Reicher
Murray A. Reicher, M.D., FACR Chief Medical Officer,
Merge Healthcare, an IBM Company

Over the past 25 years, the majority of medical imaging providers has slowly migrated away from managing paper and film-based images to embracing digital imaging informatics, such as radiology information systems (RIS), picture archive and communication systems (PACS), cardiovascular information systems (CVIS), vendor neutral archiving systems (VNAs), and digital reporting/speech recognition solutions. These solutions are supplemented by a number of subsystems for breast imaging reporting, messaging, business analytics, advanced image processing, nuclear imaging, peer review, critical results tracking, image fusion, and more.

With multiple solutions from varied vendors in place, some imaging providers find it difficult to replace key systems simultaneously and see very little value in changing just one. That is one of the many reasons why imaging providers haven’t yet upgraded early generation technologies. Others include:

  • A focus on compliance with the federal EHR Incentive Program and adoption of a new generation of hospital information systems; and
  • The economic stresses of declining reimbursement and plateauing imaging procedure growth rates that constrain budgets and make it difficult for healthcare management teams to replace multiple systems at once.

So, how do you know when it’s time to replace your imaging IT? Two obvious answers are when one of your major systems is discontinued by the vendor or when your staff becomes dissatisfied enough with a vendor to demand a change. Perhaps a more strategic answer for determining the best time for replacement is when a vendor demonstrates a solution that results in superior clinical and economic outcomes.

The smartphone of imaging technology

I often compare the current state of imaging IT to my personal situation prior to purchasing my first smartphone. Before making the switch, I owned a flip phone, camera, Rolodex, audio recorder, computer, and GPS device. My smartphone didn’t replace my phone—it replaced all of those devices with a simple, easily understood, and cost-effective solution with a superior user experience.

I believe the current generation of imaging IT solutions will be replaced in much the same way. A modular, comprehensive imaging IT system delivered via a software-as-a-service model will replace multiple individual solutions. Such a sophisticated solution will provide the benefits of faster technology iteration, built-in user learning, and a simpler, more powerful user experience.

Equally as important, it will relieve the customer of large up-front capital outlays and extensive hardware implementations. As new systems evolve, they will become truly collaborative, assisting healthcare professionals and patients in evidence-based decision-making while increasing patient-centric services and meeting national goals for transparency of health records—goals that are aligned with the American College of Radiology’s call for patient-centric radiology.

Determining when to switch

How do you know when the time is right to start shopping? Following these five steps will give you a clear picture:

  1. Take inventory. Conduct a comprehensive inventory of your current imaging IT systems. You may need to go beneath the surface to discover the full array of technologies and interfaces you own and manage. In my experience, it would not be unusual for even a small integrated health system of four or five hospitals to find 30 or more IT vendors in radiology and cardiology.
  2. Know your true costs. Tally the costs for each vendor including interfaces, capital depreciation, and internal support costs.
  3. Consider human factors. Benchmark the levels of user understanding of each system and clinical user satisfaction.
  4. Set economic and clinical goals. Determine if there are clinical functions you need to or want to provide where technology is limiting you. In other words, begin with a thorough self-assessment that establishes economic and clinical benchmarks.
  5. Evaluate facilities individually. If you operate a multi-facility healthcare organization, consider benchmarking each one individually to obtain objective measures of success and variation between facilities. Use this information to establish best practices and future targets.

The benchmarking data provides the intel needed to set goals and measures of success for your imaging system. There are two additional considerations in evaluating individual vendors:

  1. Can a vendor replace multiple existing solutions with a single, more comprehensive solution that provides a clinical benefit at lower cost?
  2. Is the vendor positioned to replace your other imaging IT solutions over time?

If the answer is “yes,” and the vendor’s claims are substantiated by customer references, you have found the right solution, and the time is now. Whether or not you choose to embark on an imaging IT replacement program now, the exercise will undoubtedly provide new insights into your total spending and performance that will be helpful in your planning efforts.

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