Economic analysis of a mutualized regional PACS solution vs a hospital-based stand-alone PACS solution

Transcription

1 Economic analysis of a mutualized regional PACS solution vs a hospital-based stand-alone PACS solution Poster No.: C-1254 Congress: ECR 2013 Type: Scientific Exhibit Authors: A. KHELIFA 1, J.-C. Dron 1, M. Moreton 1, A. De Cadeville 2, C. Lecomte 3, V. Noel 4 ; 1 Paris/FR, 2 Rouen/FR, 3 Strasbourg/FR, 4 Villers les Nancy/FR Keywords: DOI: ehealth, Professional issues, Computer applications, PACS, Computer Applications-General, Computer Applications- Teleradiology, Economics /ecr2013/C-1254 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 13

2 Purpose Several French Regions, among which Ile de France (Paris Region), Alsace, Upper Normandy and Lorraine, have launched major projects for mutualized PACS solutions. The ambition of such regional projects is to boost the implementation of PACS in small and medium hospitals. Those regional projects heavily rely on two fundamental assumptions : a) Lack for technical expertise within hospitals can be offseted by a "turnkey" regional solution which would fulfill all technical, functional and legal requirements associated to a PACS b) A mutualized solution (a "regional" PACS) can be significanlty less expensive than a stand-alone PACS. However, one of the interesting findings of those projects is that the total cost of ownership (TCO) of the PACS is almost never properly forecasted by hospitals. This usually results in severely underestimating the TCO of a local PACS and alternatively in finding "expensive" the cost of a regional solution. In order to support the regional initiatives through a pedagogic tool, we have build a model comparing both solutions. This model demonstrates that the TCO of a mutualized PACS is indeed significantly cheaper than a stand-alone one. Main assumptions and results are presented in this poster. Methods and Materials Based on data collected within a dozen of hospitals in 3 regions (Alsace, Lorraine and Upper Normandy) and unit prices resulting from 2 territorial/regional tenders for cloudbased PACS, we have developped an economic model in ordrer to assess the total cost of ownership (TCO) over 5 years of a PACS under two assumptions : a mutualized solution and a stand-alone solution. The model has then been re-applied in various hospitals - including the ones that had provided initial data - in order to assess actual TCO of their stand-alone solution compared with estimated TCO of the mutualized solution. Page 2 of 13

3 We have evaluated the total cost of ownership for 3 categories of hospitals (small, midsize and large ones). Small hospitals produce less than medical imaging exams per annum and have less than 3 FTEs of radiologists, midsize hospitals produce between 50 and exams and have under 6 FTEs, and large hospitals produce over exams per annum. Charts 1 and 2 provide principal hypotheses for cost construction. Cost of PACS has been separated into PACS and Archive in order to evaluate proper requirements for archiving (two cluster sites, PRA, etc...). Cost of interest has been introduced to compare real cost of upfront investment with cost of quarterly invoicing based on activity. Maintenance costs have been estimated by hospitals themselves. Integration and change management have been estimated through various sources, including a) the recent (2011) tender for the Community of Hospital of Sainet Etienne and Roanne and b) information delivered by PACS providers. They are strictly the same for local and mutualized PACS. Technical assistance has been calculated as a percentage of cost of PACS. Staff support has been strongly discussed with the hospitals, which tend to underestimate the human resources required by a PACS. We have retained the assumption supported by the most experienced hospitals in our panel. For functional management, data are equivalent in both solutions. Technical management and support are of course significantly lower in a mutualized solution. The main issue remains the cost of service of PACS and archiving. We started from the unit price of "Région Ile de France Sans Film", ie 1,98 for an average exam including PACS and archiving. We have made the reasonable assumption of a decrease of 5 % since 2009, ie an average price of 1,88. We have applied some majorations / minorations depending on the actual volume of each hospital. (cf fig 3). Page 3 of 13

4 This figures are consistent with tendencies given by PACS providers on current projects. Images for this section: Fig. 1 Page 4 of 13

5 Fig. 2 Page 5 of 13

6 Fig. 3 Page 6 of 13

7 Results Due to the importance of fixed costs in a PACS, a mutualized solution that avoid fixed costs is significantly cheaper in all cases for small and medium size hospitals that a local PACS (cf fig 4 and 5) For large hospitals, the interest of a regional solution remains evident (cf fig 6) provided 1) appropriate rebate on volume is applied by the provider and 2) high speed telecom solutions remain accessible at a reasonable price. Similar level of services to a local PACS is assured by the use of a local box which store on site between 6 months and 2 years of data. In addition, a regional solution guarantees the compliance with French regulations regarding archiving of medical data. Images for this section: Page 7 of 13

8 Fig. 4 Page 8 of 13

9 Fig. 5 Page 9 of 13

10 Fig. 6 Page 10 of 13

11 Conclusion 1) The TCO of a stand-alone PACS is usually severely under-estimated by hospitals. 2) The "regional" PACS at current market prices per exam is always significantly cheaper than an stand-alone one. 3) Due to importance of fixed costs, the economic gain per exam is more important in small/medium size hospitals than in large ones. However, we have demonstrated that a significant benefit is still available in some large hospitals (at exams per annum). 4) This result remains subject to availaibility of appropriate telecom networks at a reasonable price. 5) Long term storage of data is better enforced in a regional solution which is necessarily compliant with all regulations regarding medical data storage. 6) Levels of services, especially length of access time of a stored exam, can be improved by a mix of on-line and on-site storage. 7) A regional PACS allows for an easy sharing of data between hospitals. 8) This demonstrates the benefit of a regional solution in which small / medium hospitals benefits from mutualisation. However, this study, which demonstrates frequent underestimation of TCO of PACS, also implies that most ROI studies on the subject are alternatively overestimated. This study should therefore idealy be completed by another one on the actual Return on Investment of the PACS. Images for this section: Page 11 of 13

12 Fig. 7 Page 12 of 13

13 References 1. Etude pour des propositions sur une politique publique de généralisation des systèmes d'information PACS en France métropolitaine, Ministère de la Santé, novembre Région Sans Film, GCS DC-SISIF 3. CHU de Saint-Etienne, Synthèse du dialogue compétitif pour la fourniture d'un PACS mutualisé 4. Project Nimis, Ministère de la Santé d'irlande (séminaire de travail avec les promoteurs du projet) Personal Information Aïssa KHELIFA, Jean-Charles DRON and Michel MORETON are partners at HMS, a French leading consulting company in the field of project management for regional PACS / telemedicine networks. Anne DE CADEVILLE is the Health Information Systems Manager at the Regional Healthcare Agency of Upper Normandy and is the sponsor of the regional PACS project (PRATIC) Christine LECOMTE is Project Director for PACS / Tele Imaging project (SIMRAL) at the Regional Cooperation Network of Alsace. Vianney NOEL is Project Director for PACS / Tele Imaging project (MEDIALE) at the Regional Cooperation Network of Lorraine. Page 13 of 13