Enterprise Imaging Strengthens Your Quadruple Aim:  Part 2 – Reducing Costs

In Part 1 of this article we examined the positive impact of Enterprise Imaging on the Quadruple Aim. That article focused on the quality side of the value equation. This article is going to explore the numerous ways an Enterprise Imaging program helps achieve the Quadruple Aim by reducing costs. Overall, little data exists about these cost savings and this article will review the data that has been reported.

No Money – No Mission

The financial health of an organization is critical, as they say, no money – no mission. As a result, every healthcare leader constantly scrutinizes expenses. Even with high-quality patient care, positive provider experiences and excellent population health, an organization will not survive without a solid financial position.

As healthcare organizations feel the impact of COVID-19, leaders expect every department, including the information technology department, to reduce costs. In order to achieve these necessary reductions healthcare IT departments can turn to common cost reduction strategies exploited by IT departments across numerous other industries. Examples of these strategies include:

• Consolidation
• Standardization
• Automation
• An overall reduction in complexity

Infrastructure and Support Team Consolidation

With an eye to the future, healthcare organizations and vendors alike are very interested in the idea of replacing the department-specific long-term archive with a vendor neutral archive (VNA) which then serves as a resource for the entire organization. A VNA is the foundational technology facilitating infrastructure and support team consolidation.

When a multitude of archives are collapsed into a single VNA, redundant personnel, licenses, contracts and vendors can be eliminated and economies of scale can be leveraged to reduce storage costs. For example, one university health system realized a 31.5% reduction in storage costs by collapsing its radiology, cardiology and pediatric cardiology department specific archives into a single VNA. Furthermore, this health system achieved a 10-15% cost savings due to reductions in service contracts, maintenance and support. Their time to recoup investment dollars was estimated to be 2.5 years.

Workflow Standardization and Automation

Lack of standardized workflows and redundant processes create inefficiencies and excess cost. An Enterprise Imaging program presents several opportunities to address these inefficiencies and costs. For instance, ophthalmology, pathology and point-of-care imaging services such as photography and ultrasound can take advantage of the many workflow optimizing features enjoyed by radiology and cardiology. Examples of these features include:

• Electronic worklists
• Electronic association of demographics and images

Electronic Worklists

Electronic worklists eliminate the need for time-consuming, error-prone manual demographic entry. In one investigation of manual vs electronic demographic entry this transition led to a savings of 2.5 minutes per imaging study. In other words, a savings of 800 manpower hours per 20,000 imaging studies. Reducing the number of studies which failed automated verification processes resulted in further savings. Those studies must be manually verified, a process which consumes manpower resources and delays access to information.

Common Workflows

Part of the beauty of Enterprise Imaging is the ability to create workflows that are standardized, easily replicated and scalable. Let’s use point-of-care ultrasound (POCUS) as an example. Once a workflow is developed to integrate these devices with the Enterprise Imaging ecosystem that workflow can be deployed to any department. Minimal additional development work will be required. Furthermore, when the enterprise selects a single vendor, equipment costs can be reduced and the need to create multiple interfaces is eliminated. With these opportunities in mind, healthcare organizations need to look for ways to unify workflows, integrate with enterprise systems and provide long-term storage for the many POCUS systems rapidly deployed in response to COVID-19.

Elimination of Physical Media

The creation of a single centralized point for cloud-based image exchange is a considerable benefit derived from a single image archive. Often times the costs of cloud-based exchange are too high for small departments. This electronic image exchange can be used to eliminate CDs throughout the enterprise.

As a result of eliminating CDs the significant, often unrecognized manpower costs consumed in their creation and distribution are eliminated. Cost estimates range from $15-40 per CD and courier costs of up to $100,000 have been reported. A cloud-based image exchange service can reduce these costs by 50%. Additionally, these costs may be even higher in departments such as ophthalmology where a dedicated image sharing workflow usually doesn’t exist. Other hidden costs exist in the form of gaps in medical information. These gaps can result in duplicate imaging costs. We will explore these costs in a future article dedicated to image exchange.

Final Thoughts

Embarking upon an Enterprise Imaging journey can be a daunting task. The infrastructure expenses at first glance may be a deterrent to full consideration of this path. However, an examination of the opportunities for reducing costs reveals that there are savings to be recognized. Coupled with the clinical benefits discussed in Part 1 of this two-part series on the Quadruple Aim, the essential role of Enterprise Imaging in healthcare is undeniable.

References

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2. IT Architecture: Cutting costs and complexity. Available at https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/it-architecture-cutting-costs-and-complexity#. Accessed November 2, 2020
3. Using an Existing DICOM Infrastructure to Enhance the Availability, Quality and Efficiency of Imaging Throughout the Healthcare Enterprise. J Digit Imaging 32:75-80, 2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382629
4. Implementation and Benefits of a Vendor-Neutral Archive and Enterprise-Imaging Management System in an Integrated Delivery Network. J Digit Imaging 32:211-220, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456740
5. Image sharing: evolving solutions in the age of interoperability. J Am Coll Radiol. 11:1260-1269, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255288
6. Medical image exchange in the cloud: A more efficient way. HealthManagement. https://healthmanagement.org/c/hospital/issuearticle/medical-image-exchange-in-the-cloud-a-more-efficient-way. Accessed November 1, 2020