Effect of filmless imaging on the utilization of radiologic services

PURPOSE: To determine the effect of a large-scale picture archiving and com munication system (PACS) on in- and outpatient utilization of radiologic se rvices. MATERIALS AND METHODS: Data were collected at the Baltimore Veterans Affair s (VA) Medical Center (BVAMC) before and after implementation of an enterpr ise-wide PACS; the numbers and types of imaging examinations performed for fiscal years 1993 and 1996 were evaluated. These data were compared with th ose from a similar academic medical center, the Philadelphia VA Medical Cen ter (PVAMC), and with aggregate data obtained nationally for all VA hospita ls over comparable periods. RESULTS: Inpatient utilization, defined as the number of examinations per i npatient day, increased by 82% (from 0.265 to 0.483 examinations per patien t day) after a transition to filmless operation at BVAMC. This is substanti ally greater than the increases of 38% (from 0.263 to 0.362 examinations pe r patient day) and 11%(from 0.190 to 0.211 examinations per patient day) at the film-based PVAMC and nationally, respectively. Outpatient utilization, defined as the number of examinations per visit, increased by 21% (from 0. 108 to 0.131 examinations per visit) at BVAMC, compared with a 1% increase (from 0.087 to 0.088 examinations per visit) at PVAMC and a net decrease of 19% (from 0.148 to 0.120 examinations per visit) nationally. CONCLUSION: The transition to filmless operation was associated with increa ses in inpatient and outpatient utilization of radiologic services, which s ubstantially exceeded changes at PVAMC and nationally over the same interva l.