title: Financing a large-scale picture archival and communication system.
abstract: OBJECTIVE
  An attempt to finance a large-scale multi-hospital picture archival and communication system (PACS) solely based on cost savings from current film operations is reported.
  
  
  METHODS
  A modified Request for Proposal described the technical requirements, PACS architecture, and performance targets. The Request for Proposal was complemented by a set of desired financial goals-the main one being the ability to use film savings to pay for the implementation and operation of the PACS.
  
  
  RESULTS
  Financing of the enterprise-wide PACS was completed through an operating lease agreement including all PACS equipment, implementation, service, and support for an 8-year term, much like a complete outsourcing. Equipment refreshes, both hardware and software, are included. Our agreement also linked the management of the digital imaging operation (PACS) and the traditional film printing, shifting the operational risks of continued printing and costs related to implementation delays to the PACS vendor. An additional optimization step provided the elimination of the negative film budget variances in the beginning of the project when PACS costs tend to be higher than film and film-related expenses.
  
  
  CONCLUSIONS
  An enterprise-wide PACS has been adopted to achieve clinical workflow improvements and cost savings. PACS financing was solely based on film savings, which included the entire digital solution (PACS) and any residual film printing. These goals were achieved with simultaneous elimination of any over-budget scenarios providing a non-negative cash flow in each year of an 8-year term.
authors.affiliation: Department of Radiology, University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 1-Silverstein, 3400 Spruce St, Philadelphia, PA 19104, USA. Alberto.Goldszal@uphs.upenn.edu
authors.forename: Alberto F
authors.initials: AF
authors.lastname: Goldszal
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bleshman
authors.forename: R Nick
authors.initials: RN
authors.lastname: Bryan
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000639:trends; D003195:Computer Communication Networks / Q000191:economics / Q000639:trends; D017046:Cost Savings / Q000191:economics / Q000639:trends; D003695:Delivery of Health Care / Q000191:economics / Q000639:trends; D005381:Financing, Organized / Q000191:economics* / Q000639:trends; D006801:Humans; D016247:Information Storage and Retrieval / Q000191:economics / Q000639:trends; D007449:Investments / Q000191:economics / Q000639:trends; D015588:Observer Variation; D020416:Outsourced Services / Q000191:economics / Q000639:trends; D010414:Pennsylvania; D011872:Radiology Department, Hospital / Q000191:economics / Q000639:trends; D011873:Radiology Information Systems / Q000191:economics* / Q000639:trends; D014963:X-Ray Intensifying Screens / Q000191:economics / Q000639:trends