Case Study: Investing in Digital Radiography Systems

CASE STUDY: INVESTING IN DIGITAL RADIOGRAPHY SYSTEMS

Neel Veterinary Hospital in Oklahoma City, a paperless practice that purchased its first computer and electronic medical record system in 1993, prides itself on its commitment to using the latest technology. "Adding computer radiography was a natural step in the evolution of our practice," says co-owner Dr. Tina Neel.

Before taking this step, the hospital team compared the cost of purchasing and maintaining the digital radiography system with the savings from eliminating monthly automatic processor maintenance fees, the purchase of film, and associated labeling and storage supplies. "With a digital system the number of re-takes associated with processing drops considerably, saving time and minimizing staff members' exposure to radiation and to the chemicals used in conventional developing," she says. Coupled with the space regained when they stopped storing conventional films, these benefits convinced the hospital team that the purchase made sense.

The digital radiography system cost approximately $50,000, including cassettes. The hospital also pays approximately $3,000 annually for warranty and support. The hospital saves between $8,000 and $9,000 per year in fees associated with purchasing and processing conventional film.Neel Veterinary Hospital averages approximately six radiographic cases per day from current clients, emergency cases, and referrals. The practice's radiography gross income is up 60 percent in the 12 months since the purchase; the cost of the unit was recouped during the first year of use.

"When we installed the digital radiography unit, we changed our fee structure to include two separate views for each patient with the initial radiograph fee," says Dr. Neel. "This initial fee is slightly less than the cost of two films with our old system. We generate more income by requiring two films for every client, but we believe this approach improves the quality of care and minimizes the risk of misdiagnosis."

The hospital relies on the same radiographic equipment and computer system, so moving to a digital system didn't require much additional team training. "The only change is that there's no chemical developing. The cassettes come loaded with the phosphorus plates, which makes taking and developing the radiograph much less complicated," Dr. Neel says. "It's easier to teach a new employee to process the image, too."

The doctors and staff members also report other benefits:

• the ability to see greater detail and manipulate images
• the ability to access the system from remote locations for conferencing with clients and specialists
• the elimination of the storing, filing, and searching associated with conventional films
• the ability to transmit images electronically to specialists.

Another benefit: "Clients see that we've invested to improve our diagnostic skills, and they pass this information on to their families, friends, and co-workers," says Dr. Neel.

The downsides of going digital: When the computer system goes down, staff members can't develop radiographs. And the electronic storage for the digital radiographs is limited. Business manager and co-owner Sam Neel says they can store about two-and-a-half-months worth of digital radiographs. "When we run out of space, we have to call the manufacturer, and ask them to set up another folder for us, which is a small hassle."

But all in all, the hospital reports the positives far outweigh the negatives. "Going digital improved the quality of our radiography-based diagnostics tremendously," says associate Dr. Brett Boatsman. "Anatomical detail is greatly enhanced, and uncounted clients have told me how neat the system is."

LETTERS

I enjoyed reading the February article "Investing in Overnight Care Pays Off," but I must admit my gut reaction was that the technician and doctors are underpaid. Under normal circumstances, emergency room doctors and technicians are paid a premium for undesirable hours, so the return wouldn't be as great as in your case study. The article also gives the impression that the doctor works alone, which forces your doctor to act as a technician.

George Robinson, DVM

Tampa, Fla.

Louisiana State University, '81

Dr. Nelson responds: Since average transaction fees are higher in emergency cases, the doctor who works the weekend shifts makes more per 40 hour workweek than he or she would working a more normal schedule. And the weekend shift lets the doctor concentrate his or her work time into a three-day period and have four days off per week. We have a working mother who prefers this shift, so she and her husband can split the childcare, avoiding daycare. Even on the nights a technician is not on-site, there is one on call. Five of our seven doctors (and all four owners) live 25- to 30-minutes away. Since "routine" office hours run until 9 p.m., it's usually 10 p.m. to 11 p.m. before we finish charts and write orders for morning treatments. It's easier for us to stay since we'd need to be back at 7 a.m. anyway. We save an hour drive--and enjoy an hour of additional sleep--by staying at the clinic. The technicians who work on the weekend also work shifts both days, and they volunteer for the 10 p.m. to 6 a.m. sleep over time. As the overnight caseload increases, we'll add a technician and a receptionist to the shift, so we'll resemble a more typical emergency room clinic.