First Consulting Group
Information technology alone, of course, is not the answer. But the right IT investments, such as enterprise digital imaging, can be optimized through process change and performance measurement that leads to clinical transformation -- which is the key to overcoming today's challenges.
Enterprise digital imaging
Of all the technologies that promise to transform the business of healthcare, enterprise digital imaging (the extension of PACS technology across the enterprise) is probably the most significant. These networks have the potential to shave hours from the workdays of valuable clinical staff, enhancing their operational efficiency dramatically. This in turn makes it easier to attract and retain vital personnel.
Enterprise digital imaging also means rapid access to information when and where it’s needed. The result is faster and improved clinical decision-making, which in turn enhances patient satisfaction through reduced wait times for procedures. This same benefit also means patients are no longer responsible for transporting their own films from place to place -- an error-prone and time-consuming practice.
Although the potential savings of time, cost, and personnel are dramatic, the investment this technology demands is no trivial sum. The organization must not only invest in the PACS technology itself, but also in infrastructure (network, storage, and so on) and integration with and upgrades to modalities.
There are also integration issues with clinical systems and computerized patient record systems; physical renovation to reading areas and data center space; increased resources to support the new systems; and significant re-investment and maintenance costs. This typically equals several million dollars for a community-based hospital, and up to tens of millions of dollars for the largest integrated delivery networks. To justify such expenditures, the results must significantly impact the organization’s ability to achieve clinical, business, and technology objectives.
Keys to success
For those who seek to help their organizations maximize the value of digital imaging investments, there are six keys to success. For success to occur, however, there must also be clearly defined benefits, as well as enthusiastic support and commitment from management to use the investment as an opportunity for clinical transformation. But without using all six keys to success, clinical transformation will be nearly impossible to achieve.
Here are the keys we believe are critical to making an enterprise digital imaging investment not only achieve cost justification, but also lead to true clinical transformation.
1. Benefits analysis
The first step is to identify the potential benefits that can be achieved through the use of the technology and process improvement. This requires the establishment of clinical center teams to focus on gaining specific benefits from the processes relevant to each member's specific clinical area. You might try to build teams with personnel from radiology, cardiovascular, noninvasive cardiology, and emergency department and critical care centers. Also consider personnel from orthopedics, oncology, and other departments.
These teams would first look at what is being measured in the current environment, and would then identify the areas for potential improvement with specific metrics applied to measuring these benefits (for example, increase CT throughput by 15%, improve radiology report turnaround time by 50%, reduce schedule wait time for an MR procedure by two days, and so on).
The team members will need to pay careful attention to details such as the length of the measurement period. They will need to define the tools and procedures necessary to collect, aggregate, store, and process the data, and develop a way to perform ongoing benefits measurement.
2. Integrated system and process design
The process improvement component of a transformation effort should focus on developing business processes that are tightly integrated with the digital imaging technology. Most often, process design that improves operating performance and maximizes the functionality of the imaging system means creating new processes.
This requires not only knowledge of the digital imaging application, but also knowledge of the business operations so that the new system can be implemented to best support those operations. This is accomplished by using iterative design methods and scenario-based examples that can demonstrate how the new processes take advantage of the technology.
Remember that digital imaging and information systems integration must occur throughout the process design. An integrated design approach optimizes the digital imaging and information system, and increases the organization’s "buy-in" and adoption of the changes.
To evaluate the magnitude of potential improvements and benefits, map imaging-related work processes -- such as acquisition, interpretation, integration and archive, distribution, treatment and analysis, research and teaching -- across the clinical centers that either produce or use images. Identify the value of each potential benefit: increased quality, lower cost, increased revenue, increased efficiency, and so on. This helps prioritize the potential improvements.
3. Implementation
Digital imaging systems are incredibly sophisticated clinical tools that provide information at the time of decision-making. When coupled with transformed workflow, they become even more powerful.
A well-managed and structured implementation effort will ensure successful migration to the new process- and technology-enabled environment. The implementation phase of the transformation includes the traditional steps in system implementation (except for design): build, test, train. This approach applies to digital imaging technology, and can be applied to the entire implementation or phases of the digital imaging rollout.
4. Change management/risk management
An organization should incorporate a change-management program into the overall design and implementation initiative. A change-management program is key to ensuring a successful transition to the new process and technology environment. The components of such a program include risk management, training, and communications.
The objective of risk management is to identify and mitigate risks associated with the implementation of the technology and process-change initiatives generated by transformation. There are risks associated with the management of information technology, and also of other efforts not directly related to the digital imaging initiative, that could impact the project.
These include things such as common resources participating in multiple projects or committees, physical space restrictions, new demands on resources or departments, and so on. It’s important to understand the potential risks and their associated impact; develop plans to mitigate the risks; assign appropriate accountability; and develop methods to resolve conflicts and manage risk.
Training is a critical success factor to all major change initiatives, whether technology, process, or both is in transformation. It’s extremely important to incorporate technology, process, and policy and procedure into a comprehensive user training program.
5. Operations
Sustaining the benefits of digital imaging transformation and implementation over time requires that the appropriate organizational and operational structures (continuous improvement, technology operation, and clinical operation) be in place. An organization should review its clinical and information technology operations methods, modifying them as needed to fit the new processes and technologies.
This includes developing or changing departmental and organizational policies and operational procedures to support the new processes and technology. In addition, appropriate methods to manage the systems, and technology to ensure system performance standards are met, must be established. There also will need to be provisions for pro-active user and technical support; refining processes as needed to adapt to new situations; and the continuous measurement and tracking of benefits.
6. Benefits monitoring
A transformation approach to digital imaging technology implementation differs from the traditional approach to technology implementation by its sustainability and measurability. Monitoring and measuring benefits -- and adjusting processes to achieve desired results -- are key to sustaining the overall effort and continued optimization of the investment.
Critical success factors
The number of critical elements that must be in place for a digital imaging transformation effort to be successful are few but powerful. Without them, no amount of money or effort from IT staff will deliver the desired results.
Executive and clinical leadership must champion the project and be held accountable for the results. The benefits must be clearly established at the onset and must be measurable. Transformation must be undertaken with a structured approach and utilize a comprehensive methodology. There must be active participation from clinicians in appropriate areas of the organization, and there should be incentives for clinicians to participate in each phase of the project.
The champions of an enterprise digital imaging initiative must have:
- A clear vision and understanding of the initiative.
- Software that supports clinician workflow.
- Willingness to standardize processes.
- Tools to provide value to the clinician.
- Rapid measurement and communication of benefits.
- Strong project management skills.
- Work plan and project orientation.
- Ability to integrate the work of multiple teams.
- Training
- Must be specific to the audience and provided through multimedia.
- Provide just-in-time training.
- Evaluate effectiveness of training through simulation and competency.
Digital imaging technology can have a dramatic and sustainable impact on an organization -- if the organization is committed to a comprehensive approach. A comprehensive initiative offers the opportunity to maximize technology investments, measurably improve performance, and contribute substantially to an organization’s ability to meet today's toughest challenges.
By Marcia McCoyAuntMinnie.com contributing writers
April 18, 2002
First Consulting Group is a provider of consulting, integration, and information technology services to healthcare, pharmaceutical, and other life sciences organizations.
Related Reading
Negotiating PACS, from prenuptials to partnership, February 22, 2002
ASP pricing and planning strategies for PACS, January 22, 2002
Reinvestment optimizes PACS productivity, November 21, 2001
The state of the enterprise digital imaging market, October 23, 2001
Copyright © 2002 First Consulting Group
