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.