How successfully have small and mid-sized hospitals adopted digital image management?

2001 02 16 15 56 42 706 How successfully have small and mid-sized hospitals adopted digital image management? How important is the introduction of ASP models to this sector, as well as for the PACS market in general?

Mason, eMed: Small and mid-size hospitals have not adopted digital image management much beyond teleradiology. If we take the "purest" meaning of ASP, meaning the rental of application services from a data center on a pay-per-use basis, then I do not see ASP models being of importance to this sector. Rather, this market requires a turnkey solution that takes care of all the application requirements, including software and hardware. This solution should also include support for IS problems such as network design, network installation, system administration, maintenance, application and security management, and up-time guarantees.

ASP models are based on economy of scale; you share the cost of software and hardware across multiple users. Radiology image management is too on-site-application-heavy, however, requiring specialty hardware on-site such as image acquisition equipment, high-resolution monitors, high-end workstations for reading and clinical review, bar code readers, etc. Hence, pure ASP models will not play an important role in the PACS market in general.

Wanchoo, GE: A lot of the growth is coming from the community hospitals. In the last three years, PACS has certainly moved way beyond the academic metropolitan centers and the integrated delivery systems. We’ve had very small implementations, including customers with as few as 70,000 to 80,000 annual imaging procedures.

Clearly, though, there’s a market (around 40,000 procedures or less) that has been unserved. They're really needing the efficiency of PACS, and that’s where the ASP comes in. We’re seeing huge interest in deploying ASP-type solutions, whether it’s ASP-type financing or archiving off-site from this market segment.

That ASP solution is also being discussed at larger hospitals as well, where it’s a very cost-effective model for moving your long-term storage and disaster recovery off-site.

Larson, Kodak: Interest in ASPs is clearly high, judging by the high level of discourse in the press and at trade shows, although as we all know, the ultimate value proposition of this model is uncertain. From an economic perspective, one of the biggest impediments is the high cost of the bandwidth necessary to fully enable an image-intensive PACS system over the wide-area network. Nevertheless, with all the potential attraction this model provides, including reduced capital investment, technology obsolescence protection and ease of deployment and support, ASP’s will ultimately be accepted.

Right now, I believe the most prudent approach for the PACS and RIS industry is to provide a variety of ASP approaches. It is quite likely that the ultimate optimal model will be a hybrid solution, consisting of on-site enterprise PACS components such as near-term storage, workflow servers and primary diagnostic display, with remote ASP image distribution and multisite "image brokering," as well as deep archiving. More exploration still needs to be done before these issues will be understood well enough for general acceptance of ASP models.

Milan diPierro, Philips: Small to mid-size hospitals represent probably the fastest growing sector in the PACS market. As the early adopters (i.e. university and government institutions) continue to validate both the hard and soft cost savings of a PACS, the technology is becoming readily accepted by other sectors of the market.

2001 02 16 15 56 42 706

ASP models for PACS are certainly an attractive concept for all sectors of the market. However, significant education and investigation is needed before a "true" ASP model for PACS will become widespread. In a true ASP model, all PACS components (i.e. the application software, storage, and database management) are housed off-site and are accessed using Internet technology. The customer pays for access on a per-click, per-megabyte, or per-exam basis. A number of performance, image quality, and security issues need to be addressed before a true ASP model will work for PACS.

Many customers are, however, getting their feet wet with ASP concepts by engaging in SSP implementations. An SSP (Storage Service Provider) allows for the majority of the PACS components to be on-site, with archiving (and possibly disaster recovery storage) located offsite.

Primo, Siemens: Eventually policy makers at these institutions will have to face the fact that quality healthcare cannot be delivered in a cost effective way without a massive, long-overdue, infusion of IT. ASPs may be a way to get there without massive investments in a large staff of in-house, skilled, hard-to-find IT workers.

IT has to be part of the enterprise strategy and the resource planning. In-house or ASP? Both may work, but the strategy needs to be defined first. ASP will be a key facilitator, however, for the proliferation of PACS in small and mid-size hospitals. These hospitals face substantial challenges in having access to the necessary capital outlays, and have scarce resources in skilled IT staff. ASP is addressing all of these issues.

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