Exactly
what is innovation and how is it defined in health imaging and
information technology? Is it related to the size of a facility's
digital storage system or the number of digital modalities it has
installed? Or perhaps it is more important to examine how a facility
uses imaging technology to increase revenue and improve physician
productivity and workflow.
There's also the question of return on investment (ROI). Can an imaging
facility with a lot of technical bells and whistles be considered
innovative, if it hasn't met - or doesn't have - ROI goals?
Our editorial team struggled with these questions as we planned this
month's cover story about the preeminent facilities in health imaging
and healthcare IT. Ultimately, we realized that innovation is best
measured by evaluating a combination of objective and subjective data.
We created a survey to collect quantitative data that could be easily
scored and weighted, and sent it to a database of more than 10,000
healthcare contacts, including radiologists, cardiologists, PACS
administrators, CIOs, technologists, vendors and industry consultants.
Although we received responses from all over the world, we decided to
limit the results to U.S. healthcare facilities to maintain simplicity
and eliminate geographical variances.
In the first phase of the selection process, we used the returned
surveys as screening tools and created a list of some 20 applicants
with whom we conducted in-depth phone interviews. From this information
we gathered qualitative data on how each facility implements, manages
and innovates digital images. After the interviews were completed, we
reviewed all the responses and began the selection process.
Although our original intent was to select the Top 10 facilities, we
found it difficult to evaluate hospitals and specialty facilities
together. We exercised our editorial prerogative and expanded the
selection to include the Top 10 Hospitals and the Top 5 Specialty
Providers that best exemplify the spirit of innovation in digital
imaging.
Some readers may expect our list of the top facilities to include
primarily large teaching and university institutions that have access
to ample funding that often allows them to research and design
state-of-the-art health imaging systems. But smaller organizations must
develop creative business models and ways of innovation with much less
money.
So, here it is - the first annual Health Imaging & IT Top 10 Hospitals and Top 5 Specialty Providers. Because of the
diversity of the finalists, we didn't rank them numerically. You'll
find them listed in alphabetical order. More detailed information on
each facility is available on pages 15-27.
TOP 10 HOSPITALS Baltimore VA Medical Center Baltimore, Maryland
Baltimore VA Medical Center (BVAMC) installed the nation's first
enterprise-wide PACS in 1993. BVAMC's clinical PACS is GE Pathspeed,
and it plans to upgrade to GE Medical Systems Information Technologies'
Centricity this fall. The PACS is integrated with VISTA (Veterans
Health Information Systems & Technology Architecture), the VA's
system-wide HIS that has its own imaging capability for radiology and
other subspecialties.
BVAMC has been particularly diligent in studying and measuring ROI and
departmental productivity since making the digital transition. Research
studies compared projected film-based costs to actual digital costs and
found that the cost per study decreased by 25 percent. The result?
BVAMC's original PACS paid for itself after four years.
Since installing its PACS, BVAMC's overall departmental productivity
has increased by nearly 50 percent. Research using national data from
American Healthcare Radiology Administrators shows that before the
digital transition, BVAMC productivity was a little less than national
norms. Comparing the same data after the transition shows that BVAMC
productivity increased to well above the national averages.
RIS: Vista PACS: GE Centricity CR: Fujifilm AC-3/Smart CR STORAGE: EMC Clarion & EMC Centera SERVER: Vista HIS: Vista OTHER: Agfa TalkTechnology
Commonwealth Health Corporation Bowling Green, Kentucky
With three hospitals serving south central Kentucky, Commonwealth
Health Corp.'s (CHC) quest for filmless imaging grew out of the dual
need to improve patient care and increase referring physician
satisfaction. CHC's digital imaging system centers on a Synapse PACS
from Fujifilm Medical Systems USA, Inc. with EMC Corp. SAN storage
integrated with a Meditech RIS.
Since their new imaging system went online in March, CHC's patients
have benefited from more technician attention as they go through the
exam process and faster exam results. And the number of referring
physicians who want access to CHC's web-based PACS keeps growing -
which gives CHC a competitive edge over the area's other local
hospital, according to Senior Vice President and CIO Matt Ebaugh. CHC
also has seen an increase in patient throughput and an 85 percent
reduction in costs.
Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire
The first clinical x-ray in the United States took place at Dartmouth
College more than 100 years ago. Today, Dartmouth-Hitchcock Medical
Center (DHMC) performs more than 175,000 radiological exams annually.
DHMC's RIS/PACS is vnetix from IDX Systems Corp. In choosing a RIS/PACS
solution, an important factor was the ability of the vendor to
effectively utilize the hospital's existing 10MB backbone instead of
rewiring the entire hospital. Because IDX sold vnetix to DHMC on an ASP
(application server provider) model, DHMC pays per exam which allows it
to cover expenses for its imaging system out of its operating budget
instead of its capital budget.
"We have a huge draw on capital dollars already," says Monte Clinton,
director of radiology. "The chance of us getting an extra $10 million
for a PACS was pretty remote."
"When we converted, our radiologists came in the next day and started
to read," Clinton continues. "Work that would have taken a full morning
took two hours. It's been an overwhelming success. Even the skeptics
are happy."
With two nursing centers, more than 100 outpatient facilities, and
2,000 beds at seven hospitals, the Detroit Medical Center (DMC) is the
largest healthcare provider in southeastern Michigan. DMC performs more
than 600,000 digital exams annually, managing them with Cerner's RadNet
RIS and ProVision PACS.
Over the last several years, DMC has significantly enhanced its patient
care and clinical operations by deploying technology-based clinical
solutions. The tightly integrated RIS/PACS is only a single part of the
unified Cerner HNA Millennium solution, which provides physicians with
the ability to review patients' charts, order tests and medications and
evaluate results online.
According to Don Ragan, Ph.D., CIO, DMC still has a lot of
implementation and expansion before ROI can truly be measured. Ragan
contends that PACS is no longer just about ROI - it's simply the way
that radiology must be practiced in today's environment of multi-image
modalities.
Massachusetts General Hospital Boston, Massachusetts
Massachusetts General Hospital (MGH) is the third-oldest general
hospital in the United States and the largest teaching hospital of
Harvard Medical School. In 1994, MGH joined forces with other area
medical centers to form Partners HealthCare System Inc.
An early adopter of PACS, MGH recognized and accepted the risks in
pioneering digital imaging, according to Alan Schweitzer, senior
project manager for MGH's radiology department and CTO of the Radiology
Consulting Group, a management consulting firm.
"The risk was worth it from a variety of perspectives," he says. "There
are benefits that were unseen at the time." MGH is currently breaking
new ground in using data collected by its technology systems to develop
business plans and drive operational change.
MGH uses an Agfa Impax PACS with IDXRad RIS. Agfa TalkTechnology
Talkstations, used for speech recognition, have significantly reduced
the amount of time spent transcribing exam reports. An early proponent
of web-based teleradiology, MGH uses Amicas web distribution software
to enable referring physicians and satellite clinics to access the
imaging system from any Internet-enabled PC.
Comprised of 11 hospitals and more than 200 ambulatory and diagnostic
sites, ProMedica Health System serves 23 counties in northwest Ohio and
southeast Michigan. The ProMedica PACS project encompasses five
hospitals and two imaging centers that share a Philips Medical Systems
PACS, Cerner QuadRIS, and StorageTek Powderhorn archive.
Bay Park Community Hospital, which opened in 2001, was the first
ProMedica facility to support a PACS. The Toledo Hospital, ProMedica's
tertiary care hospital and home to the Toledo Children's Hospital,
houses the StorageTek archive. In 2002, it installed the Philips PACS
as a way to provide soft copy reads for its DR rooms and CT scans. By
2003, the system had expanded to include the entire radiology and
imaging department.
Other facilities that are now linked to ProMedica's digital imaging
network include Flower Hospital, Sunforest Imaging Center, and
Perrysburg Imaging Center. Future plans include adding CR to the
remaining nine imaging sites and connecting the other five ProMedica
hospitals to the network.
Providence Health System / St. Joseph Medical Center & Holy Cross Medical Center
Burbank and Mission Hills, California
When planners at St. Joseph Medical Center and Holy Cross Medical
Center in southern California began contemplating a digital imaging
solution, one of their primary criteria in selecting a vendor was the
ability to provide an enterprise-wide versus a departmental solution.
Other key criteria were the ability to prove positive ROI within a year
and the ease of use of the web-based interface.
Providence Health Systems ultimately selected Stentor's iSite
Enterprise product, and the two medical centers went from analog to
digital in four months. Since the system went live in March, film usage
has decreased by approximately 90 percent and the hospitals have
benefited from the cost reductions that accompanied the decrease in
film processing.
In addition, the workflow of the entire radiology department has
changed, according to PACS Administrator Daren Burns. In fact, the
physician that protested the most about switching from film to digital
approached Burns after the transition and congratulated him on its
success.
RIS: Cerner MARS PACS: Stentor CR: Kodak CR 800/900 STORAGE: Stentor RAID SERVER: IBM Netservers HIS: Eclipsys
Sarasota Memorial Hospital Sarasota, Florida
At 845 beds, Sarasota Memorial Hospital is Florida's second-largest
public hospital. SMH's radiology facilities include a full-service
radiology department at the main hospital campus and five outpatient
centers throughout Sarasota.
To connect the six facilities and provide its radiologists and
clinicians with web-based access to digital images, Sarasota Memorial
uses a digital imaging system based on Siemens MagicView PACS, Kodak CR
and IDX Systems' RIS. Currently, Sarasota Memorial provides its
referring physicians with CDs but is in the process of converting to
Siemens MagicWeb, which will allow password-protected access to images
maintained on the PACS from any Internet connection.
Sarasota Memorial has been digital since 1995. The benefits seen by the
hospital since implementing digital imaging include a reduction in film
costs, a drastic decrease in the length of time it takes to obtain exam
results, and better system redundancy.
RIS: IDX Rad PACS: Siemens MagicView CR: Kodak CR 800/900 STORAGE: StorageTek SERVER: Sun HIS: Eclipsys
UCLA Medical Center Los Angeles, California
UCLA Medical Center is the primary teaching hospital for the David
Geffen School of Medicine at UCLA. Its facilities include Santa Monica
- UCLA Medical Center, Mattel Children's Hospital at UCLA and the UCLA
Neuropsychiatric Hospital.
Another early PACS adopter, UCLA is a highly regarded radiology
informatics research site. UCLA has gone through several generations of
PACS and is in the process of upgrading to GE Centricity PACS. Its RIS
is from IDX Systems. UCLA Medical Center has adopted the ASP model for
warehousing and storing its imaging data, outsourcing its data storage
to GE Medical Systems Information Technologies. Current projects
include integrating the PACS, RIS and HIS and developing an integrated
electronic patient medical record with advanced capabilities.
UCLA's digital infrastructure has decreased operating costs while
increasing the efficiency of staff physicians, particularly
subspecialty radiologists. "What is important to us is the power of
efficiency inside the hospital," says Osman Ratib, M.D., Ph.D.,
professor and vice chair of information systems at UCLA's radiology
department. "Replacing the traditional film and paper trails has great
value."
RIS: IDX Systems PACS: GE Medical CR: Fujifilm SERVER: Dell/HP/Sun/IBM/Compaq HIS: Internally developed OTHER: CT: Siemens Somatom
University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
As the largest healthcare system in western Pennsylvania, the
University of Pittsburgh Medical Center (UPMC) performs more than one
million radiographic studies per year at 20 affiliated locations.
Unsatisfied with UPMC's initial PACS effort, Paul Chang, M.D., director
of radiology informatics, invented a new technology called dynamic
transfer syntax (DTS) that allows the user to see only the amount of
imaging information needed at a given time. DTS significantly reduces
necessary computing power as well as the cost of the workstation needed
to view an image, which allows workstations across the enterprise to
have the same functionality and image quality.
DTS was so successful that UPMC patented the technology, and with the
support of UPMC venture capital, created a company called Stentor Inc.
to develop a commercial product. UPMC licensed DTS technology to
Stentor and continues to serve as Stentor's research and development
lab.
UPMC's digital imaging system, based on Stentor iSite running on IBM
servers and storage. Since 2000, UPMC has accumulated more than $14
million in savings, completely paying for its PACS investment.
RIS: IDXRad PACS: Stentor CR: Fujifilm/Agfa STORAGE: Stentor SERVER: IBM eServers HIS: Cerner OTHER: DR: GE Medical
HONORABLE MENTIONS Thibodaux Regional Medical Center Thibodaux, Louisiana
Thibodaux Regional Medical Center made the switch from film-based to
digital imaging in September 2002. With less than 150 acute-care
staffed beds, Thibodaux Regional is a perfect candidate for NovaPACS,
which specializes in providing affordable digital imaging for small-
and medium-sized hospitals.
Since the PACS has been operational, Thibodaux Regional's radiologists
and physicians report significant productivity increases. In addition
to providing faster diagnostics, recent studies show that the monthly
fee for the NovaPACS is less than half of the facility's monthly budget
for film and processing costs.
With three hospitals and three outpatient sites, Frankford Hospitals
serve patients throughout northeast Philadelphia and Bucks County. In
1996, Frankford's radiology department began transitioning to digital
with the goal of increasing efficiency and achieving a better workload
balance between its six sites.
TOP 5 SPECIALTY FACILITIES Austin Radiological Association Austin, Texas
With 14 outpatient imaging centers in central Texas, Austin
Radiological Association (ARA) performs more than 320,000 exams per
year. Using a Fujifilm Synapse PACS with the IDXRad RIS, ARA also
provides radiology services to 10 area hospitals.
Because ARA wanted a consistent interface for staff and referring
physicians, they selected a web-based RIS, which drove the PACS
decision. For storage, ARA chose EMC's Symmetrix platform for
short-term storage and its Centera product for long-term archiving.
Traveling between 14 centers to read cases was a nightmare for ARA's
subspecialty radiologists - a problem solved when ARA implemented
digital imaging in 1999. ARA also can provide access to its imaging
system from any PC that's connected to the web and is actively involved
in educating its referring physicians and marketing the service to
them.
ARA offers use of its PACS to small hospitals in rural areas which
cannot afford their own imaging system. "We are quite surprised by how
many of the rural hospitals want to get on the system," says R. Todd
Thomas, CIO.
Breast Imaging of Oklahoma, a free-standing imaging center dedicated to
breast health, is one of a small but growing number of U.S. facilities
approved by the FDA to use digital mammography equipment in its
facility.
Despite the debate in the medical field about the benefits of digital
mammography versus the equipment costs, radiologists at Breast Imaging
of Oklahoma have fully embraced the technology. "Our doctors would
never go back to analog," says Debra Mitchell, M.D., CEO and managing
physician. "In our opinion, the functionality is much improved. For
example, you have the ability to manipulate and magnify the image and
it gives the radiologist much better detail."
Using a GE Medical Systems Senographe 2000D that feeds images to a GEMS
Information Technologies' Centricity PACS, mammography at Breast
Imaging of Oklahoma is completely digital. According to Mitchell,
one digital mammography machine can do the work of two to three analog
systems, which significantly increases the productivity of the clinic's
three physicians.
Northeast Radiology (NERAD) operates seven free-standing imaging
centers in New York and Connecticut and provides radiology services to
several local hospitals. NERAD, which uses a DR Systems PACS, has a
long-standing relationship with AMSYS, Inc., an IT services provider.
When Scott Nadel, M.D., NERAD's president, needed a solution for remote
image viewing, he turned to AMSYS to develop a cost-effective
teleradiology solution.
Working with Nadel to meet his rigorous requirements, AMSYS created an
electronic push process that automatically dispatches images, reports
and other patient information to the desktops of referring clinicians.
There's no need for physicians to log onto a website to see if their
cases are ready because their physicians are automatically notified.
The solution that NERAD provides doesn't require special workstations
or equipment to be installed; NERAD simply sends its referring
physicians a CD with an application and viewer. "We're more productive,
more efficient, and able to provide a depth of service for smaller
hospitals that we would have never been able to provide," says Nadel.
HIS: HBOC/Meditech PACS: DR Systems
The Indiana Heart Hospital Indianapolis, Indiana
The Indiana Heart Hospital (TIHH) is the first all-digital hospital
ever built. Open since February, the hospital is completely paperless,
filmless and wireless.
With GE Medical Systems as its clinical technology partner, TIHH
provides its patients with a clinical EMR that can include images,
text, data and cardiac waveforms. At the core of TIHH technology is GE
Medical Systems' Centricity Clinical Information Systems, which
integrates patient information with other clinical data from advanced
modalities, such as a digital cardiovascular imaging system, an ECG
system and an advanced CT system.
Because TIHH never had to manage a transition to digital technology,
its interior design is based on a digital workflow. For example, gone
are the traditional nursing stations and patient record and film
storage rooms. Patient records are accessible from each patient room
and data are wirelessly input into an electronic medical record at
patient bedside.
RIS: IDX PACS: GE Centricity STORAGE: Sun SERVER: IBM/Dell HIS: GE Centricity
Virtual Radiologic Consultants Eden Prairie, Minnesota
Virtual Radiologic Consultants (VRC) connects radiologists with U.S.
practices and hospitals experiencing physician staffing shortages. The
company's radiologists live in diverse locations, such as Australia,
France, Germany, Hawaii, Hong Kong and India.
VRC employs board-certified, state-licensed radiologists who can live
almost anywhere they can access a high-speed Internet connection. A VRC
doctor may read cases for a single hospital, a specific geographic area
or even multiple locations, but he or she must first obtain all the
appropriate state licenses and credentials - a paperwork-intensive
process that VRC manages. Nearly 150 hospitals and practices have
engaged VRC to cover emergency room evening and night shifts.
VRC provides each of its physicians with a workstation for reading
images and another one for RIS utilization and voice recognition, as
well as an IP phone that's connected to VRC's intranet. And as long as
a hospital or practice has access to a scanner that can send DICOM data
to a network destination, it can securely send its cases to VRC.
RIS: Fujifilm
Health Imaging & IT found that our
interviews yielded anecdotal data that painted a comprehensive picture
of the issues surrounding the digitization of patient images. Recurring
themes were ROI, improved workflow and productivity gains, staffing
shortages and physician acceptance of new technologies. RETURN ON INVESTMENT (ROI)
Because the cost of a picture archiving and communications system
(PACS) and other crucial elements of an integrated digital system
constitute a huge capital expense, most organizations must build a
compelling business case that the purchase eventually will pay for
itself. Most often, ROI is measured by calculating reductions in
operating costs and staff, as well as gains in productivity and revenue.
Most respondents said that ROI is a critical component of achieving
internal support to transition to digital imaging technologies. Six
months after converting from a film-based imaging system to a
completely digital setting, Providence Health System's St. Joseph
Medical Center and Holy Cross Medical Center are 90 percent filmless
and have eliminated film costs, chemistry and processing expenses, and
film library staffing. Such successes please the Providence
administrators, who insisted on ROI within a year of implementing the
system.
Some early innovators didn't have the same positive results. Measuring
only hard cost savings, its initial foray into PACS didn't give the
University of Pittsburgh Medical Center (UPMC) a positive ROI. Because
the system provided the best image quality and functionality to those
in the radiology department, non-radiologists still ordered film. "We
weren't saving money on film and processing costs, because we had a
parallel infrastructure," says Paul Chang, M.D., director of radiology
informatics at UPMC.
Chang solved the problem by inventing a technology called dynamic
transfer syntax (DTS), which allows workstations across the enterprise
to have the same functionality and image quality. Using PACS technology
based on DTS (subsequently commercialized privately), UPMC now is
accumulating yearly cost savings of $3 million to $5 million at their
largest hospital.
Of course, there's much more to ROI than eliminating film and
processing costs and reducing administrative staff. Productivity
increases are often the easiest variable to measure. Most facilities
noticed an immediate rise in patient throughput and the number of cases
read each day.
After Baltimore VA Medical Center installed its enterprise-wide PACS in
1993, Chief of Imaging Eliot Siegel, M.D., and his team tracked the
number of cases performed by radiologists and technologists per year
and compared the numbers with data from previous years. Siegel found
that productivity increased by 50 percent per radiologist and 40
percent per technologist across the board.
In many cases, switching to digital imaging or improving an existing
digital system can result in new income streams that add to a
facility's revenue. Austin Radiological Association in Austin, Texas,
collected additional revenue by offering their newly-minted PACS to
small hospitals.
"Hospitals that can't afford their own PACS can have access to a PACS
through us," says Austin Radiological's CIO R. Todd Thomas. "Plus, they
can also use our radiology staff. We package the deal as a whole; we
can bring PACS into their hospital and also bring the radiologists."
There also are intangible benefits. Many survey respondents noticed
benefits that cannot be measured, such as enhanced physician job
satisfaction and better quality of life. A digital imaging system also
can be an enormous competitive advantage, according to Matt Ebaugh,
senior vice president and CIO of Commonwealth Health Corp. "We have a
competitive hospital in our backyard," he says. "We can demonstrate to
our referring physicians that we're more innovative and keep - and even
increase - market share."
Of course, the impact on patient care is significant, but often
inestimable. "The reason we decided to create an all-digital paperless
environment was patient-driven," says Dave Furst, CIO of The Indiana
Heart Hospital, the first hospital in the world to be designed and
built completely without paper or film. "The patient focus is a very
important part of our mission, and delivering faster patient outcomes
is a critical part of that."
Patient benefits of a digital imaging system include less time in the
radiology waiting room, less time to obtain exam results, and the
ability of physicians to order additional images while the patient is
still on the table. Finally, digital imaging has drastically lowered
the number of lost images, which means an end to duplicate exams.
WORKFLOW CHANGES
Some experienced informatics administrators argue that ROI is a limited
approach to measuring success. Osman Ratib, M.D., Ph.D., professor and
vice chair of information systems at UCLA's Department of Radiology,
contends that workflow changes are the most accurate way to measure the
value of PACS. "The cost of a PACS environment is much higher than the
ROI," Ratib says. "The PACS is therefore most valuable in creating
operational efficiencies and improving workflow."
Monte Clinton, director of radiology of Dartmouth Hitchcock Medical
Center, agrees. "[PACS ROI] is not traditional, because the benefits
one sees are subjective," he says. "I would caution those who measure
ROI only by film costs and film library costs. Other factors are in
play."
"Everything in radiology changed in terms of workflow," added Daren
Burns, PACS administrator for Providence St. Joseph Medical Center.
"The handoff from the technologist to the radiologist is different."
Clinicians no longer make multiple trips to the radiology department to
view films. Technicians spend less time on clerical duties that are now
managed by the hospital information system (HIS) or the radiology
information system (RIS). Reports can be transcribed immediately after
dictation. The overall result is that staff members spend more time on
job tasks that help the facility increase revenue.
Exactly
what is innovation and how is it defined in health imaging and
information technology? Is it related to the size of a facility's
digital storage system or the number of digital modalities it has
installed? Or perhaps it is more important to examine how a facility
uses imaging technology to increase revenue and improve physician
productivity and workflow.