One of the driving forces behind the implementation of PACS is the expectation that its deployment will result in greater productivity for a clinical department. An 11-year retrospective analysis conducted at two of the largest academic hospitals in the United States and presented at the 93rd scientific assembly and annual meeting of the Radiological Society of North America, provide hard data to back up this contention.
Elkan Halpern, PhD, and a team from Massachusetts General Hospital (MGH) in Boston determined the effects of PACS and speech recognition (SR) software on radiologist productivity from September 1994 through October 2005. The researchers measured the change in monthly relative value units (RVUs) and monthly RVUs per full-time equivalent (FTE) employee in the radiology departments of MGH and New York University Medical Center (NYUMC) in New York City.
Halpern said that the team collected monthly RVU, RVU/FTE and determined the extent of implementation of PACS and SR at MGH and NYUMC for the study period.
“At MGH, PACS and SR were each introduced incrementally, division by division, starting in 1995 and 1996, respectively,” he noted. “PACS implementation reached its plateau at almost 90 percent in 2004,, while speech recognition reached 95 percent by 2002. At NYUMC, PACS was introduced department wide starting in 2003 with 90 percent rollout completed by 2005. Speech recognition was fully in use at NYUMC over the entire period.”
Halpern said that the researchers used a stepwise linear regression method to model productivity as functions of the estimated extent of PACS and SR at MGH and PACS at NYUMC. To control for simultaneous secular trends, Halpern reported that productivity was expressed as the ratio of the MGH value to the NYU value for each of the work (W), technical (T), and work + technical (W+T) RVU and RVU/FTEs.
“For all expressions of productivity, the only statistically significant effect was that of PACS at MGH, with a p-value of less than 0.0001,” he said.
At 90 percent implementation, the results demonstrated that PACS implementation at MGH was estimated to increase the W, T, and W+T RVUs by 29 percent (± 4 percent), 63 percent (± 5 percent), and 56 percent (± 5 percent), respectively. He said that the effects on the RVU/FTEs were similar.
“Using each institution as a control for the other permitted the separation of the secular trend from the effect of the introduction of imaging informatics,” he said. “PACS had a large, significant effect on the technical component of productivity and a lesser significant effect upon the work component.”
Implementing PACS at MGH had a very significant impact on both RVUs and RVUS per FTE, he said.
“Interestingly, implementing speech recognition did not have any demonstrable effect, either positively or negatively,” Halpern said.
One of the major disappointments of the study for the researchers was that they could not see any effect on the RVUs due to the introduction of PACS at NYUMC.
“We don’t know if this is a cautionary tale that only some institutions can achieve that [increase in productivity ratio],” he noted.