As PACS solutions are adopted in all sectors of healthcare-from freestanding imaging clinics to large, integrated delivery networks-clinicians, IT personnel, and administrators are looking beyond the standard, long-range return-on-investment (ROI) measures for more immediate indicators to validate investment decisions.

A myriad of reasons exist for transitioning from an analog to less film or even a “filmless” environment, including improved operational workflow, patient care, physician satisfaction, and the economic benefits that come from these as well as from the elimination of more archaic methods, supplies, and infrastructure. Yet, given its weighty price tag, the more quickly and concretely you can define ROI and “success,” the better acceptance and adoption the technology will have.

Measuring ROI in the traditional sense can take 12?18 months. For a busy specialty clinic, and many small to medium-sized hospitals, today’s decision-makers are looking for evidence of whether a financial gain and a quality-of-care ROI can be achieved-and they want it almost immediately.

Instant ROI with PACS? Is that possible? The answer must be “yes” when you consider what is at stake when a healthcare facility goes live. For the radiologists and technologists who depend on film from an analog system on one day and a new PACS installation the next, success is measured on the first day. It has to work. System downtime and compromise to the integrity of the studies themselves is not acceptable. Of course, “real” ROI measurements follow with hundreds of objective and subjective evaluations that are made against predetermined benchmarks in the weeks and months after the installation. But the lasting impression will always rest on how well the first day goes.

Stages of Planning

It is important to note that success, whether short- or long-term, cannot be achieved without first undertaking a solid, solutions-based PACS planning process leading up to the purchase, decision, and rollout.

Success comes when “stages of planning” begin with a clean sheet of paper for initial concept gathering, followed by accounting for all of the stages of PACS solutions-based planning, leading up to the go-live date. Typically, solutions-based PACS planning includes the following stages:

  • a clear understanding and definition of how PACS will add value to the organization’s values and mission;
  • a detailed PACS solution strategy that is tied to specific objectives;
  • input and collaboration from across the facility, including IT, radiologists, technologists, referring physicians, and ancillary clinicians (eg, surgeons);
  • short- and long-range needs assessments, which often evolve through the process of PACS planning;
  • evaluating and selecting a PACS vendor partner based on criteria that meet specific needs;
  • PACS modeling based on multiple scenarios;
  • developing and testing the new system selected;
  • prelaunch end-user technical training;
  • a seamless installation game plan; and
  • contingency planning in the event that things do not go smoothly on the first day.

Although every installation is different, based on variables unique to each facility, these milestones are the most important in planning for PACS. In most circumstances, a more detailed plan accounting for virtually every key decision that will be made over a 6- to 9-month period is highly recommended. And, as with most high-stakes investments in new technology, the amount of time and effort invested in planning for PACS almost always translates into a smoother installation and success in meeting long-range objectives.

“Engineering” Success

McHenry County Orthopaedics (MCO of Crystal Lake, Ill) is representative of a healthcare facility that planned its PACS needs in this fashion-factoring in immediate workflow needs while also keeping an eye on future needs.

MCO’s physicians embraced the notion that with advance solutions-based PACS planning, the facility could almost “engineer” success. But to understand and appreciate how MCO could arrive at this level of comfort when moving from an analog radiology department to PACS, one must look at the success of this specialty clinic, which is recognized for being on the forefront of orthopedic medicine.

McHenry County Orthopaedics installed a PACS in its 35,000-sq-ft facility and was able to realize benefits right away.
McHenry County Orthopaedics installed a PACS in its 35,000-sq-ft facility and was able to realize benefits right away.

The organization’s marketing theme-“Keeping Bodies in Motion”-is the first hint of what drives MCO to success. Established in 1994 with a commitment to improving the mobility, health, and human spirit of every patient, MCO has emerged as one of the Midwest’s leading orthopedic specialty clinics-and in less than 10 years. During this time, MCO outgrew its facilities and especially started to feel “growing pains” when a fifth surgeon was added to the practice.

MCO now has six highly specialized surgeons, all fellowship trained, with extensive training in various areas of orthopedics, including general orthopedics, sports medicine, arthroscopic surgery, hip and knee replacement surgery, pediatric orthopedics, occupational injuries, hand and microvascular surgery, and foot and ankle surgery.

In 2001, MCO built a new 35,000-sq-ft facility. In 2003, that facility began to implement a PACS with the goal of improving the time between diagnosis and treatment as well as achieving several practice-wide cost-saving goals and efficiencies. MCO physicians were looking for a solution that would give them the ability to view digital X-rays and MRI scans instantly, improve staff efficiency, offer enhanced viewing capabilities, and provide infinite storage of patient images.

After a competitive proposal and selection process, MCO chose SourceOne Healthcare Technologies (Mentor, Ohio) to serve as a consultant to evaluate and determine the PACS solution that would meet the facility’s needs. In addition to serving MCO in a consultative role, SourceOne served as the distributor of the PACS solution for MCO and continues as its long-term service provider in supporting MCO’s ongoing digital imaging and PACS needs.

The initial installation included a DR ceiling tube mount system from Del Medical Systems Group (Franklin Park, Ill) with a high-frequency generator coupled with a PACS from StorComm Inc (Jacksonville, Fla). And recently, MCO purchased additional high-performance Barco monitors and workstations from SourceOne, which recently entered an agreement whereby SourceOne serves as the sales and distribution provider for Barco (Duluth, Ga).

Planning for the Future

A radiographer at MCO uses the DR ceiling tube mount system from Del Medical to image a patient's ankle.
A radiographer at MCO uses the DR ceiling tube mount system from Del Medical to image a patient’s ankle.

“We took a long view toward achieving these goals,” explains Manette DeCremer, MCO’s PACS administrator. “When we began to plan for the integration of PACS into our practice, we selected a vendor and supplier who demonstrated an understanding of our mission and values and had the capabilities to guide us to a solution that met our unique and immediate needs. We also were looking for a forward-thinking advisor who understood our long-range plans and could offer us a platform for future growth. Once we made this decision, we collaborated on every key decision and established models to measure ROI.

“ROI by the numbers was, and continues to be, important to MCO; however, we were equally concerned about what I call the ?happy factor’ among those who would be using PACS, including the radiographers and our physicians,” DeCremer continues. “We absolutely needed this [implementation] to be viewed as a complete success in the eyes of each of our employees. With six physicians, one new to our practice and one a self-proclaimed ?techno-phobe,’ I was somewhat concerned about whether we could meet the short-term objective of integrating PACS with minimal stress, frustration, and down-time. To assuage my concerns, we emphasized training for everyone prior to the go-live date, and it paid off. In fact, some of the staff members that were initially skeptical have become the biggest champions of PACS.”

MCO’s success story doesn’t end with achieving the so-called “happy factor.” The facility has gone “filmless,” achieving a 98% reduction in film cost. The productivity of MCO’s radiographers has improved by 50% since implementing PACS. For example, the time previously spent pulling flash cards, typing, searching for film, and reshooting images has been eliminated, as using a PACS dramatically decreases many of the administrative duties typical of an analog environment.

Staffing has changed with the PACS implementation. MCO was able to eliminate one half-time radiographer and add a physician to the practice. Also, DeCremer says that before PACS, MCO had a 1:1 radiographer-to-physician ratio; now the ratio is 1:3.

Other benefits realized since implementing PACS include improved patient flow and increased revenue. The overall combination of productivity and cost savings has given physicians additional time to consult with patients and improve patient care.

“We used to have constant bottlenecks,” DeCremer says. “Now, our physicians often have patient images available when they walk into the examination room for the consultation. Everyone on staff comments about the added efficiencies with PACS and the ease of use with a whole new menu of clinical tools at their fingertips. Most importantly, we haven’t had a bottleneck since our PACS installation.”

This PACS installation exemplifies doing all the right things to successfully integrate digital technology into an analog environment using solutions-based, short- and long-range planning to achieve short- and long-term objectives that often range from processing more patients each day, shorter patient wait times, and, ultimately, improved care and greater profitability for MCO.

With these almost-immediate gains, one can almost predict with engineered precision where MCO is headed. Aside from striving to achieve its PACS-related objectives, the obvious future for MCO digitally will center on fine-tuning how well they use information technology -and layering on additional clinical technology as needed-to achieve improved patient outcomes. The next phase to be added to MCO’s evolving radiology department includes upgraded workstations and monitors. Given the initial success that the organization has achieved with PACS, MCO is well-positioned to achieve its future objectives.

Jerry C. Cirino is president and CEO of SourceOne Healthcare Technologies.