Top 10 Hospitals

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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 thediversity 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.

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