In these new configurations — Accountable Care Organizations among them — management’s first impulse may be to go with the most general technology from the biggest companies. By adopting general solutions for their medical imaging storage and viewing infrastructure, they believe they avoid the risk of miscommunication and problem of interoperability. As some of these groups are learning, however, this impulse can lead to solutions that threaten both the quality and financial incentives of providing care.
Medicare ACOs and more traditional private multispecialty clinics are becoming the norm in the US. More than four million Medicare beneficiaries are currently part of an ACO, for instance, and that number is expected to rise. ACOs in particular were designed with better health outcomes and lower costs in mind — their main goal is to integrate a patient’s health care by bringing together primary care physicians, specialists, and hospitals to coordinate; financial incentives help drive these groups to meet that goal.
Orthopedists play a role in ACOs, with many private and group practices integrated into these groups and many more planning to join. Specific, concrete considerations make this specialty unsuited for the kind of generic systems — particularly in terms of Picture Archive Communication Systems — that these larger groups favor.
From a cost standpoint, general radiology PACS make initial sense for fledgling ACOs. Such systems work fine for most specialists who simply need access to a patient’s images. For example, an ENT specialist may want to pull up a CT scan which was performed at one of the hospitals in the ACO. For orthopedists, however, using a general PACS can lock the surgeon into a scenario which limits his ability to plan procedures effectively, thereby unnecessarily protracting surgery times and increasing costs for unnecessary equipment storage and instrument sterilization.
Specialty PACS designed for orthopedists, on the other hand, can aid in the assessment and planning of surgeries as well as the correct sizing of implants. These functionalities can cut surgery times, improve physician confidence, and may also improve patient safety during surgery and lead to better surgical outcomes.
Benefits of Orthopedic Specialty PACS:
• Modern digital templating is a key component of orthopedic PACS. This technology accurately assesses the size of the implant for each patient, which reduces the number of implant sizes that must be brought into the OR for each surgery. Because each of these implant sizes comes with a tray of calibrated instruments, which must be sterilized even if it isn’t used, the fewer implants brought to the OR, the better. Reducing excess sizes cuts waste from hospital inventory and frees up space, but also reduces money spent on resterilizing: hospitals spend roughly $75 to sterilize each instrument tray for each implant size brought into the OR. With digital templating, the number of implants ordered is reduced from between seven and 10 to between one and three, translating into a savings of about $300 to $675 per surgery for sterilization alone.
• Other functionalities that are specific to orthopedists in a specialized PACS system include: biomechanical calculations such as the ‘hip knee angle tool,’ which can measure the angle between the shaft of the femur and the femoral head in the hip socket, allowing orthopedists to plan cut angles in a knee surgery. Leg length discrepancy is another useful function which provides the surgeon with key information for achieving optimal limb length modification in a hip surgery. Companies are currently improving these technologies as well as devising other features particular to orthopedists’ needs.
• Workflow can also be improved by specialty orthopedics PACS. In some cases, orthopedic PACS have been instrumental in increasing the number of daily surgeries for an orthopedist, primarily by enabling better planning and coordination among implant reps, surgical teams, and the surgeon. Orthopedic PACS make the pertinent images available ahead of time, and are tailored to the unique workflow an orthopedic practice needs on “clinic days” when surgeons are seeing dozens of patients in rapid succession.
• Patient safety is improved when the correct size implants are available for surgery. Why? Because knowing the right implants prior to the procedure means shorter surgeries, and shorter surgeries mean patients spend less time under anesthesia—a change that also helps speed up recovery times. One Chicago surgeon found that he was able to shorten the length of time from one knee replacement case to the next by 8 minutes with the digital templating available through his orthopedic PACS.
Multispecialty groups and ACOs alike aim to achieve coordinated care for the benefit of the patient and leverage their respective strengths for the benefit of the group. While the apparent benefits of a single generic PACS may seem aligned with these aims, opting for specialty PACS which enable provider collaboration is a better choice for supporting both the quality and financial goals these groups aim to achieve.
More articles on orthopedic surgery:
OrthoIndy rebrands Indiana Orthopaedic Hospital
Dr. Yevgeny Kats joins Blue Ridge Orthopaedic & Spine Center
Dr. Jeremy Statton joins OrthoAtlanta
