In my 25 years of informationtechnology management in four completely different industries (distribution, agricultural biotechnology, process manufacturing, and now health care), I have found that if information technology is considered a strategic resource, rather than purely a costsaving resource, the system’s efforts will be more likely to succeed. Many times over, investments in information technology, which can be extremely expensive, fail because costs are cut in training, infrastructure, and follow-up support. Information-technology projects often take longer and cost more than anticipated, but if executed well (and completely without cutting corners), can provide an exceptional payback while adding unforeseen strategic value. In 1996, when I started working at Inland Imaging, we were a group of 12 radiologists based in Spokane, Wash. In that year, we created and debt financed a business-services division to provide medical-management, business, and information- technology–related services to an assortment of medical groups and providers in our area. With the growth of our business-services division and our own radiology group in mind, we purchased systems and built infrastructure that could expand and be scaled up as needed. I knew that to grow efficiently, a company must have a common infrastructure and workflow. We made it a priority to license the software that we purchased for resale under the agreedon limitations of our software vendors. We acquired application software with enterprise-class levels of sophistication in the user and datasecurity models. This new software also used a highly developed worklist and work-routing capability that could handle many times our current examination levels. In addition, we put in place the best networking infrastructure and hired the smartest people that we could find. Though this high-end software, infrastructure, and other staff investments were not the cheapest, they have enabled us to grow extensively without starting over or adding limitations to our expansion options. The systems and information-technology services proved to be enablers of our growth, both as a radiology business and as a medical-services business. The Next Level Inland Imaging is on the cusp of expanding information-technology services and medical file-sharing capabilities to clients in order to continue offsetting the cost of our newest systems. Preliminary stages and planning have been put in place to begin developing new software that will better integrate communication among other medical networking platforms. We will also begin to expand server accessibility and management to those who wish to use our information-storage space. We have the ability to provide external client-based medical services to balance information-technology expenses and maximize return on investment. For example, as we became experts on our own radiology information systems (RIS)/PACS, which were running in our Inland Imaging centers, local hospitals decided to outsource their RIS/PACS services to our company, as opposed to handling them themselves. Two multispecialty clinics in the Seattle area with their own radiology departments (for which Inland Imaging radiologists do the interpretations) also use our information- technology services for their RIS/PACS solutions. In fact, we currently have more than 20 different organizations sharing our PACS in an application service provider (ASP) model. We even archive for a nearby hospital where a competing radiology group performs the professional services. We currently archive more than 1 million examinations per year. Not only does this provide a revenue stream for our business unit to offset our information-technology overhead, but the sharing of PACS images across organizations in our region in a single, secured database actually permits dramatically improved patient care and overall workflow. As we implemented our RIS/ PACS, we became experts on systems integration. We now provide systems-integration services for most electronic medical record systems and many hospital information systems (HIS)/RIS/PACS and other health information-technology systems as well. We have introduced a Web-based medical imaging viewer to referring clinicians’ offices, many of which have hired our field engineers to assist with other information-technology– related trouble shooting and functions. The list goes on and on of profitable opportunities that have emerged as we invested in information technology. Over the years, we have seen increased savings as a result of our information-technology investments. Today, Inland Imaging has almost 70 radiologists and six vascular surgeons, and we are running the same (albeit enhanced) software and infrastructure that we were running when we had 12 radiologists. The exact figures associated with not having to convert to entirely new systems over the past 10 years of rapid growth are unknown, but are estimated to be substantial. The medical-records and film-distribution departments have been downsized from more than 30 FTEs to five. Our staffing levels for general imaging-center operations are down, while film and associated costs are basically nonexistent. The transcription department once employed more than 30 people and now has fewer than 10, and this number is dropping due to recent extensive investment in speechrecognition systems (which we are also starting to offer as a new ASP service line). Our radiology group is almost entirely subspecialized, which we believe makes recruiting easier. It should be noted that we have significantly more information-technology staff than we did 10 years ago, so determining the exact payback of our investment is subject to processes associated with cost accounting. We are still based in Spokane, but are expanding services to the Seattle and Phoenix markets. Our business unit and informationtechnology divisions are currently looking into other value-added services that we can provide. As our radiology groups, including Inland Imaging, get larger and their work becomes more fragmented, there is an increased need for improved integrated workflow and decision support systems. We are currently building our own systems to assist us in this area, and this will include integration of multiple HIS/RIS/PACS into a single, integrated radiologist workflow system. From this single-point workflow and data-collection system, we are developing quality-assurance and utilization-appropriateness functions, along with other kinds of data analysis for various purposes. In addition, we are currently evaluating the market potential for these services.