Few will dispute that implementing a first-time RIS/PACS makes great business and clinical sense, but how about replacing a RIS/PACS? On the “income side”, it’s pretty straightforward. Not all systems—and not all vendors—are equal. System design can create true efficiency boosters such as added functionality, ease of use and workflow efficiencies, thanks to better integration and opportunities to work efficiently in distributed reading scenarios—to name but a few. But the cost side of the equation is more complicated than just looking at the cost for licenses and hardware.
Also, the total costs of switching go well beyond the initial go-live. A few examples of factors influencing ROI throughout the investment’s lifetime include the solution’s proven uptime, ability to scale as your volume grows, frequency and complexity of upgrades and the vendor’s approach to training and support.
But let’s start by looking at two other potentially major headaches—migration and integration.
Migrating data from legacy systems is one of the critical points in switching a RIS/PACS. Not only is it a time consuming process but there’s always the concern that some data might be lost in the transition. The best advice here is simple: Make sure the vendor has done it before, many times, and has good references.
The migration project will look very different depending on your data and your specific requirements; is there data from other hospitals, is there a RIS feeding information and if so, which one, is there old data, has the data been through previous migrations, which data needs to be migrated, are all your data types supported in the new system, e.g. structured reports, word documents, PDF, RTF etc?
A few of the questions you should discuss with your vendor are:
- How do you ensure that all data is transferred and that it is transferred correctly?
- How will you help us make the migration as cost-efficient as possible? For example, should all data be migrated before go live to make it a smooth procedure, or are there factors that make it more beneficial to migrate some of the data at a later stage? Make sure the vendor can be a partner in those discussions. They should have more migration experience than you and be able to guide you.
- What methodologies do you have at hand to allow for efficient migration on the fly if needed? You don’t want doctors feeling frustrated because the specific image they need is not available!
“We have helped multi-site hospitals, imaging centers and entire regions make the transition from their aging technology to our future-proof RIS/PACS platform thanks to our proven methodologies. Based on careful data analysis, we set up a strategy for preloading data in combination with smart on-the-fly migrations to make each migration as easy as possible for our customers,” says Håkan Ritzén, Chief System Designer at Sectra.
Best practice for integration
Integration often sounds smooth and easy when dicussed in the sales process, but don’t underestimate the challenges it can bring about. Again—make sure the vendor has done it before. RIS/PACS vendor capabilities should cover integration to modalities, other IT systems and third-party applications. Good integration results in an efficient workflow by providing users with immediate access to key information while also making it easy for the IT department to manage. Below, we list best-practice methodologies for medical-imaging IT integrations:
- Documentation: Create clear, comprehensive and highly detailed documentation of the enterprise workflow.
- Standards: Choose standards-based integration over proprietary integration when possible.
- Test Environment: Scrupulously maintain a complete integrated test environment using live data.
- Test Plans: Generate test plans for all integrated systems, based on the workflow documentation.
- Vendor Management: Coordinate changes with vendors from all affected systems in advance.
- Version Control: Implement a version control system to manage changes.
“Integration within medical imaging IT has been called… ‘many orders of magnitude more complex’… than other commonly recognized integrated vertical environments such as finance and banking. Understanding and working within this complexity requires specialized IT and troubleshooting skills, a comprehensive understanding of enterprise data flows, and clear and thorough documentation,” says Frederick Barton, integration specialist at Sectra.
Business continuity and disaster recovery planning
PACS is a life-critical IT system. Without it, operations cannot be pre-planned, images cannot be read, old images cannot be retrieved, etc. In other words, you need to have a disaster recovery plan as well as a business continuity plan in place, and include this in your switching cost calculations.
Ask yourself what level of disaster recovery you need and be clear with your needs to the vendor. Building for total redundancy is indeed possible but it comes at a cost.
Some of the questions you should ask yourself are: How much downtime can you afford in case of an emergency—two minutes, two hours or two days? How much data do you need to work through the disaster? Is it enough to have the system up and running again, or do you need access to all priors? The answer will differ greatly between hospitals and so will the costs. Obviously building for redundancy within a single data center is a very different task compared to having several data centers that function as a backup for each other.
Also, to ensure that you have the disaster preparedness you need, be very specific in the requirements you give your vendor. For example, simply requesting that your vendor supplies you with 99.95% uptime can mean that your PACS is down 4 h 23 min in a year, 22 min every month or 43 seconds every day. Is this acceptable to you?
“In addition to a robust PACS, we have a very qualified service organization always ready to assist customers when a challenge, or even disaster, arises. We also offer remote services to prevent unnecessary interruptions. Let’s say that a disk is almost full. Then we can warn you about it and prevent any trouble. The easiest problems to solve are the ones that never occur,” says Magnus Wiktor, Senior Hardware Architect at Sectra.
Investing in a future-proof solution
PACS has now been around for quite a while. It would seem natural that the capabilities of PACS have matured and become the norm in terms of necessary requirements and that all PACS out there would meet the most prioritized needs. However, this is not the case.
Although most PACS meet the requirements as they were ten years ago, the reality is that the world of radiology has changed dramatically and many PACS have not yet been fundamentally redesigned in line with this. It may be surprising that so many systems are rapidly becoming outdated, but there is a straightforward explanation. A PACS vendor does need a lot of courage and financial stability to be able to make the leap into a new generation no matter how much proof there is that the current generation is a dead end. The vendor also needs to be able to see past current buzzwords and see the true need driving the buzz. A truly future-proof vendor does not act on buzz but stays on top of trends to be able to deliver customer-driven development when it’s needed. Make sure you don’t invest in something that will not stand the test a few years down the road.
Some innovation areas your vendor should have considered include wide-area radiology, cloud-based healthcare, vendor neutral archive (VNA) mobile applications, and handling ever-increasing data volumes– also in a distributed reading environment.
“We work in close collaboration with research centers to find leading-edge solutions, and with our customers around the world to ensure that our products and innovations make a difference in our customers’ daily work – today and well beyond tomorrow,” says Marie Ekström, President of Sectra’s Radiology IT operations.
Evaluating the vendor behind the solution
Even though there are many criteria behind choosing a vendor, at the end of the day it’s about trust. Trust in the vendor, trust in their products and trust in the people there to deliver and support you well after the implementation.
By selecting a vendor that is experienced and has good processes to manage integration, data migration, change management, training and support your staff you can have a smooth replacement experience and peace-of-mind that comes from vendor reliability.
“We have more than 20 years’ experience in delivering, implementing and servicing complex radiology IT solutions,” says Marie Ekström, president of Sectra’s Radiology IT operations. “Our project methodology has been developed during more than 1,100 customer projects. Some of the world’s largest healthcare organizations such as Northern Ireland, Greater London and several major hospitals in New York put trust in our competence.”