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PACS as a driver for integrating healthcare systems
International Congress Series 1256 (2003) 910 – 914
PACS as a driver for integrating healthcare systems Werner Leodolter *, Karl Kocever Steierma¨rkische Krankenanstalten ges.m.b.H., Graz (A), Billrothgasse 18a/4, 8036, Graz, Austria Received 25 March 2003; received in revised form 25 March 2003; accepted 25 March 2003
Abstract In industrialized nations, it is a worldwide goal to link together the systems of different partners and organisations in the country-wise different healthcare systems. As healthcare is an issue that is closely related to the people, it is often organized with regional but at least national peculiarities, especially in Europe. The question to be discussed is how can Healthcare systems be linked together for the benefit of the patients in regard of the limited financial resources for healthcare, and what is the role of information systems in general and PACS in particular, in this context. Particularly in Europe, there are at least three levels to be considered in this context: . . .
a European level a national level one or more regional levels (province, county. . .)
The main legislative force is the national level that also plays a key role in standardisation of information security and basic administrative contents. Medical contents, etc. are seldom standardized except for some specialities like cancer statistics and other key epidemiological issues. The European level plays a minor but increasing role. There is a lot of emerging standardisation effort and extensive exchange of research on academic level. The question of a European master patient record is frequently discussed but of minor relevance for the benefit of patient concerning the number of affected patients and potential cost savings. The level where most patients can be affected with probably the highest potential of cost savings in order to provide the best possible level of healthcare to as many people as possible with given financial resources is the regional level. So this paper investigates by example of a regional hospital group in the Austrian province of Styria, how an integrated healthcare system could be established and what role PACS can play in such a setting. * Corresponding author. Tel.: +43-316-340-5312; fax: +43-316-340-5314. E-mail address: [email protected] (W. Leodolter). 0531-5131/03 D 2003 Published by Elsevier Science B.V. doi:10.1016/S0531-5131(03)00410-2
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
911
Finally, it is of interest to discuss possible general conclusions from these experiences and results. D 2003 Published by Elsevier Science B.V.
1. The way from the hospital network to the virtual hospital and further to the integrated healthcare system 1.1. What are the relevant characteristics of the Austrian healthcare system? Every Austrian citizen is insured. He has full coverage with a high standard of medical services. Additional private insurances provide higher hotel comfort in the hospital and free choice of doctors. Hospitals are mostly separated from social and private insurance agencies. Most hospitals are public owned or owned by nonprofit organisations partly subsidized by public funds. Extramural services like general practitioners and local specialists, care centers, etc. are mostly independent from hospitals. Hospitals offer ambulant services only to a small degree. These services are supposed to be provided by practitioners and local specialists. The doctors are well organised in the chambers of doctors. The payers for medical services are mostly the social insurance agencies and partly the private insurance companies. To a small degree, the patients pay for certain services for themselves. The Austrian network of acute care hospitals is densely populated with few central hospitals, among them three university hospitals, some regional centers, standard hospitals and many small standard hospitals.
2. The dilemma that drives the integration of healthcare systems Naturally, there is a conflict of goals between these
many locations with their benefit to be close to the home of the patient, to provide easy access to medical services even in less densely populated areas and the fact that especially these areas need stable employers. The opposite goal is quality assurance in terms of structural quality, specialisation and the necessity of quantities in order to provide quality.
The way out of this dilemma for hospitals and the surrounding medical services can be
to specialize by focusing on diseases, to build networks with surrounding providers of medical services and to become part of a virtual hospital organisation.
912
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
3. Developing a virtual hospital organisation In the province of Styria, the hospital network managed by KAGes—a company owned by the province of Styria—covers more than 85% of the acute care hospitals. The group manages 22 hospitals with 6700 beds, 247 000 inpatients and 633 000 outpatient visits per year. One thousand six hundred of the 15 000 employees are medical doctors. The province of Styria has a population of 1.2 million, so statistically, KAGes sees every Styrian citizen every 4 years. These figures shows that this organisation has a theoretically high potential to build an integrated healthcare system from the organisational point of view. Now, what are the results of KAGes and the province of Styria to get out of the dilemma described above. KAGes is searching for elective medical disciplines to focus on for certain regional hospitals and it already partly succeeded. There is still a lot of work to be done to maybe develop ambulatory care centers and/or care units with extramural partners in the next decade on the locations of KAGes hospitals and/or in small regional virtual healthcare organisations closely linking different locations with a KAGes hospital as nucleus. Due to the fact that many patients need special medical knowledge and experience, which cannot be provided by the staff of a local small standard hospital, there is a good chance for specialists to help the local staff in diagnosis and therapy by teleconsulting, thus,
helping the patient effectively, improving knowledge of the local staff and saving money and troublesome transports to regional centers or central hospitals
The prerequisites for such a virtual hospital organisation are
a master patient index as key element of a ‘‘common language’’ including codes for diagnoses and services, an information system infrastructure including networks, systems and applications, organisational rules concerning workflows as well as clearly defined duties, responsibilities and incentives.
4. PACS plays a key role Beginning with PACS research projects in the university hospital Graz 1985, KAGes has a great history in PACS and RIS with Prof. Gu¨nter Gell as one of the key representatives in this research field. Then, a classical and successful transfer from research to practical usage took place always accompanied by scientific evaluation:
After widely finishing the implementation in the university hospital ,KAGes started to roll-out this PACS together with the radiology system (RIS) in the nine radiology institutes of KAGes (1998 –2001).
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
913
In parallel, the usage of the PACS-pictures from 58 modalities, diagnosed on 33 special workstations was enlarged by providing radiology pictures for all medical staff with a system called PACSVIEW on standard PC (950 workstations). The cost savings in filmless hospitals are convincing. Then, teleradiology between KAGes hospitals was established according to the plan to build a virtual hospital organisation. The speed of implementation follows the requirements of the organisation. This development is promoted by KAGes top management from a strategic point of view. Radiologists outside the hospitals also developed their PACS implementations and are now interconnecting in two directions: To the hospitals to exchange radiology pictures and diagnoses. To provide the practitioners and specialists outside the hospitals with their pictures and diagnoses. This development is still at its beginnings. This development is emphasized by an offering of PACS-Archiving to radiologists and other hospitals by a daughter company of KAGes (marc). In parallel, the electronic exchange of other medical documents is developing.
5. Conclusion What can be learned and what are the conclusions?
PACS is most likely a promising investment and organisational success. Digital pictures are attractive for doctors and hospitals to invest, because they provide a considerable return on investment (ROI). PACS can save money. Radiology with PACS and RIS (radiology information system) is a classical medical service provider and has a relatively clear workflow to other disciplines. The workflow between other clinical disciplines is much less clear and more troublesome to be automated. First, manage the organisational change within the organisation—then go interorganisational—organisational development is a critical path. Definition of duties and responsibilities as well as remuneration can be clarified more easily intra-organisational. ‘‘Be a champion in your home market before you go abroad’’. Be an early adaptor—not a late adaptor. The organisational development takes its time. The investment is relatively high—no matter when you step in. Have your broadband infrastructure in place in time. PACS is a front-runner for implementing the multimedia health record. PACS is relatively highly standardised-DICOM. PACS/RIS combines structured information (Diagnosis) with unstructured information (picture). PACS promotes a master patient record as soon as it is used inter-organisational.
914
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
The patient may be interested to have access to his pictures—thus it may be a driver to patient-centric e-health. PACS is of high benefit for the patient and the costs of our healthcare systems. Transfer of radiology pictures instead of new pictures with additional costs and effort for the patient. Knowledge of previous pictures is a potential benefit for the quality of diagnosis. Radiological pictures as a basis for new applications such as computer aided surgery, etc. Locally taken pictures can be assessed by specialists far away (teleradiology, teleconsulting). So the final conclusion is: PACS is a potential driver for the multimedia health record and the integration of healthcare systems-organisational development is likely to be the critical path.
PACS as a driver for integrating healthcare systems Werner Leodolter *, Karl Kocever Steierma¨rkische Krankenanstalten ges.m.b.H., Graz (A), Billrothgasse 18a/4, 8036, Graz, Austria Received 25 March 2003; received in revised form 25 March 2003; accepted 25 March 2003
Abstract In industrialized nations, it is a worldwide goal to link together the systems of different partners and organisations in the country-wise different healthcare systems. As healthcare is an issue that is closely related to the people, it is often organized with regional but at least national peculiarities, especially in Europe. The question to be discussed is how can Healthcare systems be linked together for the benefit of the patients in regard of the limited financial resources for healthcare, and what is the role of information systems in general and PACS in particular, in this context. Particularly in Europe, there are at least three levels to be considered in this context: . . .
a European level a national level one or more regional levels (province, county. . .)
The main legislative force is the national level that also plays a key role in standardisation of information security and basic administrative contents. Medical contents, etc. are seldom standardized except for some specialities like cancer statistics and other key epidemiological issues. The European level plays a minor but increasing role. There is a lot of emerging standardisation effort and extensive exchange of research on academic level. The question of a European master patient record is frequently discussed but of minor relevance for the benefit of patient concerning the number of affected patients and potential cost savings. The level where most patients can be affected with probably the highest potential of cost savings in order to provide the best possible level of healthcare to as many people as possible with given financial resources is the regional level. So this paper investigates by example of a regional hospital group in the Austrian province of Styria, how an integrated healthcare system could be established and what role PACS can play in such a setting. * Corresponding author. Tel.: +43-316-340-5312; fax: +43-316-340-5314. E-mail address: [email protected] (W. Leodolter). 0531-5131/03 D 2003 Published by Elsevier Science B.V. doi:10.1016/S0531-5131(03)00410-2
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
911
Finally, it is of interest to discuss possible general conclusions from these experiences and results. D 2003 Published by Elsevier Science B.V.
1. The way from the hospital network to the virtual hospital and further to the integrated healthcare system 1.1. What are the relevant characteristics of the Austrian healthcare system? Every Austrian citizen is insured. He has full coverage with a high standard of medical services. Additional private insurances provide higher hotel comfort in the hospital and free choice of doctors. Hospitals are mostly separated from social and private insurance agencies. Most hospitals are public owned or owned by nonprofit organisations partly subsidized by public funds. Extramural services like general practitioners and local specialists, care centers, etc. are mostly independent from hospitals. Hospitals offer ambulant services only to a small degree. These services are supposed to be provided by practitioners and local specialists. The doctors are well organised in the chambers of doctors. The payers for medical services are mostly the social insurance agencies and partly the private insurance companies. To a small degree, the patients pay for certain services for themselves. The Austrian network of acute care hospitals is densely populated with few central hospitals, among them three university hospitals, some regional centers, standard hospitals and many small standard hospitals.
2. The dilemma that drives the integration of healthcare systems Naturally, there is a conflict of goals between these
many locations with their benefit to be close to the home of the patient, to provide easy access to medical services even in less densely populated areas and the fact that especially these areas need stable employers. The opposite goal is quality assurance in terms of structural quality, specialisation and the necessity of quantities in order to provide quality.
The way out of this dilemma for hospitals and the surrounding medical services can be
to specialize by focusing on diseases, to build networks with surrounding providers of medical services and to become part of a virtual hospital organisation.
912
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
3. Developing a virtual hospital organisation In the province of Styria, the hospital network managed by KAGes—a company owned by the province of Styria—covers more than 85% of the acute care hospitals. The group manages 22 hospitals with 6700 beds, 247 000 inpatients and 633 000 outpatient visits per year. One thousand six hundred of the 15 000 employees are medical doctors. The province of Styria has a population of 1.2 million, so statistically, KAGes sees every Styrian citizen every 4 years. These figures shows that this organisation has a theoretically high potential to build an integrated healthcare system from the organisational point of view. Now, what are the results of KAGes and the province of Styria to get out of the dilemma described above. KAGes is searching for elective medical disciplines to focus on for certain regional hospitals and it already partly succeeded. There is still a lot of work to be done to maybe develop ambulatory care centers and/or care units with extramural partners in the next decade on the locations of KAGes hospitals and/or in small regional virtual healthcare organisations closely linking different locations with a KAGes hospital as nucleus. Due to the fact that many patients need special medical knowledge and experience, which cannot be provided by the staff of a local small standard hospital, there is a good chance for specialists to help the local staff in diagnosis and therapy by teleconsulting, thus,
helping the patient effectively, improving knowledge of the local staff and saving money and troublesome transports to regional centers or central hospitals
The prerequisites for such a virtual hospital organisation are
a master patient index as key element of a ‘‘common language’’ including codes for diagnoses and services, an information system infrastructure including networks, systems and applications, organisational rules concerning workflows as well as clearly defined duties, responsibilities and incentives.
4. PACS plays a key role Beginning with PACS research projects in the university hospital Graz 1985, KAGes has a great history in PACS and RIS with Prof. Gu¨nter Gell as one of the key representatives in this research field. Then, a classical and successful transfer from research to practical usage took place always accompanied by scientific evaluation:
After widely finishing the implementation in the university hospital ,KAGes started to roll-out this PACS together with the radiology system (RIS) in the nine radiology institutes of KAGes (1998 –2001).
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
913
In parallel, the usage of the PACS-pictures from 58 modalities, diagnosed on 33 special workstations was enlarged by providing radiology pictures for all medical staff with a system called PACSVIEW on standard PC (950 workstations). The cost savings in filmless hospitals are convincing. Then, teleradiology between KAGes hospitals was established according to the plan to build a virtual hospital organisation. The speed of implementation follows the requirements of the organisation. This development is promoted by KAGes top management from a strategic point of view. Radiologists outside the hospitals also developed their PACS implementations and are now interconnecting in two directions: To the hospitals to exchange radiology pictures and diagnoses. To provide the practitioners and specialists outside the hospitals with their pictures and diagnoses. This development is still at its beginnings. This development is emphasized by an offering of PACS-Archiving to radiologists and other hospitals by a daughter company of KAGes (marc). In parallel, the electronic exchange of other medical documents is developing.
5. Conclusion What can be learned and what are the conclusions?
PACS is most likely a promising investment and organisational success. Digital pictures are attractive for doctors and hospitals to invest, because they provide a considerable return on investment (ROI). PACS can save money. Radiology with PACS and RIS (radiology information system) is a classical medical service provider and has a relatively clear workflow to other disciplines. The workflow between other clinical disciplines is much less clear and more troublesome to be automated. First, manage the organisational change within the organisation—then go interorganisational—organisational development is a critical path. Definition of duties and responsibilities as well as remuneration can be clarified more easily intra-organisational. ‘‘Be a champion in your home market before you go abroad’’. Be an early adaptor—not a late adaptor. The organisational development takes its time. The investment is relatively high—no matter when you step in. Have your broadband infrastructure in place in time. PACS is a front-runner for implementing the multimedia health record. PACS is relatively highly standardised-DICOM. PACS/RIS combines structured information (Diagnosis) with unstructured information (picture). PACS promotes a master patient record as soon as it is used inter-organisational.
914
W. Leodolter, K. Kocever / International Congress Series 1256 (2003) 910–914
The patient may be interested to have access to his pictures—thus it may be a driver to patient-centric e-health. PACS is of high benefit for the patient and the costs of our healthcare systems. Transfer of radiology pictures instead of new pictures with additional costs and effort for the patient. Knowledge of previous pictures is a potential benefit for the quality of diagnosis. Radiological pictures as a basis for new applications such as computer aided surgery, etc. Locally taken pictures can be assessed by specialists far away (teleradiology, teleconsulting). So the final conclusion is: PACS is a potential driver for the multimedia health record and the integration of healthcare systems-organisational development is likely to be the critical path.