For any healthcare enterprise, the expenditure of funds for
capital equipment follows a purchasing (or leasing) policy
established through the staff of the organization's purchasing
department. For example, the purchase of a CT (or MRI or
ultrasound) unit is accomplished by an interface between the
department wishing to place the order and the purchasing
department, mostly via an RFP (request for purchase) mechanism.
When such a mechanism is used, is there a way to ensure the
selection of a quality vendor and the satisfactory purchase of a
PACS? Here are some ideas and suggestions that institutions have
tried in order to accomplish these objectives. Some of these ideas
worked well, while others made little or no difference because the
desired goals were not initially well defined. We invite you to
think "out of the box" and send us your ideas and judgments as to
how well they worked (or will likely work). In a future
publication, we hope to summarize your ideas, and present your
experiences to share with other departments.
In setting the parameters here, we assume that a number of
prepurchase activities have taken place. For instance, we assume
that you and your staff have defined the PACS project to be
implemented, that you have identified the goal to be accomplished,
and that you have determined how success is to be measured. We
further assume that you and your staff have visited several
established PACS sites whose operation is similar to what you are
attempting to accomplish. Finally, we assume that you and your
staff have been active in the preparation of the RFP, and that
adequate funds are available to your department for implementing
the PACS project.
The vendors to whom you send the RFP should be informed that
written acceptance criteria will be in place prior to signing a
purchase contract. Additionally, many buyouts and mergers of PACS
vendors are occurring and, as such, you should request a clause in
the purchase contract which states something to the effect that if
your vendor of choice is acquired by another vendor or entity, then
the resulting vendor or organization will honor all portions of the
original purchasing contract. You also should request that your
vendor of choice agree upon an a priori policy for hardware and
software upgrades; this is necessary due to the rapid changes in
the technical parameters of hardware, software, and networking
systems, as well as to changes in the use of your PACS
(scalability).
Unfortunately, the operational expectancy of your future PACS is
short. The uncertainty introduced by rapid technical changes,
software changes, and changing demands all combine to require that
you carefully "engineer" the PACS to your individual needs prior to
purchase. For example, the monitors in the interactive grayscale
displays eventually will require replacement. You should plan to
change these monitors every two years. The possibility of
electrical power surges introduced into the PACS requires some form
of power protection device; the provision of these devices should
be in your initial plan. In addition, the huge amounts of digital
medical image data will require that you carefully monitor the
image database and implement a scalable expansion of the selected
archiving media as you approach a three-quarters full
condition.
Is it possible to protect a PACS investment? In 1980 through
1981, many researchers were predicting that PACS would be operating
in all radiology departments within the next several years.
We have, however, been humbled by our failure to fully realize
this prediction. To a large extent, this failure has been the
result of our not adequately accounting for the rapidness with
which PACS technology changes. PACS are computer systems whose
technology, software, and vendors change rapidly. Additionally,
vendors present the challenge of keeping up with company mergers
and buyouts, which may change the service and reliability offered
to their customers. The perceptions of what PACS can accomplish
filmless radiology remains constant, but the difficulties of
success remain in the details of accomplishment. The rules for a
successful PACS implementation may be as easy as the following: 1)
develop a comprehensive PACS implementation plan; 2) carefully
determine both the goal and the measures of performance to evaluate
success; 3) do all the necessary research and comparison shopping
prior to selection of a qualified PACS vendor; 4) conduct a risk
analysis in which you design the PACS implementation on all levels
including systems, personnel requirements, etc. assuming likely
changes and faults; 5) acquire an outstanding group of computer
savvy staff; and 6) devise quality control protocols that will
ensure proper operation of all components of your PACS.
PACS vendors are rooting for protecting a PACS investment;
radiology departments and their staffs root for this as well. With
the proper efforts and planning, everyone can get what they want
out of PACS.
Dr. Dwyer is Professor of Radiology at the University of
Virginia Health Sciences Center in Charlottesville, VA. He is
also a member of the editorial advisory board of this
journal.