important, errors resulting from the manual handling of CD-based images have been all but eliminated. Based on current usage patterns, the new PACS appliance system is expected to provide Jacinto with at least 3 full years of disk-based archiving.

By implementing a fully integrated, single PACS appliance, rather than a traditional PACS with numerous components, Jacinto also has been able to save on costs associated with the investment in multiple hardware components. The PACS appliance with its RAID 5 archive is offered on a single 2U rack-mountable system, which is in contrast to conventional PACS requiring complex integration of multiple hardware, software solutions and costly IT administration.

Surprising to the practice, the new PACS appliance at the Jacinto didn’t result in additional IT overhead costs, which one typically expects with implementing a PACS. The system’s proactive self-monitoring capability and fans, power supplies, and other redundant key components provide excellent availability with little administrative interaction.

With a faster and more efficient PACS solution for accessing and retrieving studies, and a system for delivering reports to referring physicians, Jacinto estimates savings of $3,000 to $4,000 each month related to managing the volume of studies on CDs alone. It also has an optimized utilization rate of the imaging modalities, which resulted in more patients scheduled for service each day. This is key to generating the incremental revenue needed to counteract the reduction in radiology service reimbursement caused by the DRA.

Based on the success of the PACS appliance in reducing costs and increasing productivity, Jacinto Medical Center is currently considering the addition of an advanced PET/CT scanner, as well as ImageGrid’s RIS module to streamline operations and accelerate our revenue cycles, which will help the practice expand its service offerings, benefit its patient community, and further secure its financial future.

Siraj Jiwani is CEO of Jacinto Medical Group, Baytown, Tex. For more information, contact .