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Adoption of alternative financing strategies to increase the diffusion of picture archiving and communication systems into the radiology marketplace

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JOURNAL OF DIGITAL IMAGING 2000年第2期13卷 108-113页

作者： Reiner, B Siegel, E McKay, P Univ Maryland Amer Radiol Serv Leonardtown MD 20650 USA Vet Affairs Med Ctr Baltimore MD USA Univ Maryland Sch Med Baltimore MD 21201 USA Amer Radiol Serv Baltimore MD USA Natl Vet Affairs Headquarters Washington DC USA

The objective of the study was to evaluate current marketplace conditions and strategies employed by major picture archiving and communication systems (PACS) vendors in the creation of alternative financing strategies, to enhance the diffusion of filmless imaging. Data were collected from the major PACS vendors in the forms of survey questionnaires and review of existing leases. Topics evaluated in the survey included current financing options available, foreseeable changes in PACS financing, role of third-party financiers, and creation of risk-sharing arrangements. Generic leases were also reviewed evaluating the presence or absence of several key variables including technology obsolescence protection, hardware/software upgrades, end-of-term options, determination of fair market value, functionality/acceptance testing, uptime guarantees, and workflow management consulting. Eight of the 10 PACS vendors surveyed participated in the data collection. The vast majority of current PACS implementations (60% to 90%) occur through direct purchase, with conventional leasing (operating or capital) accounting for only 5% to 30% of PACS installations. The majority of respondents view fee-for-lease arrangements and other forms of risk sharing as increasing importance for future PACS financing. The specific targets for such risk-sharing arrangements consist of small hospital and privately owned imaging centers. Leases currently offered range in duration from 3 to 5 years and frequently offer technology obsolescence protection with upgrades, multiple end-of-term options, and some form of acceptance testing. A number of important variables frequently omitted from leases include uptime guarantees, flexibility in changing financing or vendors, and incorporation of expected productivity/operational efficiency gains. As vendors strive to increase the penetration of PACS into the radiology marketplace, there will be a shift from conventional financing (loan or purchase) to leasing. Fee-

关键词：费用分担成本及成本分析/统计学和数值数据经济学医院/统计学和数值数据筹资组织/经济学租赁财产/经济学卫生服务使用研究/经济学采购科医院/经济学放射科医院/经济学放射学信息系统/经济学人类

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Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program

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JOURNAL OF DIGITAL IMAGING 2000年第2期13卷 228-229页

作者： Staley, S Romlein, J Chacko, AK Wider, R InformaTech Inc Telemed Serv Frederick MD 21703 USA Med Res & Mat Command Ft Detrick MD USA

Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment. Copyright (C) 2000 by W.B. Saunders Company.

关键词：费用效益分析信息管理/经济学维修/经济学卫生服务使用研究/经济学质量控制放射学信息系统/经济学人类

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Transparent image access in a distributed picture archiving and communications system: The master database broker

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 175-177页

作者： Cox, RD Henri, CJ Rubin, RK McGill Univ Ctr Hlth Dept Diagnost Radiol Montreal PQ Canada

A distributed design is the most cost-effective system for small- to medium-scale picture archiving and communications systems (PACS) implementations. However, the design presents an interesting challenge to developers and implementers: to make stored image data, distributed throughout the PACS network, appear to be centralized with a single access point for users. A key component for the distributed system is a central or master database, containing all the studies that have been scanned into the PACS. Each study includes a list of one or more locations for that particular dataset so that applications can easily find it. Non-Digital Imaging and Communications in Medicine (DICOM) clients, such as our worldwide web (WWW)-based PACS browser, query the master database directly to find the images, then jump to the most appropriate location via a distributed web-based viewing system. The Master Database Broker provides DICOM clients with the same functionality by translating DICOM queries to master database searches and distributing retrieval requests transparently to the appropriate source. The Broker also acts as a storage service class provider, allowing users to store selected image subsets and reformatted images with the original study, without having to know on which server the original data are stored. Copyright (C) 7999 by W.B. Saunders Company.

关键词： CD-ROM 计算机通信网络/经济学费用效益分析数据库(主题)/分类数据库(主题)/经济学数据库(主题)/组织和管理诊断显像信息存储和检索因特网放射学信息系统/分类放射学信息系统/经济学放射学信息系统/组织和管理人类

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Technology assessment and requirements analysis: A process to facilitate decision making in picture archiving and communications system implementation

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 62-63页

作者： Radvany, MG Chacko, AK Richardson, RR Grazdan, GW USA Med Mat Agcy Technol Support Div Ft Detrick MD 21702 USA Brooke Army Med Ctr Dept Radiol Ft Sam Houston TX 78234 USA

In a time of decreasing resources, managers need a tool to manage their resources effectively, support clinical requirements, and replace aging equipment in order to ensure adequate clinical care. To do this successfully, one must be able to perform technology assessment and capital equipment asset management. The lack of a commercial system that adequately performed technology needs assessment and addressed the unique needs of the military led to the development of an in-house Technology Assessment and Requirements Analysis (TARA) program. The TARA is a tool that provides an unbiased review of clinical operations and the resulting capital equipment requirements for military hospitals. The TARA report allows for the development of acquisition strategies for new equipment, enhances personnel management, and improves and streamlines clinical operations and processes. This is a US government work. There are no restrictions on its use.

关键词：资本筹集决策设备和供应医院/经济学卫生资源/经济学卫生资源/组织和管理医院军队/经济学医院军队/组织和管理人员管理医院放射学信息系统/经济学放射学信息系统/组织和管理技术评估生物医学人类

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Using technology assessment as the picture archiving and communication system spreads outside radiology to the enterprise

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JOURNAL OF DIGITAL IMAGING 2000年第2期13卷 114-116页

作者： Maliff, RP Launders, J ECRI Hlth Devices Grp Plymouth Meeting PA 19462 USA ECRI Hlth Syst Grp Plymouth Meeting PA 19462 USA

Picture archiving and communication systems (PACS) are being implemented within radiology departments, and many facilities are entering the next stage of PACS use by deploying PACS to departments outside of radiology and to other facilities located at a distance. Many PACS vendors and department administrators have based cost-justification analyses on the anticipated savings from expanding PACS to these areas. However, many of these cost-savings analyses can be highly suspect in their assumptions and findings. Technology assessment (TA) at the hospital/health system level is an organized, systematic approach to examining the efficacy of a technology in relation to the health system's mission and clinical needs. It can be an organized and unifying approach to aid in the distribution of limited capital resources. As extra-radiology PACS deployment is a costly endeavor, TA may be used to plan for PACS implementation throughout the enterprise. In many organizations, PACS is thought of as a radiology domain as its first uses were centered on this image-producing service. Now, as PACS technology spreads to other service areas, such as cardiology, dermatology, pathology, orthopedics, obstetrics, etc, the need to incorporate other viewpoints in a system-based PACS is necessary to avoid having independent PACS that may duplicate archives and may not communicate with each other. How to meet the diverse PACS needs of clinical services can be a challenging task;a TA program has been demonstrated to effectively handle the clinical needs, demands, and timeframes of PACS planning and support throughout hospitals and health systems. A hospital-based TA program can assist health care organizations to present PACS as a system-wide need and program rather than a radiology-based program gobbling up the capital budget. Submitting PACS to the TA review process can identify essential elements in planning and help avoid many of the pitfalls of PACS implementation and operations. Thorough c

关键词：费用节省/统计学和数值数据可行性研究医院间共用服务/经济学放射学信息系统/经济学技术评估生物医学/经济学人类

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Acceptance testing of integrated picture archiving and communications systems

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 163-165页

作者： Lewis, TE Horton, MC Kinsey, TV Shelton, PD USA Joint Imaging Technol Project Off Ft Detrick MD 21702 USA

An integrated picture archiving and communication system (PACS) is a large investment in both money and resources. With all of the components and systems contained in the PACS, a methodical set of protocols and procedures must be developed to test all aspects of the PACS within the short time allocated for contract compliance, For the Department of Defense (DoD), acceptance testing (AT) sets the protocols and procedures. Broken down into modules and test procedures that group like components and systems, the AT protocol maximizes the efficiency and thoroughness of testing all aspects of an integrated PACS. A standardized and methodical protocol reduces the probability of functionality or performance limitations being overlooked. The AT protocol allows complete PACS testing within the 30 days allocated by the digital imaging network (DIN)-PACS contract. AT shortcomings identified during the testing phase properly allows for resolution before complete acceptance of the system. This presentation will describe the evolution of the process, the components of the DoD AT protocol, the benefits of the AT process, and its significance to the successful implementation of PACS. This is a US government work. There are no restrictions on its use.

关键词：计算机系统数据显示诊断显像效率组织政府机构卫生资源医院信息系统投资质量控制放射学信息系统/分类放射学信息系统/经济学放射学信息系统/仪器和设备放射学信息系统/标准软件系统综合时间因素人类

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Planning and cost analysis of digital radiography services for a network of hospitals (the Veterans Integrated Service Network)

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JOURNAL OF TELEMEDICINE AND TELECARE 1998年第3期4卷 172-178页

作者： Duerinckx, AJ Kenagy, JJ Grant, EG Univ Calif Los Angeles Serv Radiol W Los Angeles Vet Affairs Med Ctr Ctr Med Los Angeles CA 90073 USA Univ Calif Los Angeles Med Ctr Dept Radiol Los Angeles CA 90024 USA Vet Integrated Serv Network Desert Pacific Healthcare Network Long Beach CA USA

This study analysed the design and cost of a picture archiving and communications system (PACS), computerized radiography (CR) and a wide-area network for teleradiology. The Desert Pacific Healthcare Network comprises 10 facilities, including four tertiary medical centres and one small hospital. Data were collected on radiologists' workloads, and patient and image flow within and between these medical centres. These were used to estimate the size and cash flows associated with a system-wide implementation of PACS, CR and teleradiology services. A cost analysis model was used to estimate the potential cost savings in a filmless radiology environment. ATM technology was selected as the communications medium between the medical centres. A strategic plan and business plan were successfully developed. The cost model predicted the cost-effectiveness of the proposed PACS/CR configuration within four to six years, if the base costs were kept low. The experience gained in design and cost analysis of a PACS/teleradiology network will serve as a model for similar projects.

关键词：加利福尼亚费用效益分析医院费用医院间共用服务医院退伍军人/组织和管理洛杉矶规划技术放射科医院/经济学放射科医院/组织和管理放射学信息系统/经济学放射学信息系统/组织和管理远程放射学/经济学远程放射学/组织和管理工作负荷量人类

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Integration, acceptance testing, and clinical operation of the medical information, communication and archive system, phase II

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 144-147页

作者： Smith, EM Wandtke, J Robinson, A Univ Rochester Med Ctr Dept Radiol Rochester NY 14642 USA

The Medical Information, Communication and Archive System (MICAS) is a multivendor incremental approach to picture archiving and communications system (PACS). It is a multimodality integrated image management system that is seamlessly integrated with the radiology information system (RIS). Phase II enhancements of MICAS include a permanent archive, automated workflow, study caches, Microsoft (Redmond, WA) Windows NT diagnostic workstations with all components adhering to Digital Information Communications in Medicine (DICOM) standards. MICAS is designed as an enterprise-wide PACS to provide images and reports throughout the Strong Health healthcare network. Phase II includes the addition of a Cemax-Icon (Fremont, CA) archive, PACS broker (Mitra, Waterloo, Canada), an interface (IDX PACSlink, Burlington, VT) to the RIS (IDXrad) plus the conversion of the UNIX-based redundant array of inexpensive disks (RAID) 5 temporary archives in phase I to NT-based RAID 0 DICOM modality-specific study caches (ImageLabs, Bedford, MA). The phase I acquisition engines and workflow management software was uninstalled and the Cemax archive manager (ANI) assumed these functions. The existing ImageLabs UNIX-based viewing software was enhanced and converted to an NT-based DICOM viewer. Installation of phase II hardware and software and integration with existing components began in July 1998. Phase II of MICAS demonstrates that a multivendor open-system incremental approach to PACS is feasible, cost-effective, and has significant advantages over a single-vendor implementation. Copyright (C) 1999 by W.B. Saunders Company.

关键词：密集磁盘计算机通信网络计算机系统费用效益分析数据库管理系统数据库(主题) 诊断显像可行性研究放射学信息系统/分类放射学信息系统/经济学放射学信息系统/仪器和设备放射学信息系统/组织和管理软件系统综合人类

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Experience measuring performance improvement in multiphase picture archiving and communications systems implementations

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 141-143页

作者： Reed, G Reed, DH Integrat Resources Inc Lebanon NJ 08833 USA

When planning a picture archiving and communications system (PACS) implementation and determining which equipment will be implemented in earlier and later phases, collection and analysis of selected data will aid in setting implementation priorities. If baseline data are acquired relative to performance objectives, the same information used for implementation planning can be used to measure performance improvement and outcomes. The main categories of data to choose from are: (1) financial data;(2) productivity data;(3) operational parameters;(4) clinical data;and (5) information about customer satisfaction. In the authors' experience, detailed workflow data have not proved valuable in measuring PACS performance and outcomes. Reviewing only one category of data in planning will not provide adequate basis for targeting operational improvements that will lead to the most significant gains. Quality improvement takes into account all factors in production: human capacity, materials, operating capital and assets. Once we have identified key areas of focus for quality improvement in each phase, we can translate objectives into implementation requirements and finally into detailed functional and performance requirements. Here, Integration Resources reports its experience measuring PACS performance relative to phased implementation strategies for three large medical centers. Each medical center had its own objectives for overcoming image management, physical/geographical, and functional/technical barriers. The report outlines (1) principal financial and nonfinancial measures used as performance indicators;(2) implementation strategies chosen by each of the three medical centers;and (3) the results of those strategies as compared with baseline data. Copyright (C) 1999 by W.B. Saunders Company.

关键词：规范计算机系统成本及成本分析数据收集诊断显像效率组织财务管理卫生设施/经济学卫生设施管理病案系统计算机化过程评价(卫生保健) 质量保证卫生保健放射学信息系统/经济学放射学信息系统/仪器和设备放射学信息系统/组织和管理时间因素人类

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Integrated radiology information system, picture archiving and communications system, and teleradiology - Workflow-driven and future-proof

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 199-200页

作者： Shieh, YY Roberson, GH Texas Tech Univ Hlth Sci Ctr Dept Radiol Lubbock TX 79430 USA

The proliferation of integrated radiology information system/picture archiving and communication system (RIS/PACS) and teleradiology has been slow because of two concerns: usability and economic return. A major dissatisfaction on the usability issue is that contemporary systems are not intelligent enough to support the logical workflow of radiologists. We propose to better understand the algorithms underlying the radiologists' reading process, and then embed this intelligence into the software program so that radiologists can interact with the system with less conscious effort. Regarding economic return issues, people are looking for insurance against obsolescence in order to protect their investments. We propose to future-proof a system by sticking to the following principles: compliance to industry standards, commercial off-the-shelf (COTS) components, and modularity. An integrated RIS/PACS and teleradiology system designed to be workflow-driven and future-proof is being developed at Texas Tech University Health Sciences Center. Copyright (C) 1999 by W.B. Saunders Company.

关键词：算法人工智能计算机系统诊断显像预测投资放射学放射学信息系统/经济学放射学信息系统/组织和管理软件系统综合远程放射学得克萨斯用户计算机接口工作负荷量人类

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