Abstract
Most economic studies of picture archiving and communication systems (PACS) to date, including our own, have focused on the perspectives of the radiology department and its direct costs. However, many researchers have suggested additional cost savings that may accrue to the medical center as a whole through increased operational capacity, fewer lost images, rapid simultaneous access to images, and other decreases in resource utilization. We describe here an economic analysis framework we have developed to estimate these potential additional savings. Our framework is comprised of two parallel measurement methods. The first method estimates the cost of care actually delivered through online capture of charge entries from the hospital’s billing computer and from the clinical practices’ billing database. Multiple regression analyses will be used to model cost of care, length of stay, and other estimates of resource utilization. The second method is the observational measurement of actual resource utilization, such as technologist time, frequency and duration of film searches, and equipment utilization rates. The costs associated with changes in resource use will be estimated using wage rates and other standard economic methods. Our working hypothesis is that after controlling for the underlying clinical and demographic differences among patients, patients imaged using a PACS will have shorter lengths of stay, shorter exam performance times, and decreased costs of care. We expect the results of our analysis to explain and resolve some of the conflicting views of the cost-effectiveness of PACS.
Article PDF
Similar content being viewed by others
References
Evens RG: The economic impact of technology on diagnostic imaging at a university medical center. Am J Radiol 153:179–183, 1989
Eisenberg JM: Clinical economics: A guide to the economic analysis of clinical practices. JAMA 262:2879–2886, 1989
Drummond MF, Stoddart GL, Torrance GW: Methods for the Economic Evaluation of Health Programmes. Oxford, UK, Oxford University, 1987
Eisenberg JM, Koffer H, Finkler SA: Economic analysis of a new drug: Potential savings in hospital operating costs from the use of a once daily regimen of a parenteral cephalosporin. Rev Infect Dis 6:S909-S923, 1984 (suppl, abstr)
Goel V, Deber RB, Detsky AS: Nonionic contrast media: Economic analysis and health policy development. Can Med Assoc J 140:389–395, 1989
Fischer HW: Cost vs. safety: The use of low-osmolar contrast media. JAMA 260:1614, 1986
Mooney G: Breast cancer screening: A study in cost-effectiveness analysis. Soc Sci Med 16:1277–1283, 1982
Simon DG, Lubin MF: Cost-effectiveness of computerized tomography and magnetic resonance imaging in dementia. Med Decis Making 5:335–354, 1985
Forman HP, Heiken JP, Brink JA, et al: CT screening for comorbid disease in patients with prostatic carcinoma: Is it cost effective. Am J Radiol 162:1125–1128, 1994
Yin D, Baum RA, Carpenter JP, Langlotz CP, et al: Cost effectiveness of magnetic resonance angiography in symptomatic peripheral vascular disease. Radiology 1995 (in press)
Detsky AS, Naglie GI: A clinician’s guide to cost effectiveness analysis. Ann Intern Med 113:147–154, 1990
Bombardier C, Eisenberg JM: Looking into the crystal ball: Can we estimate the lifetime cost of rheumatoid arthritis? J Rheum 12:201–204, 1985
Finkler SA: The distinction between costs and charges. Ann Intern Med 96:102–109, 1982
Becker SH, Arenson RL: Costs and benefits of picture archiving and communication systems. J Am Med Informatics Assoc 1:361–371, 1994
Cywinski J, Vanden Brink JA: Review of experience with a PACS cost analysis model. SPIE Medical Imaging III: PACS System Design and Evaluation, Newport Beach, CA, January 29–February 3, 1989
Saarinen AO, Haynor J, Loop J: Modeling the economics of PACS: What is important? SPIE Medical Imaging III: PACS system Design and Evaluation, Newport Beach, CA, January 29–February 3, 1989
Andriessen JHT, ter Haar Romeny BM, Binkhuysen FH: Savings and costs of a picture archiving and communication system in the University Hospital Utrecht. SPIE Medical Imaging III: PACS System Design and Evaluation, Newport Beach, CA, January 29–February 3, 1989
van Gennip E, Ottes FP, Poppel BM: Why do cost-benefit studies of PACS disagree? SPIE Medical Imaging III: PACS System Design and Evaluation, Newport Beach, CA, January 29–February 3, 1989
Beard DV, Parrish D, Stevenson D: A cost analysis of film management and four PACS systems based on Ethernet, FDDI, BISDN, and HPPI. SPIE Medical Imaging III: PACS System Design and Evaluation, Newport Beach, CA, 1990
Seshadri SB, Arenson RL, DeSimone D: Costsavings associated with a digital radiology department: A prelimmary study. Ninth Conference on Computer Applications in Radiology, Hilton Head, SC, 1988
Vanden Brink J, Cywinski J, Szerlag C: Cost analysis of present methods of image management. SPIE Medical Imaging III: PACS System Design and Evaluation, Newport Beach, CA, February 5, 1987
Stockburger W, King W: PACS: A financial analysis for economic viability. Appl Radiol 19:17–24, 1990
Straub WH, Gur D: The hidden costs of delayed access to diagnostic imaging information: Impact on PACS implementation. Am J Radiol 155:613–616, 1990
Hilsenrath PE, Smith WL, Berbaum KS: Analysis of the cost effectiveness of PACS. Am J Radiol 156:177–180, 1991
De Simone D, Kundel HL, Arenson RL: Effect of a digital imaging network on physician behavior in an intensive care unit. Radiology 169:41–44, 1988
Parrish D, Beard DV, Kilpatrick KE: Operational modeling for PACS: How do we decide if it’s cost effective? SPIE Medical Imaging III: PACS System Design and Evaluation, Newport Beach, CA, January 29–February 3, 1989
Taira RK, Mankovich NJ, Boechat MI, Kangarloo H, Huang HK: Design and implementation of a picture archiving and communication system for pediatric radiology. Am J Radiol 150:1117–1121, 1988
Knaus WA, Wagner DP, Draper EA, et al: The APACHE III prognostic system: Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636, 1991
Romano PS, Roos LL, Jollis JG: Adapting a clinical comorbidity index for use with ICD9-CM administrative data: Differing perspectives. J Clin Epidemiol 46:1075–1079 1993
Charlson ME, Pompei P, Ales KL, et al: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chron Dis 40:373–383, 1987
Author information
Authors and Affiliations
Additional information
Supported by Grant No. CA53141 from the National Cancer Institute, National Institutes of Health, United States Public Health Service. C.P.L. is supported in part by a General Electric Radiology Research Academic Fellowship (GERRAF) Award.
Rights and permissions
About this article
Cite this article
Langlotz, C.P., Even-Shoshan, O., Seshadri, S.S. et al. A methodology for the economic assessment of picture archiving and communication systems. J Digit Imaging 8, 95–102 (1995). https://doi.org/10.1007/BF03168132
Issue Date:
DOI: https://doi.org/10.1007/BF03168132