Pacs Implementation Within A Radiology Department Information Technology Essay

Pacs Implementation Within A radiology De take leavement Information technology EssayInformation technologies and systems keep back revolutionised the way bulk think and act in many spheres of life. Information systems are deemed to be wholeness of the major tools gettable for communication channel managers for achieving operational excellence, developing new products and serve, improving decision making and achieving competitive advantage (Laudon Laudon, 2009). The domain of information systems is an exciting evolution creating digital field in their products and services and delivering them over digital networks as being intrustd widely in worryes, including in the health aid enterprise.In the healthcare diligence, information systems invite created opportunity to restructure both the operational and architectural aspects in general, particularly in the radioscopy surgical incision (Rostenberg, 2006, p. 15). Perhaps as Jalaludin et al. (2005, p. 56) stated, no anothe r(prenominal) durability in medicament has benefited as greatly as in radiology with respect to advances in electronics and computers. The transformation of digital radiology will strive on giving way from the expensive and time-consuming endeavour of postulate and paper based methods to the faster and simpler computer based ones.As radiology continues to grow and evolve, persona changes such as reengineering information storage and delivery, as well as refining the overarching data repositories and access systems that support the healthcare consumer is required in fix to be competitive. In keeping with the ch solelyenges, a prominent feature of evolution would be the proliferation of enterprise-wide electronic get word Archiving and Communication Systems (PACS), which has changed the face of radiology by radic aloney altering the core drivers of tralatitious film-based imagination facilities.Filmless image management systems will become popular in all hospitals in the near future (Furukawa et al., 2004). and then one should investigate the merits demerits of implementing this system effectively taking into consideration the productivity improvements and cost reductions while providing better patient care.2.0 PurposeThe purpose of this report is to take PACS performance within a radiology plane section in a public sector medical centre located in Kuala Lumpur, Malaysia, as part of a strategic occupancy formulate to create competitive advantage in the ever increasing patient demand. The author will conduct an outline of the competitive environment and resources evaluating the strategic options in implementing PACS.Apart from this, an outline of the MIS requirements for the successful implementation of the selected PACS schema and the associated course of study needed to be under taken will withal be luxuriouslylighted. This will lend a hand in securing funding and to provide a roadmap for its implementation within the timeline of one (1) yea r. The judicious planning of PACS dodge business plan will aim towards reengineering information storage and digital delivery as part of fulfilling the departments goals and objectives in creating a filmless environment, thus adding harbor and improving the business of radiology.3.0 Organisational and surroundingsal Audit.The education of PACS strategy in the evolving field of radiology, as stated by Chan (2002) consists of two main interrelated processes such asgaining insight into the constitutional law and its environment andpositioning the organisation for sustained competitive advantageOrganisations need to respond to changes in their environment by continuous adaptation, which warrants making decisions on how to align and develop their products and services by keeping pace with environmental changes otherwise they will lose their competitiveness (Chan, 2002). In addition, government regulation such as Health Insurance Portability and Accountability Act (HIPAA) has drive n many to demand improvements in the management of the information systems within the healthcare system with PACS being one of the primary components of this requirement (Smith Hirschorn, 2006, p.157).As such, it is important to answer three essential strategic questions and develop the framework for PACS strategy, thus focusing on few elements that comparatively contribute to sustained competitive advantage (Table 1).strategic QuestionsFrameworkWhere is our organisation right now?Wide range of information is collected.Where do we aim to go in the future?Insight developed and options hand overd.How do we get there?Implementation of new strategy.Table 1 Strategic questions and framework in PACS strategy development (Chan, 2002)As part of gathering wide range of information to redact the framework for PACS strategy development, strategic analysis such as outer environment and organisational audit is required as shown in Table 2.Strategic AnalysisOutcomeDevelopment in radiology co ntextExternalEnvironmentReview events and trends that have occurred, occurring or anticipated to occur.Changes in economic, governmental, technologic, physical, cultural and managerial process.Mandate the conversion from the one-dimensional paper and film based systems to a purely digital department.OrganisationalEvaluate the structure, operations, resources and culture of the organisations.Identify the current capabilities and the availability for the future strategic initiatives.The support of personnel from all levels will bring it closer to the department goals of going filmless.Capabilities enhanced through proper training and coaching sessions.Table 2 Strategic Analysis in PACS development (Chan, 2002)In addition, it is also clamant to gain information regarding the interrelationships between the two. As such, a simple integrative analysis, known as SWOT is put to deathed to highlight the inherent strengths and weaknesses, as well as opportunities and threats about the org anisation and the relevant environmental factors facing the organisation in implementing PACS strategic business plan, as shown in Table 3.STRENGTHSThe development of an organisations particular set of resources, which leads to sustainable competitive advantage.Collective organisational learning that resultants in superior performance, especially in coordinating and integrating new activities and workflows.New strategy and initiatives fosters new views of the power of radiology in the health care industry, thus adding value to the services rendered.WEAKNESSESThe resulting strategy may fall out of favour as a result of plans becoming too detailed and cumber few to implement.Different divisions may be inflexible in the face of changing business conditions and new competition.Should this be unsuccessful, the managers and employees who were liable for the implementation of the chosen strategy may feel disempowered.OPPORTUNITIESBuilding new capabilities and inventive in the use of lim ited resources to close gap should there be misfit between available resources and the resources needed for the desired goal.The push to possess leadership qualities along the new development path and change management.Room to exercise visual sense and creativity throughout the development and implementation of new strategy.THREATSExternal events or environmental trends that providenot be fore feeln by observers could affect or even invalidate the viability of separately strategic option that is considered.High cost of increased government regulations in radiology practices may deter the implementation.Table 3 Authors framework of SWOT analysis about the organisation and the relevant environmental factors in implementing PACS strategic business plan4.0 Competitive AnalysisOnce the insight of an organisation and its environment is gained, it is fundamental to undertake competitive analysis. These include a definition of the immediate radiology market, a description of rivalrys an d the status of their PACS implementations (Levine, 2006, p. 37).In creating the framework to help determine industry competition, arguably the most widely used model will be Porters five forces model (Figure 1).Figure 1 The five competitive forces that shape strategy (Porter, 2008)According to Porters five competitive forces model, the strategic position of the firm and its strategies are determined by competition with its traditional direct competitors and also greatly bear upon by new market entrants, substitute products and services suppliers and customers (Laudon Laudon, 2009, p. 107).A market research conducted by Frost and Sullivan (2010) stated that the radiology markets in southeasterly Asia have considerable potential, regardless of their maturity. In addition, the analyst further reiterated that with the decline in costs and advancements in PACS applications, smaller hospitals have begun to implement PACS in radiology and also in various medical disciplines such as the cardiology and dentistry departments that produce medical images too thus enabling better image management. and then, the strategic plan should note any PACS advertising done by local competitors in order to highlight any potential threat to market share, then perform the market share at risk if PACS is not implemented at this institution to evaluate the amount of additional revenue that may be shifted to or from a competitor that has respectively superior or inferior radiology services. notwithstanding Levine (2006, p. 39) stated that, a potent argument for PACS in the strategic plan will be to compare capacity and productivity gains that can be expected to accrue from the implementation to the future increases in demand for radiological services due to the normal growth and increased market share.As such, applying Porters five forces competitive analysis in PACS strategy would generate a framework as shown in Table 4.CompetitorsGovernment hospitalsTeaching hospitalsPrivate medi cal centresPotential competitorsAll radiology businessesSubstitute productsAdvances in hardware and softwareBreakthrough products in other emerging resourcefulness technology with built-in information systemsNetworking only a few workstations together from radiology department to a particular departmentBuyersIndividual hospitals or medical centresRegional health care networks and integrated delivery systemsGovernment programmesManaged care organisationsSuppliersInformation technology providers (HIS, RIS, PACS, Application Service Providers)Manufacturers of imaging devices and suppliesTable 4 Authors framework using Porters five forces competitive analysis applied in PACS strategy5.0 Strategic ImplicationsThere are three rudimentary strategic options available to organisations for gaining competitive advantage, according to Porters Generic Competitive Strategies model (Figure 2), namely, cost leadership, differentiation and focus, thus developing the edge, which brings revenue for the organisation and takes it away from ones competitor (Mind Tools, 2011).Figure 2 Porters Generic Competitive Strategies model (MBA experience Base, 2011)With the implementation of PACS, this organisation aims to provide low-cost, thus achieving cost leadership by gaining market share, whilst maintaining favourableness and pursue a differentiation-based strategy by offering unique product and services thus offering a greater value package to customers and competitors. In addition, it is imperative to use technology, where possible, to create or enhance customer value and satisfaction.As such, Porters value chain model (Figure 3) can be generalised to the practice of radiology to identify the key value drivers to build customer satisfaction through the implementation of PACS as a new strategy.Figure 3 Porters value chain generalised to the practice of radiology (Schomer et al., 2000)The model views a series of primary and support activities that add value to the organisations prod ucts or services (Laudon Laudon, 2009). In radiology practice, these include four support activities namely, the organisation infrastructure, human resources, technology development and procurement, which is straightforward, focusing on reducing costs in these areas for both customers and organisation.On the other hand, the five primary activities, namely, inbound logistics, operations, outbound logistics, marketing and service are quite specific and leveraging using technology, such as the PACS, can a good deal significantly enhance each of these activities. Each activity has an associated cost and therefore the residual margin (black area in Figure 9) will be carry as the shareholder earnings (Schomer et. al., 2000).6.0 PACS Strategic computer program RecommendationWhat is PACS and why choose this strategic plan in a radiology set-up? PACS include computers or networks with dedicated storage, retrieval, distribution and image management, which are stored in an independent Dig ital Imaging Communications in Medicine (DICOM) format (Amber Diagnostics, 2010). PACS can eliminate many of the time-consuming processes associated with film-based medicine and enable the practice of filmless medicine (Figure 4).This adds value to the radiological services, which not only provides services by generating diagnostic reports, but also expedites the apropos delivery of results (Levine 2006, p. 27). PACS completely reengineers radiology practices by enabling ubiquitous availability of images to be electronically viewed virtually anywhere and simultaneously, resulting in improved clinical care and productivity throughout the healthcare enterprise.Figure 4 Film-based medicine and filmless medicine (Furukawa et al., 2004).The current set-up of the radiology department encompasses of digital multi-modalities such as, Computed Tomography (CT) Scan, Magnetic resonance Imaging (MRI), Digital Angiography and others performing approximately 180,000 200,000 examinations per y ear. As part of aiming towards creating a digital environment, besides procuring these digital modalities, the department has also established connectivity to a Radiology Information System (RIS) and Hospital Information System (HIS). The HIS feeds verified patient demographics to the RIS, which in turn is responsible for scheduling orders, capturing relevant clinical information and providing a platform for radiologists to prepare examination reports.However, currently hard-copy medical images are the only image capture, display and storage medium. Besides radiology, view boxes are found in diverse locations such as wards and clinics in order to view the radiological images. There is usually only one copy of film to be displayed at any one time, thus reducing the efficiency and posture of patient management.The image management in a conventional environment involves exceedingly complex, high manual and work-intensive processes involving as many as eight (8) different types of pers onnel performing up to ten (10) different tasks and takes about 1 to 4 hours to generate results Figure 5(a). However in a fully electronic environment, this can be reduced to approximately eight (8) tasks, many accomplished by computers, allowing the number of people involved to be reduced to four (4) and results to be generated within 45 minutes to 1 hour Figure 5(b). As such, the implementation of PACS will foster stronger development of consolidated delivery networks at not only the departmental level but also at the organisational level.Figure 5 Workflow process from radiological examination request to final report in a (a) conventional environment and in an electronic (b) RIS and PACS environment distrib. = distributed, Dx = diagnosis, Phys. = Physician, Sched. = schedule (adapted from Bryan, 2003)With the need for increased quality, clinical effectiveness and meeting the pressure of market competition in the digital world, PACS is seen as an opportunity to provide patients wi th clinical services that could never be provided in the analogue world. The scope and benefits of PACS reach beyond the radiology department, whereby, it also greatly expands the exposure, expense and operational impact hence the need to be comprehensive and include all key players in the decision making process, planning and the development of new strategy is crucial (Chaney Cotter, 1998).Implementing and integrating PACS requires significant planning, workflow redesign, system configuration and training. However a common problem in implementing PACS will be recognising the mix of image generation technologies or modalities and identifying different types of interfaces (Chaney and Cotter, 1998). With regard to this, older equipment already installed in this radiology department may require specialised protocol conversion to talk to the new PACS equipment although the established communication standards can be supported by the newer equipment in the market today.As such, the PACS and modality vendor input is crucial to identify the required number of modalities to be linked and whether any licensing or implementation costs attached to each modality connection will be required. An enterprise-wide strategic planning methodology for PACS, which involves a broad cross section of the imaging and user community, proposed for this medical centre is outlined as in Figure 6.Figure 6 Development of an enterprise-wide PACS strategic plan (adapted from Chaney and Cotter, 1998)Once a unified PACS strategy planning process to establish a sound business case has been undertaken, the next timbre will be developing a invite For Proposal (RFP) and conducting the PACS vendor plectrum process. The PACS equipment needs and archive size requirements are instrumental in preparing an effective RFP. The RFP will include detailed specifications for the locations and types of required equipment and a high-level project plan in order to specify the installation accurately as shown in Figure 7.Figure 7 PACS life calendar method overview (adapted from Chaney and Cotter, 1998)In addition, it is also imperative for vendors to be able to specify all devices required during the vendor quotation phase of the project. Finally, establishing connections to the already existing RIS-HIS, computed skiagraphy, digital radiography and results reporting may consume months prior to the roll-out of the system as shown in Gantt Chart (Appendix 1).7.0 Financial analysisThe monetary analysis plays an integral part of the business case development and is crucial to the assessment of the economic viability of the proposed PACS initiative. This would set the stage for the technical and performance specifications prior to the establishment of a procurement exercise.Lim (2008) stated that the budgets for PACS encyclopedism project are usually identified as capital budget estimate, which encompasses the probable costs to acquire and implement the technology and recurrent budget es timate that represents the projected future costs of managing and maintaining the system in a sustainable operational state. The capital and recurrent costs descriptive items are as shown in Table 5.Types of costsDescriptions of items great costsCapital purchase costs of PACSInstallation and commissioning costsAny costs associated with imaging equipment upgradesInfrastructure costs (e.g. data centre, network, computers for image distribution)Change managementRecurrent costsStaff and accommodationConsumablesOngoing trainingUpgrade costsTable 5 Capital and recurrent costs for PACS acquisition project (Lim, 2008)With regards to the PACS acquisition, Lim (2008) further stated that there are a few financial models to be considered when acquiring PACS, namelyThe traditional purchase, where purchase is outright and owned and managed by the institution, with vendor providing technical support under a service contract agreement, which is a common method in public sectorApplication Service Pr ovider (ASP), where the facility purchases a service from the vendor with charges based on fee-per-service arrangementsLeasing models, which can have some financial incentives in private sector context.The proposed budgetary costs for PACS implementation recommended for this public sector medical centre is based on a traditional purchase acquisition model, which illustrates how a capital and recurrent budget may be established amounting to costs assumption of RM 3,487,000 presented in Appendix 1. However, calculating the purchase, upgrade and running play costs is only half of the budgeting task, the other side of the equation is the cost savings, efficiencies and service improvements that this technology can bring to an imaging facility.These savings include film and stationery costs such as jackets, chemistry costs, film storage and handling including space and file room staff, processor purchase and running costs. Therefore it is important to undertake a cost-benefit analysis to see whether an individual option has financial or economic merit.A study conducted by Van ginep et al., (1994, cited in Becker and Arenson, 1994) stated that the overview of data from 15 cases collected with CAPACITY (Cost and Critical Analysis of PACS Indicating its Yield) cost-modelling software suggests that, when the cost of hardware components is allowed to drop 5% to 25% per year, some hospital-wide systems will become less expensive than film in the future with breakeven between 4-8 years, which is applicable for this scenario. As such, with the fast decreasing price of digital storage in the current market, it is deemed that PACS will provide cost and space advantage as compared to film archives. However, a downtime contingency plan, where costs for backup film feeling using laser printers is also crucial to support successful implementation.Cost benefit analysis will provide useful information, but not all the answers. Therefore, one should also consider the intangible b enefits such as the service efficiencies and quality improvement that PACS can generate, particularly with fast throughput of images hence these factors should be taken as part of any economic justification.8.0 ConclusionThe informed decision to select, implement and operate PACS begins with a sound, business oriented approach and judicious planning up front in implanting PACS as a strategy. As such building a documented business case and report is the first step to establish baseline expectation for system implementation throughout the enterprise as well as providing an accountability structure and project leadership as has been presented in this report.In this age of high information density and the necessity of its efficient and rapid dissemination through the integrated delivery of networks in healthcare, enterprises should see the decision to implement PACS as a necessary step in maintaining their market position. The greater value of a secure and fast repository of images prov ided by PACS, will improve the detection of disease through improved patient outcomes. These factors will have a huge impact on the way medicine is practiced and the quality of care patients receive. As such it is important for the radiology department to adopt PACS considering the service efficiencies, cost savings and service quality improvements that it can generate thus creating a competitive advantage in the business of radiology.9.0 ReferencesAMBER DIAGNOSTICS. 2010. Radiology Management System RIS / PACS. Amber Diagnostics WWW http//www.amberusa.com/ris/ris-index.asp (29 October 2010).Becker, S. H. and Arenson, R. L. 1994. Costs and Benefits of Picture Archiving and Communication Systems. Journal of the American medical checkup Informatics Association. Online journal. 1(5). pp. 361-371. http//www.ncbi.nlm.nih.gov/pmc/articles/PMC116218/ (10 April 2011).Bryan, R. N. 2003. The Digital rEvolution The Millennial Change in Medical Imaging. Radiology. Online journal. http//radiol ogy.rsna.org/content/229/2/299.full. (22 March 2011).Chan, S. 2002. The immensity of Strategy for the Evolving Field of Radiology. Radiology. Online journal. http//radiology.rsna.org/content/224/3/639.full. (25 March 2011).Chaney, D. M. and Cotter, N. K. 1998. Comprehensive business planning for PACS. Applied Radiology. Online journal. 27(12). (http//www.appliedradiology.com/uploadedfiles/Issues/1998/12/Articles/v0027i12/00801387/main.pdf (25 March 2011).Furukawa, H., Endo, M. Aramaki, T., Morimoto, N., Uematsu, T., Yukizawa, S. and Yuen, S. 2004. Picture Archiving and Communication System Introduced to a New Japanese Cancer Center Hospital. Japanese Journal of Clinical Oncology. Online journal. 34 (7). pp. 425-428. http//jjco.oxfordjournals.org/content/34/7/425.full (20 March 2011).Frost and Sullivan. 2010. Overview of Total Southeast Asian RIS-PACS Market. 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Biomedical Imaging and Intervention Journal. Online journal. http//www.biij.org/2008/4/e32/e32.pdf (12 April 2011)Appendix 1PACS Implementation Strateg y Plan Gantt Chart (activities based on PACS life cycle overview presented in Figure 7)PhaseActivitiesMonthJun-11Jul-11Aug-11Sep-11Oct-11Nov-11Dec-11Jan-12Feb-12Mar-12Apr-12May-12Jun-121PACS comprehensive planning (business technical, functional)2PACS vendor selection signing of contract3PACS system implementation, training testing4PACS implementation system support and enhancement