Evaluating the implementation of picture archiving and communication systems in Newfoundland and Labrador

MacDonald, Donald M. (2008) Evaluating the implementation of picture archiving and communication systems in Newfoundland and Labrador. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Evaluating the Implementation of Picture Archiving and Communications System (PACS) in Newfoundland and Labrador In November 2007, the Newfoundland and Labrador Centre for Health Information (NLCHI) completed implementation of a provincial Picture Archiving and Communication System (PACS) on behalf of the provincial government. A benefits evaluation was undertaken to determine the impact that this PACS implementation had within the province of Newfoundland and Labrador. -- The evaluation was carried out on the island portion of the province with a focus on 2 of the 4 provincial Health Authorities. The evaluation was guided by the report Towards an Evaluation Framework for Electronic Health Records Initiatives (Neville, Gates, MacDonald et al 2004), which emphasizes significant stakeholder involvement at each step of the evaluation, and triangulation of data where ever possible. The evaluation was designed as a pre/post comparative study utilizing project documentation, administrative data, surveys and key informant interviews as the primary data sources. -- The findings of this study provide convincing evidence that clinicians, administrators and support staff strongly support the implementation of a provincial PACS. Factors contributing to the success of the provincial PACS included: a) a positive political and financial environment, and b) the approach taken by NLCHI in engaging key stakeholders throughout the implementation, and through this process establishing a sense of ownership within the regional health authorities. The benefits of PACS, in particular, immediate access to historical and current exams and reports from multiple access points 24/7, and site-to-site physician/radiologist consultations, were also seen as key to the success of the PACS implementation. -- The realization of a provincial PACS did not come without its challenges. From a clinical perspective, PACS resulted in a decrease in physician to radiologist consultations within a site, although this has been offset somewhat by an increase in consultations between sites. From the administrative side, PACS was very costly to implement and to maintain, making it difficult to justify PACS based solely on a financial costing model. The primary reasons for not achieving a return on investment for PACS in many sites was a combination of low exam volume, a pre-existing efficient film environment, and the high costs for PACS hardware, software and ongoing maintenance.

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