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      Budgeting for PACS

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          Abstract

          There are a number of models for the acquisition of digital image management systems. The specific details for development of a budget for a PACS/RIS acquisition will depend upon the acquisition model – although there are similarities in the overarching principles and general information, particularly concerning the radiology service requirements that will drive budget considerations.

          While budgeting for PACS/RIS should follow the same principles as budgeting for any new technology, it is important to understand how far the implementation of digital image management systems can reach in a healthcare setting. Accurate identification of those elements of the healthcare service that will be affected by a PACS/RIS implementation is a critical component of successful budget formation and of the success of any business case and subsequent project that relies on those budget estimates.

          A budget for a PACS/RIS capital acquisition project should contain capital and recurrent elements. The capital is associated with the acquisition of the system in a purchase model and capital budget may also be required for upgrade – depending upon a facility’s financial management processes.

          The recurrent (or operational) cost component for the PACS/RIS is associated with maintaining the system(s) in a sustainable operational state.

          It is also important to consider the service efficiencies, cost savings and service quality improvements that PACS/RIS can generate and include these factors into the economic analysis of any proposal for a PACS/RIS project.

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          Most cited references27

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          Emergency radiology coverage: technical and clinical feasibility of an international teleradiology model.

          The purpose of the study was to determine the feasibility of international teleradiology, utilizing day-night time differences, for online interpretation of overnight computed tomography (CT) studies. One hundred and two consecutive Emergency Room patients who underwent CT examinations between the hours of 11 pm and 7 am were enrolled. All age groups and study types were included. CT studies were transmitted from the in-hospital PACS system (Kodak, Fremont, Calif.) to a web-based server (Medweb, San Francisco, Calif.). A radiologist in Bangalore, India, working an 8 amto 4 pm day shift, downloaded and reviewed the studies on a desktop PC using a 128-kbps internet connection at 10-20:1 wavelet compression and generated a report. The report was then uploaded to the server, noting the time at upload. Each study report was compared with the official in-house diagnostic report and concordance assessed on a three-point scale. Mean download time was 8.14 s per image. For head CT reports ( n=47), the mean turnaround time for a final transcribed report was 39.5 min. For abdomen/pelvis CT reports ( n=48) the mean turnaround time was 84.4 min. Out of 106 cases, there was discordance between the clinical diagnostic report and the study report in 20 (19%); however, on subsequent review the teleradiology report was found to be correct in 13 of these. Day-night time differences across the globe can be utilized to provide overnight emergency radiology coverage using web-based teleradiology. Scan download and report upload times are within acceptable limits.
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            SCAR Radiologic Technologist Survey: analysis of the impact of digital technologies on productivity.

            As medical reimbursements continue to decline, increasing financial pressures are placed upon medical imaging providers. This burden is exacerbated by the existing radiologic technologist (RT) crisis, which has caused RT salaries to trend upward. One strategy to address these trends is employing technology to improve technologist productivity. While industry-wide RT productivity benchmarks have been established for film-based operation, little to date has been published in the medical literature regarding similar productivity measures for filmless operation using PACS. This study was undertaken to document the complex relationship between technologist productivity and implementation of digital radiography and digital information technologies, including PACS and hospital/radiology information systems (HIS/RIS). A nationwide survey was conducted with 112 participating institutions, in varying degrees of digital technology implementation. Technologist productivity was defined as the number of annual exams performed per technologist full-time equivalent (FTE). Productivity analyses were performed among the different demographic and technology profile groups, with a focus on general radiography, which accounts for 65-70% of imaging department volumes. When evaluating the relationship between technologist productivity and digital technology implementation, improved productivity measures were observed for institutions implementing HIS/RIS, modality worklist, and PACS. The timing of PACS implementation was found to have a significant effect on technologist productivity measures, with an initial 10.8% drop in productivity during the first year of PACS implementation, followed by a 27.8% increase in productivity beyond year one. This suggests there is a "PACS learning curve" phenomenon, which should be considered when institutions are planning for PACS implementation.
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              PACS reading room design.

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                Author and article information

                Journal
                Biomed Imaging Interv J
                biij
                Biomedical Imaging and Intervention Journal
                Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Malaysia
                1823-5530
                01 October 2008
                Oct-Dec 2008
                : 4
                : 4
                : e32
                Affiliations
                PACS Support Unit, Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
                Author notes
                [* ] Present address: Radiology Support, Clinical and Statewide Services, Queensland Health, 13-15 Bowen Bridge Road, Herston, Queensland 4066, Australia. E-mail: lawrence_sim@ 123456health.qld.gov.au (Lawrence Sim).
                Article
                10.2349/biij.4.4.e32
                3097744
                21611017
                14e14320-be00-4d54-9dde-69f4d0e54779
                © 2008 Biomedical Imaging and Intervention Journal

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 April 2008
                : 21 July 2008
                : 26 August 2008
                Categories
                Review Article

                Radiology & Imaging
                budget,purchase,pacs,radiology
                Radiology & Imaging
                budget, purchase, pacs, radiology

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