By Tyler Speakman, MD Buyline Analyst

Purchasing a modern imaging system is a balance between departmental needs and enterprise requirements.

Advancements both in the technology and approach from vendor partners have a major effect on how facilities are forced to think about current and future solutions. The quality of a system cannot be judged on cost alone. There are great systems that are expensive and there are great systems that are not. The very definition of "great system" depends entirely on how well a vendor's solutions fit your particular needs, how well it integrates into and/or enhances your workflow and how well it improves your efficiency.



The common thread connecting providers on this issue is the inherent challenge faced to deliver valuable information in a fast and cost-efficient manner, while also enabling superior patient care experiences.

Here are a few thoughts on achieving success in considering system or enterprise functionality:

Integration
It’s extremely important to determine specifically how your solution will interface and integrate with other applications. Modern systems have multiple touchpoints for integration, both in and out of the hospital. Understand the exact costs and application functionality involved with any integration with your CIS, EMR or imaging modalities. Avoid vendors that appear to, or have a history of being less than cooperative with other vendors. Vendors who care about your business understand you will have existing systems in place from competing companies. Vendor neutral archives, or VNAs, for example, have broken down barriers between departments and changed how vendors work with providers and clinicians.

Workflow and imaging analytics
Current vendor focus has shifted heavily to developing applications that directly support clinical workflows at the hospital. Vendors now focus on “service line” support, meaning applications are developed from a single system to support differing clinical practices (i.e. radiology, cardiology, specialty). This has evolved from the historic practice of supporting separate departments, or service lines, as wholly different products.

Medical images account for the largest data source in a patient’s medical record and, as a result, many vendors are coming up with imaging analytics/deep learning medical imaging solutions to better extract and analyze the information presented in images.

Imaging analytics will continue to be integrated in existing systems, and potentially become a hallmark of new systems, for point of care decision support, second opinion, early detection of a few diseases, workflow improvements and better outcomes.

Predictive analytics, fueled by artificial intelligence (AI), support clinical workflows and reduce the time required to perform case review. Several vendors are focused on supporting mid- to small-size acute care facilities that lack bandwidth to review case volume.

AI can develop algorithms that scan an image and separate abnormalities requiring review. Minor, more common issues that do not indicate larger issues are triaged accordingly so that clinicians can focus on problem areas first.

Outsourcing
As technology advances, hospitals are more apt to outsource data management services and hosting due to potential cost or responsibility reductions, while still maintaining a smaller on-site cache for image storage (i.e. speed to download). This is a major consideration given the current climate we are in regarding merger and acquisition activity in the provider space.

Health care systems nationwide are working to integrate disparate systems to an existing infrastructure and scale to meet new bandwidth needs. On-site data centers and management teams are generally expensive, difficult to scale and largely inflexible. Cloud-based services, however, provide a different strategy to managing the perils of integrating these systems and allow a focus shift back to patient-impacting issues, such as clinical practice standardization.

Cost-effectiveness of this balance between off-site/on-site balance is still open for debate as many vendors make up the margin in support fees and/or consultations. There are pros and cons to both to be considered on a case-by-case basis.

Outsourcing has also emerged as a top consideration in defense of cyber threats, particularly for small- to mid-sized facilities. Very few systems maintain adequate infrastructure of systems and people to support in-house management of cybersecurity. The outsourcing of responsibility and effort has been well received in the industry, especially as threats against health care providers rise.

Vendors often approach cybersecurity similarly and outsource data management and hosting to large services (i.e. Google, Amazon).

Purchase structures
• Capital vs. ASP (Alternate Service Provider) model. A capital purchase typically gives your facility more control and ownership, but with a higher up-front cost. ASP models are similar to a lease, which typically offer hands-free maintenance and cheaper initial costs, but are potentially more expensive in the long run. However, an ASP may be a very viable short-term solution if you are in transition and need a solution that can be implemented quickly without a long-term investment.

• Web-based vs. Web-enabled. Due to evolving standards of speed and security over the web, many tele-cardiologists, referring physicians and physicians at home have found case reviewing over the Internet to be an invaluable time saver. "Web-enabled" systems imply a stand-alone application that has been adapted or modified to allow web functionality. "Web-based" systems imply the PACS product was built from the ground up to view and manipulate data over the web (i.e., an Internet-based interface). Web-based systems are growing in popularity as they are explicitly designed with a web interface in mind and often require little or no installation for offsite PCs.

Regardless of the financial scope and parameters of your project, all costs must be laid out clearly in the quotation. The cost of each component, a breakdown of all professional service hours, and just as important, the ongoing costs of maintenance, upgrades and storage expansion must be up-front and forthcoming in the contract. Avoid clauses quoting prices at "then applicable rates" without some form of an estimate, whenever possible.

About the author: Tyler Speakman joined MD Buyline in 2017. Along with health care IT, he specializes in capital budgeting and project management for multiple technologies, including nurse call systems, OR integration and PACS. Prior to joining MD Buyline, Speakman worked as a portfolio executive and sourcing executive at Vizient, and as an operations manager for a Premier Healthcare subsidiary. He also spent several years as a capital equipment analyst and has clinical experience as a physical therapy tech.