Picture Archiving and Communication Systems (PACS) are expected to replace the currently existing film systems within the decade. However, presently there are no formal measures to evaluate the cost-effectiveness of image management systems. The objective of this Program Project is to develop a methodology to compare the cost-effectiveness of a PACS and the existing film management system. We will measure cost-effectiveness in the Medical Intensive Care Unit, the Emergency Department, and in the outpatient Neurology suite. The effects of diagnostic outcomes on health outcomes will also be estimated. The first project develops and evaluates a model that describes the diagnostic value of an image management system. The model will be validated and tested to determine its predictive capability. The second project evaluates workstations for clinical effectiveness, analyzes the radiologist-referring physician interaction, and studies physician acceptance. Teleconsulting between the radiologist and the referring physician including the transmission of outside images from the referring physician to the radiologist will also be studied. The third project utilizes clinical-history derived rules to optimize the display with diagnostically-relevant information. The fourth project uses the results of the other projects to measure the cost-effectiveness of PACS. Both direct and indirect costs before and after implementing PACS will be combined with data from the diagnostic value model to derive the incremental cost-effectiveness and to compare the usefulness of PACS to other medical interventions. The Operations core is responsible for software development, data collection, and quality control. This Program Project will provide the methodology for other institutions to determine the value of implementing PACS in their environment. Additionally, it may be applicable for the assessment of other medical technologies and to aid in the comparison of investments in such technologies.
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