The annual meeting of the Society for Computer Applications in Radiology (SCAR) brought record numbers to Orlando this year from June 2nd-5th. Attendance jumped 18 percent to 2,975 at the meeting that marked SCAR's 25th anniversary. High attendance at the many educational sessions showed they were a core interest of attendees. Here is a summary of a sampling of educational sessions.
The Economics of Filmless Radiology
SCAR U analyzed the economics of filmless radiology with the help of Paul Nagy, PhD, director of informatics research at University of Maryland, who provided strategies for buying PACS on a small wallet. Eliot Siegel, MD, vice chair of radiology at University of Maryland, focused on the economic challenges of dealing with a PACS divorce. Bruce Reiner, MD, director of radiology research at the VA Maryland Health Care System, and Sean Casey, CEO of Virtual Radiologic Consultants, teamed up to share the concept of grid radiology.
PACS on a Small Wallet
The PACS market is evolving into a more mature market. Hardware prices are dropping, and software integration is becoming increasingly critical, Nagy said. Hardware accounts for less than 30 percent of the cost of PACS.
Commercial off-the-shelf hardware can meet many needs in radiology, according to Nagy. A commercial 2 megapixel monitor is suitable for reading almost all studies except DR and CR.
While hardware and software have relatively short lifespans, standards last 25 to 50 years. "Learn IHE and DICOM and use it where applicable to solve problems," Nagy said. Integration is a key concern; although all vendors conform to DICOM, the standard is flexible with varying levels of integration among products. Finding out whether or not proposed vendors connect at the RSNA Connectathon can save integration time and costs after the purchase.
Nagy offered four vendor selection tips:
- Don't select one vendor prematurely.
- Market competition is a positive; use it to your advantage.
- Learn from all vendors.
- Rely on the KLAS report for user satisfaction information.
Several other details can trim PACS costs. Line item pricing allows buyers to see and verify the cost of all components - particularly hardware that can be purchased from other suppliers. Asking for a software-only price ensures that hardware is not tied into legacy components. The contract should specify payment on acceptance, which can be measured by functionality or filmlessness.
A decision matrix that evaluates the total cost of ownership, functionality, technology, integration capabilities and industry relationships can guide the purchase decision, Nagy said. Relevant users should stick to relevant components. That is, radiologists should analyze functionality; and IT should review technology.
Economics of a PACS Divorce
Both first and second time PACS buyers can learn from PACS divorces, Siegel said.
Once a hospital or imaging center and PACS vendor decide to part ways, data must be migrated from the old PACS to the new one with data migration - taking approximately 30 percent as long as data acquisition. That is, if the first PACS operated for five years it will take 1.6 years to migrate the data to the new system. Costs for data migration range from 40 cents to $1.20 per study, Siegel said.
Data migration options include third- party migration vendors or the facility as most PACS vendors are unwilling to assume responsibility for the task. Siegel offered a combination approach as a possible solution to the data migration quandary. That is, maintaining the first PACS as the radiology PACS and replacing the enterprise wide distribution system, providing the new enterprise system with copies of new studies and enabling access to priors. "This may be the first step in the migration strategy or a long-term solution," Siegel noted.
Siegel concluded with advice for profiting from the spate of PACS divorces.
- Include obsolescence protection in the contract.
- Limit pre-paid service contracts.
- Consider a software-only PACS migration if you have a strong and motivated IT department.
- Focus less on the RFP and more on vendors' track record.
- Don't forget to calculate time and cost required to swap vendors.
- Don't plan for a long-term relationship with one vendor.
Grid radiology is the way of the future
Grid radiology is a concept of the radiology environment of the future that aims to solve problems of increasing image utilization and data complexity as the radiologist