Now considered core technology for acute care providers, as well as some types of ambulatory care centers, diagnostic imaging technologies are enabling transformations not only in clinical efficiencies, but also in care delivery. In most healthcare provider organizations, diagnostic imaging capabilities already extend well beyond traditional radiology departmental roots. Clinicians in multiple specialties, including cardiology, dermatology, gastroenterology, magnetic resonance imaging (MRI), molecular imaging, nuclear imaging, pathology, teleradiology and ultrasound, consider imaging procedures as essential diagnostic tools.

As the transition to end-to-end advanced digital imaging systems continues to grow, replacing traditional film-based imaging systems, new opportunities arise. In addition to streamlining clinical workflow efficiencies, emerging technologies are not only enabling clinicians to make diagnoses with increased precision, but to identify disease states at far earlier stages and intercede with interventions and treatments at far earlier stages.

This is a market sector not only in transition, but poised for major change. The emerging field of predictive diagnostics, which marries databases and sophisticated information management tools and technologies, is changing not only the way medicine is practiced, but also where interventions are managed and who oversees them. Quicker turn-around times, coupled with the benefits of better outcomes related to earlier diagnoses and interventions, make these systems desirable, if not imperative, for care provider organizations if only from a quality improvement vantage point.

Although these systems are expensive, they offer a revenue source, provided they are sufficiently used. This gives organizations with budgets able to accommodate big-ticket purchases, especially large institutions and healthcare networks, a clear advantage, at least until the regional market reaches its saturation point. Smaller care provider organizations, however, continue to be hampered by the significant cost of entry. Organizations must also be able to afford ongoing support and maintenance costs, at least until the associated revenue stream kicks in.

To meet demand, vendors active in the digital imaging market are not only bulking up, primarily through acquisition, but also committing large investment budgets to research and development efforts. A steady stream of innovative and highly-sophisticated diagnostic systems and equipment are constantly creating upgrade and new purchase opportunities for provider organizations.

Would Consider Changing Dlagnostic Referral Patterns if Images More Accessible Do Not Have Diagnostic Imaging Department

Organizations with departmental PACS

Able to Capture Images in Digital Format

RIS and PACS, now and future

Seeking to better understand the current state of radiology information system (RIS) and picture archiving communication systems (PACS) in hospitals, health systems and ambulatory care centers, as well as upcoming plans for these care provider organizations, Vendome Group LLC, publisher of Healthcare Informatics, conducted an online survey in April 2007.

A total of 396 members of the Healthcare Informatics Research Panel—representing a broad cross-section of management and professional groups, geographic location, size and type of care delivery and health plan organizations—completed online interviews for the study. Ambulatory care centers not owned by health systems were also well represented.

Although the survey focused heavily on systems currently in use and planned in acute care facilities, we wondered how ambulatory care-based facilities without diagnostic imaging departments were being affected by the industry's transition to digital image capture and access to digital images. Almost half didn't see it as having a direct effect on their current referral practices, reporting that the number one determinant in where imaging studies are conducted is related to the patient's insurance coverage.

However, these referring physicians were nearly evenly divided when asked if they would consider changing diagnostic referral patterns if they could access images more easily and quickly. (See Figure 1) However, time is not a major issue for many ambulatory-based physicians. In most cases, their referrals are not classified as emergencies. Although reading common diagnostic images are well within their expertise, most prefer to defer to the appropriate consulting specialist. Within the group of those care providers who make diagnostic imaging referrals but lack a diagnostic imaging department in their organization, nearly a quarter said the availability of digital images would have no effect on their referral patterns as they don't interpret images, but rely upon the referral/specialist's report.

Radiology and PACS in acute care facilities

All hospitals and health networks with large bed counts had radiology and PACS implemented and a large majority of all types of care providers have diagnostic imaging departments. Most can capture digital imaging data and use PACS.

Among organizations using a PACS to manage the storage, retrieval, distribution and presentation of medical images, 89 percent of hospitals and health delivery networks reported having a departmental system, with penetration highest (95 percent) for large hospitals and integrated health delivery networks with 500 or more beds. Slightly more than one-quarter of standalone businesses, almost all ambulatory care centers, said they had a departmental PACS. (See Figure 2)

Although PACS implementations continue to grow, especially among small and mid-size care provider organizations, all types of organizations struggle with capturing images in digital format. Once again, access to funding and the bigger budgets that accompany hospitals and healthcare delivery networks, is enabling those facilities to lead the way in digital image capture. More than half (56 percent) of those surveyed said their acute care hospital or healthcare network has the capability to capture digital images. Among those representing teaching and academic facilities, 29 percent claimed that capability. Specialty and government acute care facilities reported 8 percent and 7 percent, respectively. (See Figure 3)

Cost continues to be a major deterrent in diagnostic imaging implementations, so said many of those surveyed. And it isn't just the cost of acquisition, they say. Significant ongoing costs associated with maintenance and support are ongoing concerns. But that certainly isn't the only criticism aimed at vendors and products.

Integration, interoperability and compatibility issues topped responses to the inquiry that asked, "What change in the market, products available or improvements would you most like to see in the diagnostic imaging market?" Integration with the electronic medical record was a frequent citation, but respondents say they want diagnostic imaging system compatibility with a range of other clinical systems, including cardiology, other image-based specialty departments and pathology.

If end users stand by their opinions during vendor negotiations, they'll be negotiating for more than cost, however. They have many complaints about existing products and services. In addition to vendor support issues, functionality, flexibility and ease-of-use were frequent mentions.