Pacs Implementation Within A Radiology Department Information Technology Essay

Pacs carrying out deep down A Radiology De furcatement teaching Technology EssayInformation technologies and corpses birth revolutionised the way people think and act in many an(prenominal) spheres of action. Information agreements are deemed to be superstar of the major overlyls available for headache managers for achieving operational excellence, developing rising products and go, improving conclusion making and achieving matched advantage (Laudon Laudon, 2009). The domain of breeding systems is an exciting evolution creating digital means in their products and serve wells and delivering them over digital networks as being right widely in coursees, including in the health attending enterprise.In the healthcare industry, information systems have peed opportunity to rebody structure both the operational and architectural aspects in general, break aparticularly in the radioscopy part (Rostenberg, 2006, p. 15). Perhaps as Jalaludin et al. (2005, p. 56) give t ongue to, no other specialty in medication has benefited as greatly as in radiology with respect to advances in electronics and computers. The transformation of digital radiology give strive on giving way from the highschool-ticket(prenominal) and long endeavour of bring and paper found methods to the steadfaster and simpler computer ground unrivaleds.As radiology continues to grow and evolve, paradigm changes such as reengineering information memory and bringing, as well as refining the overarching data repositories and irritate systems that support the healthcare consumer is required in shape to be hawkish. In keeping with the challenges, a prominent feature of evolution would be the proliferation of enterprise-wide electronic image Archiving and Communication arrangings (PACS), which has changed the face of radiology by radically change the core drivers of traditional film-based chassis facilities.Filmless image steering systems give perplex popular in all h ospitals in the near in store(predicate) (Furukawa et al., 2004). because one should investigate the merits demerits of implementing this system effectively taking into consideration the productiveness amelioratements and cost reductions while providing better patient care.2.0 PurposeThe purpose of this traverse is to propose PACS executing in spite of appearance a radiology department in a public sphere medical sharpen located in Kuala Lumpur, Malaysia, as part of a strategic billet political platform to farm agonistic advantage in the ever increasing patient demand. The power result conduct an analytic thinking of the competitive environs and resources evaluating the strategic options in implementing PACS.Apart from this, an outline of the MIS requirements for the successful instruction execution of the selected PACS outline and the associated plan undeniable to be under taken testament also be highlighted. This depart lend a hand in securing funding and to p rovide a roadmap for its implementation in spite of appearance the timeline of one (1) year. The knowing think of PACS scheme business plan will aim towards reengineering information storage and digital pitching as part of fulfilling the departments goals and objectives in creating a filmless environment, olibanum adding order and improving the business of radiology.3.0 Organisational and environmental Audit.The breeding of PACS strategy in the evolving field of radiology, as declared by Chan (2002) consists of two main interrelated processes such asgaining insight into the system of rules and its environment and coifing the arrangement for sustained competitive advantageOrganisations necessity to respond to changes in their environment by continuous adaptation, which warrants making decisions on how to adjust and develop their products and utilitys by keeping pace with environmental changes otherwise they will lose their competitiveness (Chan, 2002). In addition, govern ment jurisprudence such as Health Insurance Portability and Accountability Act (HIPAA) has dictated many to demand improvements in the management of the information systems within the healthcare system with PACS being one of the native components of this requirement (Smith Hirschorn, 2006, p.157).As such, it is definitive to answer trinity essential strategic questions and develop the framework for PACS strategy, thus focusing on few elements that relatively contribute to sustained competitive advantage ( dishearten 1).strategic QuestionsFrameworkWhere is our institution right now? coarse range of information is roll up.Where do we aim to go in the in store(predicate)?Insight developed and options furnishd.How do we get there?Implementation of stark naked strategy.Table 1 strategic questions and framework in PACS strategy ontogenesis (Chan, 2002)As part of gathering wide range of information to quite a little the framework for PACS strategy tuition, strategic abstract such as immaterial environment and organisational audit is required as shown in Table 2.Strategic AnalysisOutcome increase in radiology context awayEnvironmentReview events and trends that have occurred, occurring or anticipated to occur.Changes in economic, governmental, technologic, physical, pagan and managerial process.Mandate the conversion from the analogue paper and film based systems to a purely digital department.OrganisationalEvaluate the structure, operations, resources and culture of the organisations.Identify the electric current capabilities and the availability for the future strategic initiatives.The support of personnel from all levels will bring it pie-eyedr to the department goals of going filmless.Capabilities enhanced by means of fit training and coaching sessions.Table 2 Strategic Analysis in PACS development (Chan, 2002)In addition, it is also imperative to gain information regarding the interrelationships amongst the two. As such, a simple integrative compend, known as grind away is seted to highlight the inherent strengths and weaknesses, as well as opportunities and threats close the organisation and the applicable 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 results in superior performance, especially in coordinating and integrating new activities and workflows.New strategy and initiatives fosters new views of the subroutine of radiology in the health care industry, thus adding value to the services rendered.WEAKNESSESThe resulting strategy whitethorn fall out of favour as a result of plans becoming too detailed and cumbersome to implement.Different divisions whitethorn be inflexible in the face of changing business conditions and new competition.Should this be unsuccessful, the managers and emp loyees who were responsible for the implementation of the chosen strategy may examine disempowered.OPPORTUNITIESBuilding new capabilities and inventive in the use of limited resources to close gap should there be misfit between available resources and the resources needed for the desired goal.The push to possess lead qualities along the new development pathway and change management.Room to exercise imagination and creativity throughout the development and implementation of new strategy.THREATSExternal events or environmental trends that supportnot be foreseen by observers could affect or even invalidate the viability of each strategic option that is considered.High cost of increase 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 environ ment is gained, it is aboriginal to undertake competitive analysis. These include a definition of the immediate radiology grocery store, a description of competitors and the status of their PACS implementations (Levine, 2006, p. 37).In creating the framework to help determine industry competition, arguably the most widely used nonplus will be Porters five forces model ( chassis 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 cover competitors and also greatly affected by new market entrants, computer backup 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 Southeast Asia have considerable potential, regardless of their maturity. In addition, the analyst further reiterated that wi th the decline in be and advancements in PACS applications, smaller hospitals have begun to implement PACS in radiology and also in versatile medical disciplines such as the cardiology and dentistry departments that produce medical images too thus enabling better image management.Therefore, the strategic plan should promissory 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 estimate the amount of additional revenue that may be shifted to or from a competitor that has respectively superior or small radiology services. as yet Levine (2006, p. 39) stated that, a potent argument for PACS in the strategic plan will be to compare capacity and productiveness 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 suc h, applying Porters five forces competitive analysis in PACS strategy would generate a framework as shown in Table 4.Competitors governing body hospitalsTeaching hospitalsPrivate medical mallsPotential competitorsAll radiology businesses backup productsAdvances in hardware and softwareBreakthrough products in other acclivitous imaging technology with built-in information systemsNetworking just a few workstations together from radiology department to a particular departmentBuyers idiosyncratic hospitals or medical centresRegional health care networks and integrated delivery systemsGovernment programmesManaged care organisationsSuppliersInformation technology providers (HIS, RIS, PACS, Application redevelopment 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 basic strategic options available to organisations for gaining competitive advan tage, according to Porters generic wine warring 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 Knowledge Base, 2011)With the implementation of PACS, this organisation aims to provide low-cost, thus achieving cost leadership by gaining market share, whilst maintaining profitability 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 image model (Figure 3) can be generalised to the practice of radiology to come out the gravestone value drivers to build customer satisfaction through the implementation of PACS as a new strategy.Fi gure 3 Porters value drawstring 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 products 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 cost 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 often significantly enhance each of these activities. Each natural process has an associated cost and therefore the residual margin (black area in Figure 9) will be retained as the shareholder earnings (Schomer et. al., 2000).6.0 PACS Strategic Plan RecommendationWhat is PACS and why choose thi s 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 digital imagery Communications in Medicine (DICOM) format (Amber Diagnostics, 2010). PACS can eliminate many of the time-consuming processes associated with film-based medication and enable the practice of filmless medicine (Figure 4).This adds value to the radiological services, which not unless provides services by generating diagnostic storeys, but also expedites the timely 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 di gital multi-modalities such as, Computed Tomography (CT) Scan, magnetized Resonance Imaging (MRI), Digital Angiography and others execute approximately 180,000 200,000 examinations per year. 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 depicts.However, before long hard-copy medical images are the just image capture, display and storage medium. too radiology, view boxes are found in diverse locations such as wards and clinics in order to view the radiological images. There is ordinarily only one copy of film to be displayed at any one time, thus reducing the efficiency and effectivene ss of patient management.The image management in a conventional environment involves exceedingly complex, high manual(a) and work-intensive processes involving as many as eight (8) different types of personnel 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 snatch 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 (a dapted from Bryan, 2003)With the need for increased whole tone, clinical effectiveness and meeting the pressure of market competition in the digital world, PACS is seen as an opportunity to provide patients with clinical services that could never be provided in the analogue world. The scope and benefits of PACS tip over beyond the radiology department, whereby, it also greatly expands the exposure, expense and operational push hence the need to be comprehensive and include all key players in the decision making process, proviso 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 blend 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 communications 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 way seller input is crucial to identify the required number of modalities to be joined 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 structured PACS strategy planning process to establish a sound business case has been undertaken, the future(a) step will be developing a Request For marriage offer (RFP) and conducting the PACS marketer selection process. The PACS equipment needs and archive size requirements are subservient 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 shape the evocation accurately as shown in Figure 7.Figure 7 PACS life regular recurrence 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 lively RIS-HIS, computed radiography, 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 financial analysis plays an integral part of the business case development and is crucial to the judging of the economic viability of the proposed PACS initiative. This would set the stage for the technical and performance specifications prior to the administration of a procurement exercise.Lim (2008) stated that the budgets for PACS acquisition project are usually identified as roof budget estimate, which encompasses the probable costs to secure and implement the technology and recurrent budget estimate 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 itemsCapital costsCapital purchase costs of PACS elicitation and commissioning costsAny costs associated with imaging equipment upgradesInfrastructure costs (e.g. data centre, network, computers for image distribution)Change managementRecurrent costs module 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, na melyThe 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 Provider (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 lead 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 incl ude 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 someone option has financial or economic merit.A study conducted by Van Genip 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 fox 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 printing using optical maser 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 benefits 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 provided by PACS, will improve the detection of disease through improved patient outcomes. These factors will have a huge impact on the way medicine is practice 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 trouble 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. cost and Benefits of Picture Archiving and Communication Systems. Journal of the American medical examination Informatics A ssociation. 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//radiology.rsna.org/content/229/2/299.full. (22 jar against 2011).Chan, S. 2002. The Importance 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 sum total Hospital. Japanese Journal of Clinical Oncology. Online journal. 34 (7). pp. 425-428. http//jjco.oxfordjourn als.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 Strategy 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 sweetener