Transcript PACS 101 System Selection Methodology

PACS System Selection
Methodology
Rex Osborn
2004
Project Methodology
We support a full spectrum of project activities.
Plan
• Readiness
Assessment
• Strategic
Benefits
• Total Value
Calculation /
Financial
Planning
• Executive
Education
• Budget
Approval
Architect
Integrate
Optimiz
e
• Requirements:
Technical,
Functional,
Integration, &
Process
• Implementation
Planning
• Administration
• Implementation
and Integration
• Reinvestment
• Clinical
Scenarios
• Process
Improvement
Baseline
• Process
Improvement
Measurement
• Maintenance
• Technology
Selection and
System Design
• Vendor
Contracting
Redesign
Optimize
Planning
Plan
Archite
ct
Integrate
Operate
Step 1. Assessment and Financial Planning
Image volumes:
Priorities based on image volumes and users who need access
to them
Operational readiness:
Experience with and willingness to use digital images
Support staff readiness:
Dedicated resources in the imaging departments and in
Information Services
Clinical systems readiness:
Common patient and study indexing schemes and interfaces
between the clinical information systems and the enterprise
imaging system
Equipment readiness:
Standard configurations and adequate space for all
components
Network readiness:
Adequate bandwidth, redundancy, security and performance
Plan
Link to Strategic Direction
Strategic Direction
Clinical
Quality
Enable
Growth
Service
Excellence
Physician
Partnership
Community
Service
Employer
Of
Choice
Improve Patient Care and
Satisfaction
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Efficiently Read Multi-Image and
Serial Studies
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Increase Involvement in the Care
Delivery Process
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Eliminate Unread Studies
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Easily Find Any Image, Anywhere
Throughout the Healthcare System
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Improve Physician Satisfaction
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Project Objectives
Reduce Lost and Misplaced Films
Improve Report Turnaround Time
Provide Concurrent Access to
Diverse Image Information
Integrated with EHR
Reduce Operational Costs
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Plan
Integrate with Overall IT Plan
Many organization’s Vision is to provide their clinicians an integrated, “content-rich” point of
care environment that transcends departments on a common workstation enabling timely
access to a patient’s comprehensive clinical information for optimum diagnoses and treatment.
Imaging is a significant portion of the required clinical information.
Plan
System Readiness Planning
Focus Area
Planning Steps
Executive Leadership Committed to a structured approach: e.g. enterprisewide planning, multi-year investment, policy that no
departments can opt out.
Physician
Acceptance
Physician project champions working with site
coordinators who help educate the physician
community on the benefits of PACS.
Enterprise
Connectivity
Network enhancements are budgeted to provide an
enhanced, reliable network and storage.
Clinical Integration
Integration plans and system acceptance testing
procedures.
Data Confidentiality
Systems planning for user log-ins and passwords
integrated with the EHR.
Technology
Obsolescence
Contractually bind the vendor to upgrade PACS
hardware and software - purchase workstation,
network and storage separately from existing vendors
System
Implementation
Have a dedicated project management and train PACS
administrator's.
Plan
Identify Success & Risk Factors
Factor
Risk
Level
Steps
Executive Leadership
Sustained commitment to a structured and
disciplined approach against plan: program
management, funding, purchasing, operating
procedures. No departments opt out.
Physician Acceptance
Identify a physician project champions and site
coordinators who will help educate the physician
community on the benefits.
Enterprise Connectivity
Incremental network enhancements are budgeted
to provide an enhanced, reliable network and
storage.
Clinical Integration
Have a solid contract with the vendor for system
acceptance; bind system acceptance to final
payment.
Data Confidentiality
Enterprise systems support user log-ins and
passwords and may be integrated with the EMR.
Technology
Obsolescence
Contractually bind the vendor to upgrade hardware
and software to keep the system current.
Purchase workstation, network and storage
separately for your existing vendors.
System
Implementation
Have dedicated project management to deliver a
successful implementation.
Establish High-Level
Implementation Plan
Hospital USA PACS Implementation Roadmap
DEC
NOV
OCT
AUG
JUL
SEPT
DEC
NOV
OCT
SEPT
AUG
JUL
MAY
APR
MAR
FEB
JAN
DEC
NOV
OCT
SEPT
2004
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MAY
APR
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DEC
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MAY
APR
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OCT
SEPT
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2005
2003
OCT
SEPT
AUG
JUL
JUN
MAY
2002
Phase 1 - Implement PACS Infrastructure and Digital Modalities
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
2004
OCT
SEPT
AUG
JUL
JUN
Phase 0 - Pre-Implementation
PACS Planning
PACS Internal Marketing and Approval Process
Vendor Selection
Contract Negotiations
Implementation Planning
MAY
2003
JUN
Implementation Phase and Activities
JUN
Plan
Network Improvements and Upgrades
Build/Implement HIS/RIS Interfaces
Implement Back-Office Equipment
Begin Acquiring/Archiving Images from all Modalities
AUG
SEPT
OCT
NOV
DEC
AUG
SEPT
OCT
NOV
DEC
JUL
JUL
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
OCT
SEPT
2004
AUG
JUL
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
OCT
SEPT
AUG
JUL
2004
2003
OCT
SEPT
AUG
JUL
JUN
Phase 3 - Expand Web Image Access
Implement Enterprise-wide Web Image Access to remaining remote
sites and physician offices/homes
PACS training
Expand PACS services to ORs
MAY
2002
JUN
MAY
APR
MAR
FEB
JAN
DEC
NOV
2003
OCT
SEPT
AUG
JUL
JUN
Phase 2 - Implement PACS Review Stations
PACS training
Implement Diagnostic Workstations in all Reading Areas
PACS Training
Implement Clinical Review Stations in ED & Critical Care Areas
PACS training
Implement Enterprise-wide Web Image Access on hospital campus
MAY
2002
Calculate Financial Impact
Plan
Outflows
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Capital
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Capital
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Core / Back-office
User Equipment
Computed/Digital Radiography
Modality Upgrades
Infrastructure Upgrades
System Integration
Renovations
Vendor Services
Re-investment
Operational
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DI/PACS System
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Inflows
Support Staff
DI/PACS system maintenance
CR/DR maintenance
Network equipment maintenance
Incremental network cost
Potential increase revenue
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Reduction in missed billings
Increase in utilization
Operational
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Labor
Film
Film processing
Supplies
Storage space
Courier / Transportation
Plan
Sample-PACS Financial Model
Radiology PACS Summary Costs
Baptist
Health Health
SystemFacility
USA
PACS Component
PACS Workstations
PACS Core/Back Office
Computed Radiography
Radiology Information System
DICOM Upgrades
Network Upgrades
Data Center Renovations
Radiology Renovations
Third Party Services
TOTAL CAPITAL (10% disc)
Potential Add'l PACS Disc (15%)
TOTAL CAPITAL (Discounted)
PACS Reinvestment (15% every 3 yrs, thru 2013 )
TOTAL CAPITAL INVESTMENT THROUGH 2013
Hospital
A
Baptist LR
HospitalNLR
B
Baptist
Hospital C
Arkadelphia
$
858,000 $ 177,000 $ 90,000 $
1,590,000
539,000
189,000
1,080,000
540,000
428,000
1,456,000
40,000
80,000
60,000
488,000
116,000
33,000
50,000
200,000
429,000
107,000
$ 6,191,000 $ 1,559,000 $ 800,000 $
(529,200)
(188,400)
(106,050)
$ 5,661,800 $ 1,370,600 $ 693,950 $
$ 1,101,600 $
322,200 $
Possible Operating Expense Reductions & Avoidance (cumulative thru 2013)
Incremental Operating Expenses (cumulative thru 2013)
Heber
Hospital
SpringsD
OPC
MRI
OP1LR
OPCOP
2
MT1
OPC
3
OP
NLR
TOTAL
90,000 $ 130,000 $
189,000
135,000
428,000
-
65,000 $ 130,000 $
27,000
27,000
-
100,000
33,000
15,000
28,000
840,000 $ 293,000 $ 107,000
(106,050)
(39,750)
(13,800)
733,950 $ 253,250 $ 93,200
125,550 $ 125,550 $ 119,250 $
1,540,000
2,696,000
2,476,000
1,456,000
280,000
29,000
742,000
50,000
200,000
536,000
$ 186,000 $ 9,976,000
(23,550)
(1,006,800)
$ 162,450 $ 8,969,200
41,400 $
70,650 $ 1,906,200
$ 10,875,400
$ (21,768,269)
$ 11,071,339
$ (10,696,930)
Architect the Solution
Plan
Archite
ct
Integrate
Operate
Step 2. Architect: Vendor Selection
Technical, Functional, &
Process Requirements:
Priorities based on diagnostic, clinical, and technical needs of
the organization
Clinical Scenarios:
Developed to demonstrate DI capabilities and evaluate vendors
ability to deliver functionality and workflow improvements
System Design:
Based on Vision & Guiding Principles, Requirements,
Standards, Technology,
Vendor Selection:
Selection approach aligned with organizations goals &
objectives
Contract Negotiation:
Standard configurations and adequate space for all
components
Architect
Determine Priorities
Image Viewers
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Physician Offices
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Surgery
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Pulmonology
Neonatology
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Pediatrics
Internist / GP
Endoscopy
Critical Care
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Radiation Oncology
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Pathology
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Orthopedics
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Other
Oncology
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Neurology
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Radiology
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Vascular Cardiology
Cardiology
Radiology
Cardiology
Image Creators
Angiography
CT
C-Arm
Computed Radiography
Diagnostic (X-ray)
Digital Radiography
Fluoro
MRI
Mammo
Nuclear Medicine
PET
Tomo
Ultrasound
Cardiac Catheterization
Echo/Doppler
EEG
EKG
Fetal Heart Monitoring
Holter
TEE
OB/Gyn.
Clinical Specialties
Image Intensivists
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Architect
Selection - Sample
Goals & Objectives
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To mitigate your risk during
the vendor selection and
contract negotiation process
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To ensure the selected
solution meets requirements
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Provide investment
protection to ensure
investments in the solution
are properly timed and
aligned with an overall
strategic vision
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Guarantee Integration to
Enable Digital Workflow
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To arrive at a well-designed
solution with preferred
digital imaging vendors
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To develop a comprehensive
contract that will set a
strong foundation for both a
successful implementation
and long-term relationship
between Bassett and the
vendor
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To shorten the time-tocontract with the vendor
Architect
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Approach: Leverage the IHE*
Standards
Allows for focus on workflow solutions, not connectivity issues
Lowers integration costs – implementation durations
Minimizes custom interfaces – clearly defined interface owners
Vendors representing 90% of the digital imaging market
participate - RIS, CVIS, PACS, Modality, Web, Reporting, 3D
Workstations, Voice Recognition Systems
You get integrated information systems vs. information islands
ADT
RIS
*Integrated Healthcare Enterprise
MPI
HIS
PACS
Display
Modality
Architect
Example: Selection Criteria
Criteria
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Functionality
Weight
25%
Definition
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Technology
15%
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Cost
15%
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Experience
15%
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Integration
Vision
30%
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Source
Functionality Coverage
Detailed Scenario Ratings
Overall Scenario Ratings
Application Maturity
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Technology Assessment, Ownership
Cost of Ownership
Technology Risk Assessment
Number/ Complexity of Integration
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Preliminary Cost Models
Implementation /Benefit Timing
Cost of Ownership
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Customer Service
Implementation Depth, Methods
R&D Expenditures
Annual Contracts
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Alignment with Vision
Shared integration approach
Vendor track record, IHE, CCOW
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RFP Response
Demonstration
RFP Response
Clinical Site Visit
Evaluation
RFP Response
Vendor - Cost
Benefit Models
(RFP)
References
RFP Response
Clinical Site Visit Evaluation
References
RFP Response
Clinical Visit
Visit Evaluation
Architect
Example: Workflow Enablement Guarantee
Proof of Concept Scorecard
Requirements
Image Acquisition Performance
Time First Image is acquired to first image read (lossless display)
Review Workstation Usability
Desktop Defaults configurable by user
Defaults include, applications accessibility, User defined hanging
protocols
Global Worklist and image Availability
Key Filmless Workflow
Cath Lab
Proof of Concept
Approach
Vendor Y
demonstration/site visits
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Need to conduct measurements
demonstration/site visits
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Need usability feedback
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Need
usability
feedback
Images
and past
reports were easier to
access on Vendor X
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demonstration/site visits
demonstration/site visits
demonstration/site visits
Referring
demonstration/site visits
ER/Trauma
demonstration/site visits
Cross Domain Complex Study
site visits
Fault Tolerance
No single point of failure
Continuous operation in degraded mode
Site Integration Expectations
Rapid Deployment Capable
Multiple Imaging Sites
RIS/CVIS Integration
Integration w/ADT,ORM,ORU
Patient Care Inquiry
Modality Integration & Support
DICOM C-STORE, SC, MWL, PPS
Comments
Vendor X
Vendor X 3D package does not allow for
integration with 3rd party SW
Need templating software from 3rd party
vendor Measurement tools better on
Vendor Y
Does not identify if images are on film
only
design review
design review
site screen
site visits
demonstration/site visits
demonstration/site visits
site visits
Integration Experience with modality vendors
site visits
Expedient Process to resolve integration issues
process review
Vendor X is a SW only approach Vendor
Y provides true disaster recovery
Vendor X will not be ready until future
release
Need process review
Architect
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Examples of Final Contract Exhibits, System Configuration, and
Bill of Materials:
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What’s in a Contract and Why
Terms and Conditions
Bill of Materials
License Software Module Schedule
System Requirements Compliance Matrix from RFP
Specifications and Acceptance Testing Protocols
Payment Schedule
Service Agreements
Project Milestones
Escrow Agreement
User Documentation
Original RFI/P/Q Response and Subsequently Issued Requirements &
Specifications
Works in Progress Agreements
Ensure common understanding and agreement to cost,
performance, capacity, and scalability
Minimize client risk associated with vendor terms and conditions,
solution offerings, costs, and future product direction.
Architect
Project
Initiation
Technology Selection Process
Organize
Selection
Teams
Develop
Requirements
Workflow Analysis
Prepare and
Distribute
RFP
Vendor
Responses
Requirements
Session
Analyze Vendor
Responses
Down Select
to 2 Vendors
Assess Against
Current Vendors;
Identify Benefits
Prepare
Scripted
Scenarios
Final Approval
Executive
Presentation
and Approval
Recommend
Vendor(s)
Of Choice
Conduct
Reference
Calls
Conduct Vendor
Demos
Using Standards in Selection
Architect
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For enterprise systems to be successful, standards are
critical
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Guarantee information flow which allows the organization to
focus on workflow solutions, not connectivity issues
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Less integration complexity and lower costs shorten
implementation durations
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Minimize custom interfaces and clearly define which vendor
owns each integration boundary
*Integrated Healthcare Enterprise
Prenuptials for Partnerships
Architect
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Terms and Conditions Referencing Exhibits:
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Service Levels
Bill of Materials
Schedule of Software
Acceptance Testing Procedures
System Requirements and Performance Specifications
Project plan and Statements of Work Links to Payment
Service and Maintenance Agreements with Uptime Guarantees
Training Materials, Schedules and Documentation
The Original RFP Response
Product Roadmaps
Goals
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Ensure agreement - costs, project scope, system performance,
capacity, and scalability
Understand and mitigate risk associated new product offerings
and future product direction
Integrate
Archite
ct
Plan
Integrate
Operate
Step 3: Integration & Implementation
Pre-Implementation Planning: Detailed Program Plan built to align all resources and steps
necessary for successful implementation
Process Improvement:
Further define specific DI transformation objectives, establish
baselines metrics
Implementation Management:
Establish DI Program Manager, team, tools and processes
Organization Training:
Develop and conduct training based on system functionality
and transformation objectives and processes
Implementation & Integration: Implement and integrate according to Program Plan
Improvement Example
Integrate
"After organizing work flow to take maximum advantage of the capabilities inherent to PACS, we saw the number of steps involved in
scheduling, producing, reading, reporting and billing a single chest radiographic study decrease from 59 to nine"
"Clinicians are now able to quickly retrieve diagnostic images-in full fidelity with imaging reports at workstations we've deployed throughout the
medical center," says Siegel. "Because we're saving them time, clinicians are able to focus more attention on patient care, delivering care
Workflow
that's of higher quality than ever before." – VA Hospital ER
Baltimore
ER enters order in
TDS with a stat
note
Trauma team is
paged
Yes
Patient arrives
TDS prints
requisition with
patient information
Trauma
No
Exam is performed
Patient information
from TDS is
printed out and
given to radiology
Radiologist reads
exam
Paperwork printed
and given to tech
(Before 5 pm
ONLY)
Tech brings film
back to radiology to
be read
(Before 5 pm ONLY)
Radiologist reads film
Exam is performed
Tech hangs the
images on ER
rotator
Dispatch tech to
read film
Yes
Priors requested
Patient checked out
of ER - noted on
ER board
Tech allocated to
patient
Receptionist
arrives patient
Simultaneous
Process
Tech gets patient
Clinical decision
rendered
Contact file room
X-ray cassette
taken to ER
processor
Wet read
performed by ER
clinician
Film on site
Technologist
completes order
on Maxifile
Radiologist
overreads or reads
the stat images (if
necessary)
Note - Highlighted areas can be eliminated with PACS
No
ER process
continues without
films
Tech takes patient back
to ER - patient checked
back in on board
File room strips
the rotator - every
2 hours
Films are printed
Films filed in the
file room
Integrate
Driving Accountability
Integrate
Resource Optimization
100%
90%
80%
Facilities
Administration
70%
50%
Consultant
Modality Vendor 2
Modality Vendor 1
40%
PACS Vendor
IT Department
30%
Rad/Card Departments
Rad/Card Groups
60%
20%
10%
0%
Transform
Implement
Operate (Six Months)
Project Timeline
Integrate
Modality/
DICOM
Assessment
FCG
Engaged
Current
Environment
Assessment
RFI
Released
Network
Assessment
Implementation
Team Resource
Checkpoint
Contract/Re-quote
Released
PACS RFP
Released
Workflow Redesign
CR
Workshop
Network Preparation
Board
Approval for
PACS
Site Visits and
Reference Checks
PACS
Vendor
Selected
Archive
Installed
Acceptance Test
Complete
Interface Design
Modality Integration
Contract
Complete
“GO”
Negotiations
PACS
Planning
Softcopy Reading
Web Distribution
PACS
Training
Kickoff
Facilities Preparation
Staff
Interviews
PACS
Subnetwork
“Live”
Database Preparation
GO LIVE
Implement, Operate,
Optimize
DI Architecture,
Selection
PreImplementation
Planning
12 - 16 Months
DI Transformation – Operate
Plan
Archite
ct
Integrate
Operate
Step 4. Operate: Transform & Operate
Operations:
Daily diagnostic and clinical operations
Maintenance &
Administration:
System performance, capacity, availability, vendor support,
system administration
Process Improvement:
Measure performance improvements against baseline and DI
Transformation objectives; further refine processes to gain
additional benefit from DI Transformation
Reinvestment:
Plan for and reinvest in DI systems and architecture as
appropriate