January 18, 2019 -- Anyone who has worked in a hospital imaging department or outpatient center that utilizes diagnostic imaging knows the effects of a system outage. It doesn't matter if the cause of the downtime is a network issue or an integration problem, or if the application simply stopped working. The results are the same: frustration, lost revenue, and degraded patient care.
In today's digital world, medical imaging is deeply integrated into many clinical operations, so when images are unavailable -- whether they're newly acquired images or priors for comparison -- many clinical workflows stop. It's perhaps no surprise that the most requested feature of any PACS during a selection process is proactive IT monitoring of the system.6
In addition to the clinical impact of downtime, there are also revenue implications. Due to imaging system outages alone, lost revenue for a medium-sized (200-bed) facility can amount to almost $300,000 annually.
In addition to the direct impact of lost revenue, secondary effects occur, which can include rescheduled procedures, delayed surgeries, and postponed discharges. These secondary effects, while important, are outside the scope of this article and should be addressed in subsequent research.
Demand For Proactive Monitoring
Some 32% of radiologists have rated system continuity and functionality as their top priority.6 Subdivisions of this category include downtime prevention, with a global weight of 0.179, and tools for continuous PACS performance monitoring, weighted at 0.085.
For comparison, the highest-rated image manipulation feature in PACS selection, convenience and responsiveness in manipulation of images, had a global weight of 0.068.6 PACS administrators and IT professionals rated these sections even higher, with real-time monitoring being a focus for 47% of respondents.
These results should not be overly surprising; if the system is not available, other features such as user-interface or image manipulation become irrelevant. A key takeaway is that both the IT and clinical user communities place significant value on system uptime and monitoring.
Turning to the purely financial side of downtime in imaging, it is important to note that Basu and Jackson reported 37% of a hospital system's revenue is derived from imaging sources.1,5 Additionally, Becker's Hospital CFO Report reveals that annual per-bed revenues that are attributable to imaging average $370,190.3 A further breakdown shows per-bed imaging revenue of $189.54 per hour.
Armed with these figures, we can calculate the real impact on revenue from a system outage. At the high end, Becker et al estimated that the average duration of a single downtime incident is 3.5 hours, which, for the aforementioned medium-size facility, results in lost revenue of $132,716.2
On the low end of estimates is Change Healthcare's evaluation of downtime, which indicates $15,833 per hour of lost revenue (approximately 15.4% of revenue is imaging-based).4 This generates a facility cost of $55,415 for a single downtime incident.
Averaging these two estimates yields a per-downtime cost of more than $94,000, a figure that doesn't factor in the residual effects of patient care or physician satisfaction.
While the lost revenue of a single downtime incident is clearly significant, the frequency with which these events occur must also be taken into account. The expected number of 3.5-hour downtime incidents ranges from 2.3 to 7.0 outages per year.2,7
Assuming a frequency at the low end of three to four incidents per year, the consequences of radiology system downtime on lost revenue are compelling, residing somewhere between $282,197 and $376,260 per year. Of course, the dollar amounts will increase as the number of downtime incidents or beds increases.
Limitations And Future Research
How can we get a better understanding of the effects of system downtime on radiology? Future research can expand upon current findings by directly measuring facility imaging revenue instead of aggregating and assuming a percentage of overall hospital revenue. Additionally, future research could improve accuracy by measuring procedure volume as an indicator of facility size versus simply aggregating the number of beds. Outpatient imaging volumes have a tremendous effect on revenue and are imperfectly measured by the number of beds.
A final improvement in the current research of system downtime would be to expand the scope beyond the single imaging system of radiology PACS to include the ever-expanding role of imaging and centralized archives across the healthcare enterprise.
Given the data presented, it is clear that the cost of network downtime in radiology is significant and that its effects on healthcare organizations can be far-reaching. The financial implications are of a magnitude that demands attention and solutions that are relevant to operations.
Fortunately, there are products in the marketplace that go above typical IT monitoring and are able to proactively monitor all aspects of the imaging ecosystem from a single dashboard, which can dramatically reduce the duration of a downtime. Facilities and health systems should invest in such resources to minimize the occurrence of imaging system downtimes, thereby also mitigating the financial effects of downtimes.
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