Merger Mania’s Implications for Imaging IT

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Ask any health–IT executive for a synonym for change, and a probable response is merger/acquisition. The rapid pace of consolidation among physician practices, individual hospitals, hospital enterprises, and hospital-chain corporations has generated an unprecedented level of organizational, operational, and technological change. From a radiology perspective, what happens to the installed base of legacy imaging-informatics systems of merging entities? What are the strategies and decisions that have an impact on imaging informatics? From an operational perspective, the best and most enduring strategy, in Geisinger Health System’s experience, is to install the same RIS, PACS, and related software across an enterprise and to consolidate long-term archives. Over the long term, Geisinger Health System has found this to be as cost effective as (and potentially more cost effective than) keeping an acquired hospital’s legacy systems. In addition to its hospitals, Geisinger Health System has nearly 60 community-practice sites serving 44 Pennsylvania counties. In the past 2.5 years, the organization has added three Pennsylvania hospitals (Geisinger-Community Medical Center of Scranton, Geisinger-Shamokin Area Community Hospital in Coal Township, and Geisinger-Bloomsburg Hospital) through mergers/acquisitions. Geisinger Health System is awaiting approval from the Pennsylvania attorney general to add Lewistown Hospital through merger/acquisition. On September 9, Geisinger Health System and Holy Spirit Health System (Camp Hill, Pennsylvania) announced the signing of a letter of intent to explore ways that the health-care organizations can work together. Holy Spirit Health System includes the 315-bed Holy Spirit Hospital (Camp Hill). John A. Cardella, MD, associate CMO and systemwide chair of radiology, explains, “Our IT strategy is to absorb any new health-care facility that joins our health system by providing it with IT systems that it is not likely to be able to afford on its own. We replace all IT systems with what has been deployed at Geisinger Health System. This includes the RIS, PACS, speech-recognition/dictation systems, the archives, and the EHR—everything.” The capital investment and other resources allocated to implementing these changes are expensive, but the up-front financial outlay is more cost effective, in the long run, than allowing an acquired facility to continue to use the systems that it has in place. Cardella explains, “With disparate IT systems, a merged enterprise can turn out to be a Tower of Babel, so to speak.” He adds, “To deal with the challenges of integration and transparent interoperability of disparate legacy systems, it is necessary to invest a lot of time integrating systems, building interfaces, and writing custom code (to get disparate systems that are not designed to communicate with each other to do so). Even after investing that effort, the end-result IT environment will not be efficient. Human effort will be required to overcome the limitations of the cobbled-together systems.” He says that expediency (or financial constraints) at the time of an acquisition might be the rationale for keeping two or more different RIS and PACS in operation, but in the long term, the actual cost of doing so at many different operational levels tends to be much greater than the cost of replacing the systems and unifying the informatics environment at the time of the merger. Technical Aspects Mike Leighow, vice president of operations of Geisinger Health System’s radiology service line, says that the most challenging aspect of a conversion is migrating images from a legacy archive to the system’s PACS. Geisinger Health System contracts with an application service provider, so a fee is charged for each archived exam. Assigning medical-record numbers, consolidating the files of patients who might have used more than one identity, and other data-migration issues all are challenges that the radiology IT team expects to face. Geisinger Health System’s long-term archiving strategy is to add a VNA, although basing this archive in the cloud remains a challenge because it involves protected health information. At Geisinger Health System, a radiology-informatics oversight group carefully plans every known aspect of the conversion and implementation; the group consists of key leaders from the IT department, physicians and staff from the radiology department, and the radiology-informatics staff. The group sets the agenda