Not for the faint of heart
Buying a PACS can be daunting - there is little room for error in such an expensive undertaking.
Challenges include:
- A working knowledge of rapidly changing technology
- An unbiased insight into the business strategies of potential suppliers
- Incorporating existing equipment
- Considering changes to current operations, especially the role of the radiology technologist
- Accounting for the various skills and apprehensions of a multitude of potential users
- Accommodating complex practice patterns of radiologists and referring physicians, especially in the Emergency Room, Operating Rooms, and Exam Rooms
- Impact of organization changes within the enterprise
- Impact of changes in the health care industry
Deployment Strategy
Even if an organization can afford an entire PACS at one time, there's an order to the deployment process. The expression, "the devil is in the details", is very true in PACS deployments. Determining the optimal sequence and getting all of the potential users to accept the new way of doing things is the challenge.
The system designer must break the PACS into simple application-specific clusters that might focus on individual problems and ultimately mesh to form a vastly more complex enterprise-wide system.
A stable and long-lived infrastructure must be designed so that components purchased in the earliest phases are not obsolete when the final phases are completed.
A successful deployment schedule must string "little successes", simple but effective changes in the operations of the department whose very effectiveness builds acceptance and confidence.
To be successful, the system designer must
- Chose the right solutions to the right problem
- Gently nudge the professional staff just beyond the edge of their experience
- Bring a multi-phase project in under budget.
- Every enterprise is unique. Otherwise, everyone could buy the same thing with equally good results.
Two Step Process
There is a basic two-step process to buying a PACS, planning and vendor selection.
Planning includes:
- Needs assessment
- Business case analysis
- System design
- Deployment Strategy
Vendor selection includes:
- Review and refine requirements
- RFI/RFP
- Finalist's evaluations at shows, demos and site visits
- Final section and negotiation
Planning
Planning is a comprehensive study to make sure you don't waste money on your PACS. You must consider:
- Organization dynamics
- Existing technology
- Optimal PACS configuration
- Phased implementation plan
The planning process must meet the needs of:
- Imaging department's customers
- Department professional, technical and clerical staff
- For both immediate needs and future
Planning is based on:
- Operation data and expenses
- User preferences and skill-sets
A resulting plan and system design must accommodate various constraints:
- Technical
- Organizational
- Political
- Operational
- Financial
Getting all the various stakeholders throughout the enterprise to all agree on the plan is also critical.
The Gray Consulting planning and design process includes:
- Current State Analysis
- Impact Study
- System Design and Implementation Strategy
- Cost Estimate
- Payback Analysis
The outcome of the planning process is a roadmap for implementing PACS, typically over a multi-year period, but it is possible to deploy a complete system in less than a year.
Vendor Selection - Potential Pitfalls
Most assume that the first step of vendor selection is the Request For Proposal (RFP).
RFPs for a complete PACS are very time consuming to prepare. Considerable effort is also required to prepare the PACS team to understand the responses. The number of vendors considered is usually limited to 3 because of the time required to analyze and report on full system RFPs.
A full system RFP must describe the design strategy and rationale in great detail. This will attract considerable debate and argument from the vendors, who will want to argue their strategy.
Many vendors today will not respond to a complex RFP unless they are already engaged in the selling process with the facility and believe that they have a good chance to win the deal. Since it is not unusual for a prospective PACS buyer to overlook a number of companies and products, the client may never discover just how good their PACS solutions may be, if those companies choose not to respond.
Vendor Selection - A Better Way
Experience has shown that it is easier to select the right components or vendor by first using a Request For Information (RFI). The RFI collects product and corporate information without telling the vendor exactly what you intend to build. Asking for detailed information, the RFI yields a level of detail the team needs to decide which components best fit the present phase and fit with subsequent phases. This approach also eliminates arguing strategy with potential vendors.
All of the major PACS vendors have responded to the Gray Consulting RFI. Since 90% of the document remains the same with each publication (approximately 10% of the questions are new to address changes in technology or requirements), and the question numbering system remains the same, all of the major vendors have continued to respond to the invitation to submit responses. The client will not miss out on an opportunity to discover the best PACS solution.
The RFI is sent to numerous companies ñ any that the team believes has the right components, or is included for political reasons. The RFI weeds out all but the best 2 or 3 finalists.
The RFP is then drafted to address remaining questions and to resolve business and legal issues. This RFI/RFP combination gives the team much greater control over the system design and vendor compliance.
The Gray Consulting vendor selection process includes:
- Design Review of any existing system plan and strategy
- Refinement of System Specs
- Description of required vendor services to support the proposed system
- Development of RFI
- Evaluation and summary of RFI responses
- "Short list" submission
- Development of RFP
- Evaluation and summary of RFP responses
- Site visit preparation
- Vendor or system integrator selection
- Negotiations
