Assessment of Methods Used to Import External Brought-In Image Data Using Activity-Based Costing/Activity-Based Management

Background: With filmless operation becoming widespread in Japanese hospitals, medical images provided for referral purposes are frequently stored using portable media such as compact discs. Few facilities import brought-in data into their own Picture Archiving and Communication Systems (PACS) with a clearly defined responsible creator at the time of data storage. Currently, no literature analyzing this series of tasks exists. Objective: This study aimed to determine the best workflow for importing brought-in images into PACS in order to optimize management and costs. Methods: We created three different importation operational workflows (postmedical examination importation, pre-medical examination importation, and pre-medical examination importation using Temporary PACS for storage), and clarified the decision maker, who decides when to lock and prevent further image modifications, and the responsible creator of the image. Task analysis of each operation was carried out using Activity-Based Costing and Activity-Based Management, methodologies used in the field of management accounting. Results: Task analyses revealed that post-examination importation increased the burden on physicians, in addition to increasing operational costs. It was also shown that an explicit responsible creator did not exist with pre-examination importation. When pre-examination importation was conducted using Temporary PACS, physicians were both decision makers and responsible creators. Moreover, the burden on physicians was low and the costs could also be kept low. Conclusion: We analyzed importation tasks involved in bringing external images into PACS. Our results indicate that, from the perspective of management and costs, it is most efficient to import images using Temporary PACS servers.