Economic and clinical impact of filmless operation in a multifacility environment

The transition from conventional film-based to filmless operation at the Ba ltimore Veterans Affairs (VA) Medical Center has resulted in a large number of clinical and economic benefits. The integration of the Department of VA hospitals in Maryland into the VA Maryland Health Care System has resulted in the opportunity to establish a "virtual" radiology and nuclear medicine department. This integrated department is based on a wide area network in which outlying medical centers use a central hospital information system/ra diology information system (HIS/RIS) and a central commercial picture archi ving and communication system (PACS), as well as a VA-developed image manag ement and communication system. The creation of this virtual radiology/nucl ear medicine department has resulted in additional savings and improvements in clinical care. The benefits of the PACS are made possible, to a large e xtent, by the high level of integration of the PACS and medical modalities with the hospital information and transcription systems. Our experience sug gests that it is absolutely essential to integrate the PACS into the patien t's electronic medical record to maximize efficiency and clinical effective ness of the system. Copyright (C) 1998 by W.B. Saunders Company.