How can hospitals and imaging centers avoid downtime and its inevitable consequences? PACS consultant Michael J. Cannavo of Image Management Consultants in Winter Springs, FL, offered tips to attendees of the American Healthcare Radiology Administrators (AHRA) meeting in Denver.
What is downtime? Or, how to read a service contract
In service contracts for medical imaging information technology such as PACS, RIS, and other systems, downtime doesn't refer to a computer that is partially operational; that's still considered "uptime" by the vendor, Cannavo said.
"If it works, but it just doesn't work well, that system is still up [according to vendors]," he said. "If the radiologist hits the button and can go for a cup of coffee before the images come across the network, it's still up. It's only when he hits the button and nothing happens that the system is really considered down."
A $2 million system has a 15% purchase price service contract of $300,000 per year, or $25,000 per month. If it runs all day every day, that's 8,760 hours per year. In this scenario, 99% uptime equals about seven hours of downtime per month, 21 hours semiannually, and 87 hours per year. That's a lot of dead time, Cannavo said, and no one's profiting -- not patients, not radiologists, and certainly not the facility.
"If your system is down for seven hours in a week, your life will be a living hell," he said.
But here's the rub: a facility's warranty may be based on weekday operational hours, but the uptime guarantee may be based on 24 hours, seven days a week. If most vendors measure downtime quarterly, the whole PACS network could be down for an entire week and it would still be considered functional. And most service contracts don't cover workstations, archives, modality interfaces, and RIS interfaces, according to Cannavo.
"Usually it's just the server that's covered," he said. "Period."
Downtime can have far reaching effects. If a PACS network gives a facility about 20% more throughput, when the system is down, productivity decreases by this same amount, while costs for film, re-entering data, and IT resources spike and patients get increasingly frustrated by cancelled or rescheduled exams. And what about primary care providers, who may stop referring if they can't get their images and reports in a timely manner, or liability issues that can arise from delayed readings?
The bottom line is to prevent the system from going down in the first place, Cannavo said. He outlined three options for preventing downtime:
Continuous-availability systems: Components are duplicated so that a backup component is always available. Only one copy of software is required.
Shared-component systems: One active system backs up another active system if one of them fails. Requires duplicate hardware and two copies of software
Clustering: Variation of shared-component systems; matched components do not have to be duplicates of each other. Also requires duplicate hardware and two copies of software.
All three options have drawbacks: Continuous-availability systems cost 30% to 40% more than standalone hardware; shared-component systems need a test server for backup, which can take one to two hours to reconfigure for this purpose; and the clustering model requires extra cost for duplicate hardware, load-balancing software, and two copies of applications software. Each facility needs to weigh the pros and cons of these options, but the key is to insist on one to minimize downtime, Cannavo said.
"It all depends on the facility," he said. "A hospital needs full redundancy, but an imaging center might not."
A key strategy for defeating downtime? Read the vendor's service contract carefully, and don't be afraid to tinker with it. Most facilities buy them as a matter of course, but that attitude can be costly.
"If you actually read the vendor's contract, you might reconsider it," Cannavo said. "Be prepared to negotiate service terms and conditions or walk away and do service on a time-and-materials basis."
By Kate Madden Yee
AuntMinnie.com staff writer
July 29, 2008
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