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Effect of Filmless Imaging on the Utilization of Radiologic Services¹

¹ From the Department of Radiology, Veterans Affairs Maryland Health Care System, 10 N Greene St, Baltimore, MD 21201 (B.R., E.L.S., R.E.C.); the Departments of Radiology (B.R., E.L.S.) and Medicine (F.J.H.), University of Maryland School of Medicine, Baltimore; American Radiology Services, Baltimore, Md (B.R.); Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (C.F.); and the Department of Radiology, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa (M.S.). From the 1997 RSNA scientific assembly. Received June 2, 1999; revision requested July 29; revision received August 24; accepted October 20. Address reprint requests to E.L.S.

PURPOSE: To determine the effect of a large-scale picture archiving and communication system (PACS) on in- and outpatient utilization of radiologic services.

MATERIALS AND METHODS: Data were collected at the Baltimore Veterans Affairs (VA) Medical Center (BVAMC) before and after implementation of an enterprise-wide PACS; the numbers and types of imaging examinations performed for fiscal years 1993 and 1996 were evaluated. These data were compared with those from a similar academic medical center, the Philadelphia VA Medical Center (PVAMC), and with aggregate data obtained nationally for all VA hospitals over comparable periods.

RESULTS: Inpatient utilization, defined as the number of examinations per inpatient day, increased by 82% (from 0.265 to 0.483 examinations per patient day) after a transition to filmless operation at BVAMC. This is substantially greater than the increases of 38% (from 0.263 to 0.362 examinations per patient day) and 11% (from 0.190 to 0.211 examinations per patient day) at the film-based PVAMC and nationally, respectively. Outpatient utilization, defined as the number of examinations per visit, increased by 21% (from 0.108 to 0.131 examinations per visit) at BVAMC, compared with a 1% increase (from 0.087 to 0.088 examinations per visit) at PVAMC and a net decrease of 19% (from 0.148 to 0.120 examinations per visit) nationally.

CONCLUSION: The transition to filmless operation was associated with increases in inpatient and outpatient utilization of radiologic services, which substantially exceeded changes at PVAMC and nationally over the same interval.

Index terms: Economics, medical • Picture archiving and communication system (PACS) • Radiology and radiologists, socioeconomic issues

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