Applied Radiology

Assume that you have purchased a PACS (Picture Archiving and CommunicationSystem) and teleradiology system from a vendor. What are the responsibilitiesof the vendor to you, the client? All too often vendors feel that once youpurchase such a system, they are no longer responsible for the product. Mostinstitutions sense this attitude and prepare elaborate contract clausesregarding such items as maintenance, upgrades, replacement, and softwareupgrades. The reality is that you, the client, depend upon the vendor to assistin making the resulting purchase a true benefit to your operations.

No doubt you can think of many aspects that the vendor should be responsiblefor. Informing you as to the proper use of the product is one important servicewhich you expect the vendor to provide. This requires the vendor to visit yoursite at least once a month to determine the level of satisfaction.Additionally, you expect the vendor to provide information regarding newproduct developments that may enhance the performance of the system, such asobject-web for Intranet distribution, new NT workstations, and securitysystems. You also should be made aware of evaluations of the vendor'sproducts that are being conducted at other sites (throughput, HIS/RISinterfaces, and system acceptance metrics).

As the client, assistance in dealing with a maintenance program is importantto you. You have concerns such as, "How do we deal with computer hardwarechanging every 8 months?" "How do we deal with 12-month computersoftware changes?" "How might we cope with maintenance costs (trainon-site staff; utilize remote system monitors)?"

The issue of an upgrade program is critical to the success of any PACS andteleradiology system. You need to know if the vendor will assist with thereplacement of hardware, such as grayscale monitors (which have life cycles ofapproximately 18 months). The vendor should be expected to determine if yourinstitution can lease equipment at a reasonable cost, even though mosthealthcare facilities do not like to lease equipment, as cost estimates arebased on lease terms of 18 to 24 months.

Educational programs can be offered by the vendor. Bringing the productdevelopment managers to the client's site enables the vendor toincorporate new applications into future products. Providing vendor-sponsoredseminars at the client's site also can provide a worthwhile educationalexperience. Such seminars should include operational solutions from other sites("Here is what we did to facilitate our trauma physicians' need forradiology services to be available on a 7-day, 24-hour basis"), and futuretechnological developments (such as archiving systems and new networktechnologies).

Other responsibilities you should expect a vendor to assume include partialpayment for software upgrades, maintaining up-time (98%), and providing toolkits (display protocols, system monitors, and audit trails). Hospitals aredeveloping enterprise-wide systems, demonstrating the ability to interface intoany healthcare database, such as electronic records and images, and providingPACS and teleradiology interfaces. Vendors impact these systems by developingworkflow engines to manage image data, and compression engines to takeadvantage of reduced image file sizes. It is the responsibility of the vendorto make you aware of these developments, so that your site may achieve the fullbenefit of what a system has to offer.

Remember, you do not want your vendor to go out of business because ofexcessive client overhead. Yet, clients should expect vendors to becomeproactive for their sites. A large number of vendors will be bought out andwill change management; this requires, you, the client, to be certain thatstandards (DICOM HL-7) are an integral part of your system. The best protectionis for you to have a knowledge base of the operation and technology of a PACSand teleradiology system.

Dr. Dwyer is Professor in the Department of Radiology at University ofVirginia Health Sciences Center in Charlottesville, VA; he is also a member ofthe editorial advisory board of this journal.