As meaningful use standards become a crucial component of medical care, many hospitals and clinics are looking to upgrade or even fully replace their picture archive and communication systems (PACS). Such a switch is not something to be taken lightly, and the solution often isn’t as simple as “plug and play.” Typically, hundreds of thousands of images from numerous modalities need to be converted to the new system. And aside from choosing a system that best suits their individual needs, organizations need to consider a range of factors, from network security and HIPAA to cost and staff training.
To help sort out the daunting task of replacing a PACS system, three healthcare facilities shared their experiences with Imaging Technology News.
Davis Health System in northern West Virginia went live with an entirely new PACS, cardiology PACS (CPACS) and voice recognition system in 2010 to help carry it into the future of healthcare. Although it has a busy radiology department – doing more than 75,000 imaging studies per year – Davis Health is a relatively small player with a 90-bed community hospital. Much of its experience revolved around partnering with a vendor who would give it the same type of focus as a larger university hospital.
Debbie Thorpe, the director of radiology at Davis Health, says the organization needed a Web-based way for radiologists, cardiologists and vascular surgeons to read their studies. However, even though they were adding a CPACS system, they did not want to hire additional staff.
On the other hand, Children’s Hospital of Colorado looked for a vendor who was willing to push their system to new heights. Radiologists at Children’s do 140,000 imaging exams per year, and they weren’t willing to accept a simple cookie-cutter system. They needed a top-of-the-line solution that could adapt to the hospital’s diverse needs. The hospital also had simply outgrown its old system. Chris Goodale, the former radiology data systems administrator, says costs associated with upgrading the existing system were so high, it made more sense to convert to an entirely new system.
Another scenario had evolved for ProHealth Care in Wisconsin, which needed a PACS that could effectively operate over a large geographic distance. Since most of its radiologists also work at other clinics in the region, service and familiarity were key.
Additionally, at the time, ProHealth Care wanted to migrate nearly a decade’s worth of images into its vendor-neutral archive so it could cut the amount of work per study in half. Because there isn’t a standard for the DICOM archive for study updates and patient updates, all new information essentially had to be entered twice. According to Mike Morateck, the manager of imaging informatics at ProHealth Care, every time someone fixed, merged, split or deleted studies in the PACS, they also had to do it again in the system’s DICOM archive.
Morateck said they wanted to integrate the two, but their former vendor also had a DICOM archive and refused to integrate its PACS with a competitor’s system.
A Team Effort
In all three cases, the process started out with heavy research and the formation of an investigation committee.
Thorpe joined Nina Virone, the CIO of Davis Health System, as well as the director of IS, the PACS administrator and the hospital’s technical manager on the decision-making committee.
Goodale says Children’s Hospital first formed an extremely diverse team to tackle the project. Before the investigation process was even started, the organization made sure that any stakeholder group was represented. Subject matter experts from the electronic medical record (EMR), information technology (IT) and infrastructure teams were all included. In addition, networking, IT security, database administration and radiology representatives were part of the team. Goodale says the team even had surgeons, emergency department providers and an interventional radiologist.
The reasoning behind the extensive team was twofold. First, it ensured that the hospital had all its bases covered. The diversity allowed the team to look at vendors from virtually every angle and address any questions that came up. More importantly, though, it helped create buy-in before the selection process even started.
“Giving everyone the option to look at every system we were thinking about and using their feedback was a really good idea,” Goodale says.
The team met with six different PACS vendors at a conference and had each address specific issues and workflows that they wanted their next system to meet. Based on the responses, the team went through an extensive scoring and evaluation process to weed out systems that wouldn’t meet their needs.
From there, they sent out requests for purchase (RFPs) to the four remaining vendors. Each RFP was then judged on a variety of factors, from security and access to integration and workflows.
ProHealth Care also formed a PACS steering committee, which included management, radiology, cardiology and heavy user representatives. That team spent roughly six months determining what features they needed in their next-generation PACS system.
Since most of ProHealth’s radiologists also practice at other clinics in the area, Morateck says they looked at systems that were common across the region.
“We also factored in PACS systems that were installed geographically in the area and other places that our physicians practiced,” he says.
Although it wasn’t an overriding factor, Morateck says the fact that McKesson’s PACS was already installed in nearly three-quarters of the nearby heath systems did play an important role in the final decision.
Seeing It in Action
After getting approval, the team from Davis Health went on numerous site visits to see the system it was considering in action. For Thorpe, seeing the PACS work in the real world was invaluable.
“I have to see it work,” she says. “I have to see it in my world. I have to be able to imagine it in my world, not just sit and watch a presentation.”
Additionally, Thorpe says site visits offered another benefit: getting unbiased opinions from users.
“The people in these departments, they’re honest with you,” she says. “If they don’t like something, they’ll tell you, and if they like something, they’ll tell you.”
Davis Health eventually decided to convert to McKesson’s PACS.
After narrowing the field down to two vendors, Children’s Hospital also contacted other users to determine the relationship between vendor and client. Based on the team’s evaluations and various user feedback, Children’s opted to go with FujiFilm’s Synapse PACS system.
Go-Live
Perhaps the most important factor in Davis Health’s successful conversion was the service provided by the vendor. Virone says there were several instances that could have derailed the project or pushed it behind schedule were it not for McKesson’s service and dedication.
“If there was a roadblock, they removed it,” she says.
For example, once the clinic started converting images, it realized another server was needed. Within 24 hours, Virone says the server was sent out, installed and operational, which was no easy feat given that the hospital is three and a half hours from the nearest major airport.
All of that contributed to an extremely fast turnaround time. From start to finish, Virone says the entire process took about four months. Nearly all the images were fully converted six months later.
ProHealth Care, which also selected McKesson, had a smooth go-live experience. All told, Morateck says the process took longer than expected – nearly two years in all – because the contracting took almost a year.
Goodale says it took a few years for his facility to complete the entire process. Part of that was due to the lengthy evaluation, but at the time, he says Children’s Hospital had just moved to a new facility. The new system has been live since May 2010, although at time of publication, Goodale says the hospital was still migrating images to the new system.
Words of Advice
Based on his experience, Goodale advises organizations to ensure that the vendor’s project manager meshes with the hospital’s norms and culture.
“Seriously think about having some type of criteria by which you want your project manager to fit,” Goodale says. “These can be norms that you have as an organization or as a team, or just what your expectations are.”
That wasn’t the case initially for Children’s Hospital, and it ended up delaying the project.
“If we were to do it all over again, I think we would encourage the vendor to allow us to be a participant in selecting who the project manager is,” Goodale says.
Morateck says that clinics should budget double the amount of time initially predicted for data migration.
“I could tell you just from experience in the trench, I’ve had RIS conversions, HIS conversions and then PACS conversions,” he says. “And every single one of the conversions had issues and required probably at least twice the time it was supposed to take to implement correctly and do cleanly.”
But most importantly, all three agree that the relationship with the vendor is key.
“Words are very easy to say,” Virone says. “When someone says they have a ‘partnership’ with a vendor, it has to be a commitment on their part and on our part.”
August 06, 2024 
