Image data flows and bottlenecks in medical informatics: exploratory dynamic simulation of radiologic processes at a moderate-size California medical center

The objective of medical informatic systems is to enhance the efficiency of the medical process, especially as it relates to patient interaction with the health care system. We use a dynamic simulation model to estimate the current performance of a moderate size radiological unit in an urban health care center. The principal findings include description of existing informatics processes, as well as calculated results from dynamic statistical simulation of the system. Bottlenecks were observed throughout the process, with simulation estimated maximum queues ranging from 33.9 hours (fluoroscopy) to 254.3 hours (general X-rays). The impact of digital systems (e.g. PACS) on each delay point is also discussed. We demonstrate that the dynamic modelling approach such as by the ARENA model can answer specific questions pertaining to streamlining of complex, multistage medical information processes and assist in cost/benefit analysis for implementation of all digital alternatives to existing systems.