"If you take care of the patient, everything else will fall into place," he says. "If you do, you'll provide good patient care at a very high speed, and in turn, that will give you the revenue you are looking for."

A decade ago, Tomo walked into a boardroom at SJEH with a 1-foot piece of CAT5 cable in one hand and a pitch to transform the hospital in the other. Tomo told his fellow executives that if they wanted to have a state-of-the-art facility at some point, he was holding what they needed.

Tomo walked out of the meeting that day with the OK to spend $2.5 million to build the best WAN he could. It worked. Last year when Tomo wanted to get a PACS, RIS and an EMR, he returned for another nod. Tomo chose American Fork, Utah-based NovaRad Corp. for imaging, and in May his hospital rolled out NovaPACS.

Tomo says he selected the product for its reputation, cost, and ability to let him say goodbye to film. By transitioning to a shared imaging system, doctors can see pictures in any place, at any time, marrying patient care and revenue generation.

"A doctor can wake up in the middle of the night and by 4 or 5 a.m. know what he's doing that day," Tomo says. If in reading the images it's discovered that further treatment is needed, the patient can be routed appropriately, but "if everything is good, he can discharge the patient and you can fill the bed that day."

Patricia Gillespie agrees and says PACS is about efficiency and efficacy. Gillespie is administrative director of imaging services at the 322-bed community teaching hospital. When Gillespie joined SJEH one year ago, she knew all about PACS and NovaRad, as she had been at a facility that operated with it. "This is the way medicine should work," she says.

In addition to speed and safety, NovaPACS provides a redundant server to answer SJEH's "what-if" disaster recovery questions: "Suppose there is a tornado," Gillespie says. "Suppose there is a hurricane." Wet, crushed, lost; with film, just about anything can go wrong, and "if it's ruined, it's ruined." Prior to NovaPACS, Gillespie says everything was done by hand. "There was manual order entry, darkroom, hanging film, file room."

Getting off film has been a savings both in terms of cost and workflow. (SJEH continues to film on occasion when requested: eg., for a medical school lecture.) "Film is costly, chemicals are costly. Maintenance on the equipment, the film room staff, it's all money," Gillespie says.

The medium-sized hospital is realizing another saving: time. For hospital flow, PACS allows the attending in the ICU or ER to see the film immediately, and doctors can see if tube placements were done correctly. "No more chasing, hanging films, putting them back in folders, re-filing them, flipping them around, wondering, did they get filed this month? Last month?" Gillespie says. "None of that exists. You want to look at that later that night, go right ahead. It's right there, any time you want it."

With the change in workflow and in seeing something so useful so quickly, comes a larger systemic move. Tomo calls computer systems an instrument of change "not so much as in a technological way, but in a procedural way." What they do, he says, is give people the ability to change the way that people run a process or a function. "Whether you blame the computer or not," he says, "what it does is it forces everybody to look at what has been done a certain way for the last hundred years."