Feature
by Leonard A. Levine
Apr 9, 2003
Even today, PACS still competes
with other technology investments for scarce medical IT dollars. Demonstrating
how a PACS can improve technologist productivity can help make the case that
the investment is justified.
PACS is proving itself to be as technologically necessary to an efficient
radiology department as a RIS. Software-only solutions and decreasing memory
costs continue to make PACS more affordable for even the smallest
hospital-based radiology practices. Yet, the decision to purchase a PACS is
often postponed.
One of the most common reasons for delaying the PACS purchase is that many
other projects in the enterprise compete for limited capital funds. The chief
financial officer typically needs to see a return on investment (ROI) that
makes the PACS financially attractive relative to other projects. The CEO and
COO want the project to contribute to fulfilling the mission of the hospital, solve
service-related issues, and increase the productivity of employees and the
competitiveness of the hospital. It is imperative that PACS advocates
communicate its potential benefits to the decision-makers in the most
articulate and quantifiable way possible.
Illustrating the impact of PACS on radiology workflow by modeling productivity
improvements, cost avoidance, new capacity and revenue opportunities is an
effective means of communicating some of the benefits of a PACS. This
article outlines the principals for quantifying PACS-related benefits that can
be achieved through improvements in technologist workflow.
METHODS
Methods for articulating and quantifying the benefits of a PACS may be elicited
from the technologists during the interview process or through more rigorous
observation and measurement. A combination of both methods typically yields the
most information about opportunities for productivity and other improvements
that will accrue from a successful PACS implementation.
Technologists from each modality should be included in the interview and
observation process to define the PACS-related productivity improvements
specific to their modalities and to your institution. Familiarity with business
process reengineering and industrial engineering techniques is helpful for
synthesizing the information into models that are meaningful and convincing to
key decision-makers.
PRODUCTIVITY OPPORTUNITIES
The objective of the productivity analysis is to determine whether
technologists will be able to perform more exams in less time with a PACS. Film
processing, handling, and transport activities may be quantified on a per exam
or per patient basis. For example, if it takes five minutes per exam to process
film, match a prior, and prepare the jacket for the radiologists, then the
number of annual exams multiplied by five minutes will yield the productivity
opportunity, in terms of minutes for that particular modality. Another simple
example is the potential savings of two to five minutes per patient by
eliminating manually entered patient demographic and exam information at the
modality by deploying DICOM Worklist Management.
Each modality within your institution will have unique opportunities for
improving productivity as a result of implementing a PACS. Many smaller
community hospitals, for example, use older teleradiology systems for
after-hours interpretations. Many of these systems transmit exams one image at
a time. Technologists may need to spend 20 minutes or more just to transmit a
full set of CT images.
Another example is the amount of time that can be saved by eliminating the need
to refilm lost images. It may be more reasonable to calculate the total time
saved based on the number of occurrences per week. Overall productivity gains
can be significant. Studies conducted at the Baltimore VA, for example,
documented a 40% increase in technologist productivity for general radiography
in a filmless PACS environment.
CAPACITY OPPORTUNITIES
Additional exam capacity can be calculated by dividing the total technologist
time saved from elimination of film activities by the average patient
turnaround time without film-related activities. The patient turnaround time
without film-related activities is equal to the total current patient turnaround
time minus the time required for the film-related activities.
Caveats and assumptions should be clearly stated for any calculation. A
two-technologist staffing model per resource, for example, will limit the
productivity gains since scanning can continue while one technologist processes
and handles film. Productivity improvements due to reduced film handling and
processing in MRI will be minimized because these activities are usually
performed while patients are being scanned.
REVENUE OPPORTUNITIES
Capacity opportunities can be used to estimate potential increases in revenue.
Additional revenue estimates for each modality are calculated by multiplying
the average collection rates based on payer mix by the increased exam capacity
and average charge per exam. Only revenue for outpatients should be included in
the calculation.
Several assumptions and caveats need to be included with any projected revenue
calculations. If there is a high degree of appointment availability, for
example, it may not be reasonable to predict an increase in volume commensurate
with the productivity opportunities. In short, revenue opportunities are only
valid to the extent that there is unmet demand for radiology services.
COST AVOIDANCE
Capacity gained through improved technologist productivity can be used to
illustrate how much of the future demand for radiology services can be met
using existing human and capital resources. Estimated productivity improvements
should be used to justify cost avoidance in hiring additional technologists who
might otherwise be needed to meet future demand. This point needs to be
emphasized since the first reaction of many senior administrators is to view
the potential gains as a reason to reduce labor.
The results can be modeled in terms of total salary and benefits avoided or in
terms of labor cost per exam. If the latter, then the projected labor cost per
exam should be compared with what the cost would have been had a PACS not been
purchased. Further, if current equipment is near 100% utilization and estimates
for future demand for radiology services are high, arguments can be crafted to
illustrate that fewer pieces of equipment may be needed in the future to meet
the projected demand.
SUMMARY
Institutions that rely heavily on agency technologists can make a stronger
argument for reducing or avoiding future personnel costs by improving the
productivity of technologists. Institutions that use non-technical personnel
such as film librarians for many of the film handling tasks will have less
opportunity for improving technologist’s productivity through a PACS
implementation. The decision whether to include quantified benefits from
increased technologist productivity in the PACS ROI will depend on how well the
arguments are modeled and articulated to the key decision-makers.
Mr. Levine is senior business systems consultant for The Radiology Consulting
Group and senior project manager in informatics in the radiology department at
Massachusetts General Hospital. He can be reached by e-mail at llevine@partners.org.
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