Surviving PACS divorce takes practical preparation

Planning for your next PACS within the contractual confines of a current implementation is a prudent business strategy, two University of Southern California radiologists advised fellow users.

"Do not consider PACS to be a once-in-a-lifetime purchase. Although long, happy marriages are possible, rapid evolution of new technology, functionalities, and workflows mean that at some stage you may either be longing for more or unable to cope with what you have," said Drs. Rasu Shrestha and Edward Grant.

Think in terms of five to seven-year life cycles and think beyond just the PACS, they said in an informatics exhibit at RSNA 2007. Without the proper infrastructure, PACS is nothing but an expensive paperweight.

Common reasons for a PACS divorce include dissatisfaction with support or service, lack of functionality, lack of integration with other systems and applications (e.g., with voice recognition or mammography systems), inability of PACS to scale to a facility's needs, empty or unfulfilled vendor promises, unintuitive workflow, and high maintenance.

Replacements are expected to account for 36.7% of PACS contracts and 56.7% of total market revenues by the year 2012. This means that growing numbers of users are likely to switch vendors in the future.

USC originally had a research PACS, complemented by moderate use of a vendor-supported PACS at the USC County Hospital and USC Children's Hospital. When a full vendor-supported system was then acquired, it became clear that the applications were not well integrated and the PACS suffered from major shortcomings. The only way to clear the road for a singular PACS across the USC enterprise was to divorce the original PACS provider, the authors said.

They recommend negotiating the service contract at the same time as the equipment price. If holding on to an older PACS application, bear in mind that service costs remain about the same, but that the asset will keep depreciating over time, thereby increasing the total cost of ownership. Financial experts should study the fine print, making sure there are no hidden charges or end-of-term financing restrictions, and users should consider creative PACS financing options.

"Changing PACS vendors after a long relationship can provoke nearly as much stress as the original courtship," said Shrestha, who now works as a radiologist at the University of Pittsburgh Medical Center.

The importance of advanced planning and value building cannot be overemphasized, particularly during contract negotiations, Shrestha and Grant said. Know what you want, document your requirements, communicate clearly, and don't accept only verbal promises.

Users must look at volumes and ask whether the PACS can handle tomorrow's increased demands. They should consider the total cost of ownership, including support costs, licenses, and HL7 integration costs. They must ensure the PACS fits their needs and weigh the amount of customization required. The system's compatibility with the existing infrastructure, plus the vendor's credibility and long-term commitment to remote and onsite support, are other considerations.

"Incorporating processes like risk assessment, risk management, and negotiation before signing the contract will enable customers to have the appropriate documentation in place. This is important not just in case of a fallout but also as a guiding set of principles for the day-to-day operation of the PACS," they said.

Users should conduct a technology audit to evaluate the existing products and solutions and to identify inconsistencies of any sort in the PACS application or vendor. After assessing the risk, they need to mitigate those risk factors by renegotiating the clauses.