Enterprising Imaging Strategy: What Are You Really Getting in Return?

C-suite executives: Do you know what your current imaging infrastructure is costing you, and do you have a sense of the return on investment you stand to gain from an investment in enterprise imaging? How will you stay competitive in an era of changing reimbursement, and how do these questions factor into your current enterprise imaging strategy?

If a hospital expects to thrive in the healthcare marketplace of the future, they have to put a premium on IT investment, and the issue of image archives/data storage is increasingly going from "nice-to-have" to a "must-have." While putting fully operational electronic health records in place remains the top priority for hospital IT leaders, industry experts such as the Advisory Board Company, as part of its imaging performance partnership program, are telling all their hospital members to invest in PACS Enterprise Archives, and adopt a corresponding strategy for management of these systems. The reason is that providers are bringing in more studies, which are then growing in size once they are stored. Furthermore, images are going to need be managed as well as stored, and the current system is becoming more and more unwieldy. Just the cost of servers to house all these data can easily balloon to an unsustainable level.

Steven Tollemost successful health systems don't manage in silos. Instead, they have an enterprise imaging strategy with a singular focus: to provide electronic access to any medical image, anywhere, anytime. This applies to all silos within hospitals and works to eradicate that style of thinking and management. Images make up a critical part of the diagnosis process. Yet even today, the most common way they're exchanged among providers and referring physicians is by copying the image onto a CD and giving it to the patient to take to the next appointment at a specialist's practice or a hospital. This process is simply inefficient. It lends itself too much to human error and the risk of the CD being unreadable on the facility's PACS. Additionally, right now many hospitals have different PACS for each image-rich service line (e.g., one for cardiology, one for orthopedics and so on).  

Realizing hard cost savings from an enterprise imaging strategy

The ROI for transitioning to an enterprise imaging system can definitely add up. For example, large medical centers can save as much as $2 million per hospital in hard costs alone, just from switching from CD purchasing and storage management to digital archives. On average, hospitals are currently spending between $8 and $15 per CD. In some cases, health systems spend as much as $100,000 per year in courier costs alone just to transport CDs from hospital to hospital.

Switching to archives also creates greater staffing efficiencies, through improved flexibility in how hospitals staff their services. Hospital IT departments often need to maintain a separate system and staff for each PACS systems in different clinical departments, whether it's cardiology, radiology or orthopedics. If only one overarching system is involved, which is serviced by one vendor, those separate staffs can be diverted to other internal needs.  Furthermore, a significant number of CDs cannot be uploaded and read without additional involvement from IT specialists. With vendor neutral archives, costs in that area can be reduced and resources could be diverted to more value-added IT projects. Finally, hospitals can save money on the number of contracts needed for maintenance and archiving.

For those who already have multiple PACS in place, an enterprise archive is important because it frees administrators from the costs of migrating different PACS systems and building multiple interfaces to each PACS system to enable viewing of images for referring physicians.  

Where to begin with an enterprise imaging strategy: Start with the foundation

Hospital CIOs may think that an enterprise imaging strategy may involve reinventing the wheel, and some institutions have done just that. Some have built entire electronic medical record software systems that integrate clinical and research information from different back-end hospital IT systems into a single unified interface. They employ hundreds of IT developers, working for more than a year, to create a complete EMR architecture. Although efficiencies can eventually be achieved, the price tag for implementation can be pretty steep.

So what about health systems that aren't looking to completely transform their entire enterprise? Quite frankly, there's no real pressing need to do so. If a hospital's cardiology department is happy with its corresponding PACS system, then there's truly no reason to replace it. That said, a bedrock archive that can store images from all existing PACS systems is a huge step toward a complete enterprise imaging system. Purchasers unsure of where to begin should start with that bedrock, and also include disaster archiving and the ability to save as many as ten years of images.  

After a hospital has that bedrock archive in place, they're all set for image access and sharing technology, which will allow providers and specialists to share and look at images without using any CDs. The images can be seen on a "zero footprint" universal PACS viewer, which can be accessed either directly or via an embedded link inside the EHR that enables viewing of images on any browser-based electronic device, such as an iPad, iPhone or Droid, to name but a few. Having an archive that anyone can get to from anywhere, on any device, is going to be a huge help and will save a lot of money in the process. Furthermore, the cost of having to upgrade a health community's computers (which currently number in the hundreds) is also going to be deferred. A physician will simply be able to talk to a colleague about a patient and also see the corresponding image through the universal viewer on his/her desktop or mobile device.

However, if a CIO or CFO is looking to completely revamp a hospital's enterprise imaging strategy, or just beginning to implement such a strategy (and most providers fall into this latter group), then he or she should treat this purchase in the same manner other enterprise purchasing efforts in the hospital, with one contract for all systems. If buyers just have one contract in place, it gives them the leverage that they may not think about today. When the time for a hardware refresh comes up, the cost of switching is more manageable. Finally, an enterprise archive — coupled with departmental PACS systems — on one contract from one vendor, frees the hospital from the cost of various PACS systems migration. Also, look for a vendor that can actually do everything and has the ability and bandwidth to work with different groups and differing administrators.

A more manageable alternative for an enterprise imaging strategy may be that of Dignity Health, headquartered in San Francisco. Dignity Health is the fifth largest health system in the nation with 10,000 physicians and 55,000 employees across Arizona, California and Nevada. Dignity implemented a long-term VNA, which provides a central location for all DICOM images. This has translated to 3.25 million studies alone in 2012, and a combined 1.5 petabytes of information on the primary and secondary archive. Dignity also implemented image sharing software on the primary VNA, and integrated with its health information exchange. Further options are being considered for next year, but this change alone will for now bring about significant ROI in hard costs and in efficiencies.

The argument for a vendor neutral archive

A VNA goes beyond the traditional process of archiving in PACS to create a centralized, standardized, consolidated system that holds and manages the lifecycle of all images from each individual silo across multiple PACS, sites and specialties. This system morphs all DICOM headers into a standard format so that any of the DICOM viewers within the healthcare network can display the images, regardless of which PACS originally held the image. Consequently, the images are much more accessible to the healthcare network's physician community at large.

Although VNA is called an archive, it is so much more than image storage because the system keeps track of all types of diagnostic images for all patients — not just DICOM radiology images. For example, a physician can quickly access all patient images from cardiology, neurology, orthopedics and other medical departments in a single system, at one time. This patient-centric approach saves time for the physician, supports the faster delivery of care for the patient and guards against duplicate imaging.

A VNA also manages the lifecycle of images, making it easier and more cost efficient to comply with regulations regarding patient information archiving. These include the security policies issued through HIPAA in 2005, which require a disaster backup and recovery plan for all stores of patient data. CIOs can implement policy-based-deletion protocols, which help comply with regulations, but also allow the hospital to avoid holding onto an image longer than necessary.   

The benefits of a state-of-the-art enterprise imaging system are clear: A comprehensive image exchange reduces administrative workload and enables faster treatment. Images can be easily archived, available on-demand and accessible at the point of care, eliminating frustrations like waiting for images and unreadable CDs. Real-time access to any image on any web-enabled device enables faster and broader health information exchange. And access to a complete history of images decreases the need for both duplicate imaging and needless exposure to radiation. This new vision goes beyond PACS to make image sharing truly interoperable and accessible in real time on any approved browser-based electronic device — without having to load and support additional software and without complicated and unnecessary movement of data.

Such a transformation to an enterprise imaging strategy will bring about exciting and substantial returns on investment in hard costs for hospitals in a short amount of time, as well as significant competitive advantages and ability to attract top staff. It's an exciting time to be in the healthcare IT field, and in this era of reform we will see more advancements and greater efficiencies in the way we deliver care to patients.

As the senior vice president of solutions management, Steven Tolle leads product strategy and go-to-market business planning for Merge Healthcare. He brings over 20 years of unique healthcare industry experience working in start-up or high-growth organizations in multiple healthcare sectors including healthcare technology and information exchange, pharmaceuticals, managed care, behavioral healthcare, academic medicine, preferred provider organizations and disease management organizations. Prior to joining Merge, Mr. Tolle served as senior vice president/general manager at OptumInsight, where he led the physician community business unit.

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