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Computerworld - Imagine trying to talk the CEO of a cash-strapped hospital into buying a multimillion-dollar IT system. It's not an easy chat, but that's the challenge hospital CIOs face when trying to sell management on picture archiving and communications systems (PACS). The systems capture, store and display patient X-rays and other images in digital form instead of on film.

In fact, many hospitals are balking at the technology's high price tag. Although PACS have been used since the mid-1990s, about two-thirds of U.S. hospitals haven't purchased one yet, estimates Jocelyn Young, a health care industry analyst at market research firm IDC.

However, CIOs who have succeeded in purchasing PACS technology can point to advantages such as cost savings, improved workflow, better patient diagnoses and even a competitive advantage over hospitals that don't have the systems.

"The most obvious cost avoidance is film processing, as well as real estate savings for film image archives. But a lot of the benefits also have to do with improved workflow and eliminating mistakes or misplaced film," says Young.

The key to building a business case for a PACS is to figure out which part of the business has the deep pockets and passion to push it through, according to a recent report by Antonio Garcia, an analyst at Frost and Sullivan Ltd. "The simple truth is that PACS will cost a great deal of money. Success often depends on which department (MIS, radiology, administration, etc.) has the most money for medical IT," he wrote.

Success in the Bronx

"I have never done an implementation of any system that has so dramatically impacted the way we do business," says Dan Morreale, CIO at North Bronx Healthcare Network, one of six regional networks established by New York City Health and Hospitals Corp.

Two years ago, at a cost of $6 million, Morreale's organization went live with a PACS in the Jacobi Medical Center and North Central Bronx Hospital, which have a total of 870 beds. The vendor was Agfa HealthCare, a unit of Mortsel, Belgium-based Agfa-Gevaert NV.

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For Morreale, the task of justifying PACS implementation was made easier by radiology department personnel, who educated physicians about the benefits of the system. Plus, the IT department had been pushing for a PACS to complete the organization's conversion to electronic patient records.

As a result of its PACS, North Bronx Healthcare Network saves almost $2 million per year by eliminating costs associated with film and paper-based reports (see box). "We've found that you can see the ROI easily. In addition, we took the approach that this is a set of tools that provides a higher quality of care and patient safety. Those are the driving forces," notes Morreale.