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The Hidden Costs of Radiology
November 1, 2007
Four years ago, St. Louis-based Metro Imaging implemented a new radiology information system at its five standalone diagnostic imaging sites employing seven radiologists and 70 other personnel.
The new system from Milwaukee-based Merge Healthcare was Windows-based, a technological and cultural leap from the practice's decade-old, DOS-based radiology application.
Right out of the starting gate, practice administrators underestimated how long it would take everyone to get used to the new system. "It probably took them three to four months to get comfortable scheduling and registering patients," recalls Christine Keefe, CFO. "Everything was different. It really took a long time for them to do it without thinking."
Consequently, the practice had to overstaff for a while to maintain productivity, an unanticipated cost of the diagnostic imaging upgrade.
In recent years, Metro Imaging has added a picture archiving and communication system and document scanning and digital dictation software from Merge, and a digital mammography imaging system from Siemens Medical Solutions, Malvern, Pa.
Along the way, the practice has found more hidden costs associated with radiology systems. But it's also avoided some expenditures by subsequently expecting the unexpected.
For instance, the practice bought mammography viewing software from Merge because it could use the software on existing workstations while Siemens' software required proprietary workstations.
Metro Imaging also avoided additional costs by implementing digital mammography at only one site but the viewing software at five sites. It also introduced the viewing software to one site per month and shifted staff to each site to provide more hands-on training.
In addition, the practice bought hardware on its own from Round Rock, Texas-based Dell Inc. instead of from the imaging vendors.
Many unanticipated costs can be avoided by better policing vendor behavior before and after an I.T. contract is signed, says Vince Ciotti, president at HIS Professionals Inc., a Santa Fe, N.M.-based consulting firm that specializes in vendor contract negotiations.
Too often, radiologists fall in love with new technology and not enough attention is put into really studying contract language to spot possible hidden costs down the road, he adds. "Someone's handed the contract to look at before signing."
In fact, many steps that organizations can take to minimize hidden radiology costs also apply to other information technology purchases, Ciotti contends (see story, page 26).
Conversely, vendors themselves can be a source of information on how to avoid hidden costs and should be asked to share their experiences at other client sites, says Kim Schmeichel, senior technical analyst at Merge Healthcare (see story, page 28).
Seven-hospital Florida Hospital in Orlando first took the PACS plunge in 1996 when it signed a contract with Agfa Healthcare, Greenville, S.C.
The Florida division of Adventist Health System was an early adopter of Agfa's technology. Being an early adopter carried some risk but also gave the delivery system leverage over the vendor and guaranteed ample support. CIO Andy Crowder also ensured there was some risk sharing by adding a cost-avoidance stipulation before the contract was ever signed.
Crowder added up what the delivery system was spending on film, showed it to Agfa and told the vendor, "In no way, shape or form is my expenditure allowed to go above what I'm spending on film," he recalls. The result? "Agfa was incredibly motivated to do what it took to keep costs below that number," he adds.
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