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A New Offering – RIS/PACS Consulting
Services
What are PACS &
RIS?
PACS (Picture Archiving and
Communication System) is a medical oriented IT system that manages the
clinical aspect of the radiology environment by providing access to
radiology exams and reports over local and wide-area networks. A typical PACS includes the
capture, archiving, display, processing and distribution of medical images
and associated data.
PACS is a complex system,
requiring the integration of multiple imaging modalities and healthcare
information systems from a variety of manufacturers. State-of-the-art PACS
technology is based on proprietary software that integrates various
hardware, storage and network environments. A typical PACS is the outcome
of hundreds of man-years in development and integration.
RIS (Radiology Information
System): IT system that manages the administrative aspect of the radiology
department including patient management, scheduling, documentation
management, billing, materials, etc.
In most current
implementations, an interface (or tighter integration) between PACS and
RIS is required. The two systems are co-dependent: PACS typically relies
on RIS for patient demographics, scheduled exam and report data; RIS can
benefit from access to image data available through
PACS.
Solution Overview
PACS is a mission-critical system. Choice of
the wrong vendor, the wrong solution concept or even the wrong acceptance
tests may lead to catastrophe: the system may be found unusable at worst
or sub-optimal at best. Implementation times may be unexpectedly prolonged
due to lacking interfaces with other systems and undefined
responsibilities among different vendors. Many PACS customers have ended up
with paid-for systems that remain wholly or partly unused or that do not
live up to the original customer expectations. On other occasions,
customers only use part of the system capabilities and may be unaware or
unable to exploit the full breadth of a truly integrated PACS/RIS
solution.
Benefits and
Advantages
Our
solution focuses on the services that are crucial to the continuous,
post-installation success of an integrated PACS & RIS implementation.
We specialize in those services that guarantee that the implemented PACS
will function optimally over time in the context of the customer’s imaging
devices, departmental and enterprise-wide information systems and clinical
and business workflow. The end result will be a better, smoother process
that guarantees the full integration of the RIS and PACS solutions with
the operational and medical requirements of the purchasing
institutes.
Methodology
Customer Site
Survey & Project Plan
We believe the key to successful PACS/RIS
implementation starts with a thoroughly conceived project plan. The
project plan begins with a comprehensive survey of the customer’s existing
environment.
A site survey will investigate in detail the
customer imaging equipment, network infrastructure, IT systems, medical
staff, workflow, and other parameters which are valuable for the
definition of the customer’s needs and the corrective steps which may be
needed before any other step towards PACS is taken. Such corrective steps
will be presented as pre-requisites for PACS installation in the resulting
project plan.
The most common example for this service is
analyzing the customer’s network infrastructure and recommending the
necessary improvements to support the additional load of image data.
Another common example for such service is analyzing the customer’s RIS
(or lack thereof) and recommending an upgrade or replacement in order to
lay the ground for a successful PACS/RIS
implementation.
Beyond the recommended PACS pre-requisite
steps, we will use the site survey data to build a PACS implementation
plan. This project plan will include proposed milestones and timelines
against which all potential systems and vendors can later be assessed
before the selection and measured after the implementation. We would like
to highlight some of the unique components of the project plan as we offer
it:
- Detailed lists of imaging equipment and
its required integration with PACS/RIS – This represents an
often-overlooked area due to the multitude of imaging device models and
their heterogeneity. Though industry standardization over the last
decade has sought (and, to a large extent, succeeded) to make such
integration feasible in most cases, large variations in implementing the
standards still account for unrealistic expectations and/or sub-optimal
interface requirement specifications.
- In-depth current workflow analysis and its
required transformation with PACS/RIS – On many occasions, customers
provide vendors with much information about their pre-PACS workflow, but
leave it to the vendor to suggest how PACS may change or improve this
workflow. We propose to help the customer build an educated vision of
their desired workflow with PACS/RIS prior to system/vendor selection.
This will ensure that a vendor is selected that can best realize the
customer’s own vision rather than directing the customer towards the
vendor’s biased vision.
- PACS/RIS required interface specifications –
These should be derived from the required post-implementation workflow.
Unfortunately, customers tend to leave this area at the hands of vendors
believing only they have the expertise to discuss and agree on such
interfaces. This often results in inadequate interfaces or insufficient
integration to support the customer’s expected post-implementation
workflow. Worse still, since multiple vendors are often involved,
“finger pointing” between vendors can cause implementation to drag and
become an on-going source of frustration to customers. To avoid all
this, we propose to include detailed itemized interface specifications
in the project plan. Such specifications will be based on the
capabilities of existing systems (e.g. where PACS is added to an
existing RIS). Vendors will later be assessed (pre-implementation) and
measured (post-implementation) based on the same.
- System implementation, on-going maintenance
and training – This will include headcounts for the various PACS/RIS
user groups and support staff as well as all other resources that will
be made available to the PACS project, such as space for PACS/RIS
servers and workstations, training areas and materials, marketing
resources, etc. It is in this context that recommendations will be made
on how much and in which areas should be outsourced to the selected
vendor.
The outcome product of this service is a PACS
project plan, including the site survey report as an addendum. The
customer will have the option to use this document as the basis for its
subsequent PACS/RIS implementation, or contract with us for further
services as listed below.
Request For Proposal (RFP)
Creation
Though other consultants offer this service
today and boilerplate PACS RFP’s can easily be found on the Web, we
believe our competitive advantage in offering this service will be in
basing our work on the site survey and project plan built as described
above. In fact, these documents will be used as the cornerstones for the
RFP document. Using this methodology, we believe we will be able to offer
those clients who purchase this additional service from us much higher
value for a very competitive cost.
In addition to covering all technical aspects
of the PACS/RIS workflow, implementation and on-going maintenance and
training, the RFP will include administrative and financial guidelines for
the prospective vendors. The RFP will also define some metrics for
proposal evaluation based on the customer’s priorities.
The outcome product of this service is a
complete RFP tailored to the needs and requirements of the customer and
ready for distribution to potential vendors. The customer will have the
option to use this document as the basis for its subsequent PACS/RIS
vendor selection, or contract with us for further services as listed
below.
Vendor Selection
Depending on the customer’s legal and
procedural requirements, either an open or closed RFP will be issued. In a
closed RFP, we propose to help the customer, through our extensive
industry knowledge and based on key customer requirements, identify which
vendors should be invited to respond to the RFP. Alternatively, we can
help carve out specific parts of the RFP (e.g. in the form of a Request
For Information, or RFI) so that only suitable vendors can be short listed
for quote solicitation. Either way, our services in this context will
shorten the vendor selection process and make it more
efficient.
Since our RFP includes embedded metrics for
proposal evaluation, we will be able to provide the customer with
objective overall and specific rating in each area. The outcome product of
this service is therefore a prioritized list of vendors along with a
summary of the strengths and weaknesses of their respective proposals. The
customer will then have the option to engage in contract negotiations with
the top vendors from this list or contract with us to help further using
the services listed below.
Contract Negotiation
Support
Since most hospital legal, purchasing and even
IT staff have no idea about PACS/RIS requirements, we believe our
participation in this stage of the procurement process can help the
customer avoid costly and sometimes critical mistakes and pitfalls.
Assuming the customer has also contracted with us for the vendor selection
service, we should also be extremely well positioned to point out specific
areas of concern and potential pitfalls with each vendor’s
proposal.
The outcome product of this service is a PACS
contract where all critical vendor commitments are included. The contract
must ensure that the vendor has enough “skin in the game” associated with
each such commitment so as to cover the potential damage to the customer
if the commitment is ultimately not met. Once a contract is signed, the
customer has the option to hold the vendor to its implementation or
contract with us for further support services as listed
below.
PACS/RIS Acceptance
Testing
To the extent that a project plan has been
prepared as suggested in section 2.1 above, it is in the context of this
service that we help the customer confirm that their requirements have
been met. Most testing must be performed at the customer’s site and on the
actual installed system. Some testing may (and sometimes should) however
take place over remote network connections or in vendor (or 3rd
party) provided staging environment.
The major advantage for the customer in
purchasing this service from us (as opposed to leaving it at the hands of
the selected vendor or internal staff) is in our ability to offer
objective expert assessment of the test results. A great deal of PACS/RIS
acceptance testing depends on factors outside the control of the selected
vendor. Our expert assessment will help the customer analyze which test
results should genuinely stand in the way of system acceptance and which
ones actually point in different directions. Examples of the latter can be
non-conformities in other devices, systems or
networks.
The outcome product of this service is a list
of system non-conformities. With the proper contract in place, this list
should lead to an iterative process of corrective action on the part of
the vendor and subsequent acceptance testing until the system passes all
acceptance tests or other arrangements are made between the customer and
the vendor. At the conclusion of the system acceptance, the customer will
have the option to assume full responsibility for post-installation system
management or contract with us as needed for the services listed
below.
Post-Installation Quality Assurance &
Evaluation
Since PACS/RIS is a dynamic system, managing an
ever-changing environment of imaging devices, procedures and users, it
requires on-going optimization, quality assurance and auditing. Though
PACS/RIS vendors, for obvious reasons, tend to focus on passing the system
acceptance tests, a PACS/RIS implementation never really ends there. It is
during this post-acceptance phase that we believe customers need expert
analysis, advice and guidance more than ever. Vendors are typically
contracted for on-going maintenance, which they typically regard as their
highest margin source of revenue. In other words, their incentive in this
phase lies in minimizing their cost. A good maintenance contract (to be
negotiated along with the system purchase contract) will give the customer
guarantees for addressing and resolving issues identified during this
phase. Oftentimes this however is not the case.
Even when the contract provides for vendor
remedies, it is often very hard for the customer to analyze the source of
the system issues they struggle with. They may even find it hard to
evaluate whether or not such issues are “normal” and should be accepted or
addressed at some level beyond the PACS/RIS system or whether they
represent system malfunctions.
We offer to help customers ensure that their
PACS/RIS functions according to specifications on an on-going basis or as
a limited time service, e.g. to analyze a specific problem or perform a
snapshot audit of the state of the system. Such expert analysis and report
– the outcome product of this service – can then be used either to
approach the relevant vendors with increased confidence and supporting
data or devise a solution or an improvement in
house.
Team and Experience
Tesnet is working with a group of professional
key individuals with extensive background in the PACS environment and many
years of experience. This
team is part of Tesnet’s professionals with proven experience in Quality
Assurance and Testing in general, and within the field of Health related
projects in particular.
Related
Experience
PACS Consulting Services – Past
experience
Sheba
Medical
Center:
Sheba
Medical
Center is the largest hospital
in Israel
and has more than 1,900 beds. It treats 125,000 inpatients, 155,000
emergency visits, and 850,000 outpatients annually.
Faculty and
staff: More than 800 physicians and approximately 5,800 healthcare
workers and support staff.
The team of experts that join Tesnet in
providing this solution included a group of then IBM employees,
specializing in system engineering, project management and hardware
/software design and implementation.
In
1993 the hospital and IBM launched a pioneered joint venture for
implementing IBM’s newly developed PACS in the hospital. At that time,
PACS and its implementation were totally new concept.
Our team had participated in the requirements
definitions phase, escorted the development of the product and managed the
project execution in the hospital radiology department. Including
infrastructure design and implementation, hardware and software
installation, and staff training.
In 1995, the product was ready for
beta testing. Teaming up with the Radiology department staff, we had
designed and implemented a new hospital-wide workflow from scratch, The
transfer from hard-copy interpretation to soft-copy implementation opened
a new era in the whole hospital as radiology studies, which were the
possession of the radiologists by then, became available to every
physician in the organization, using the Web based distribution system
that was implemented as a part of the PACS.
The vendor conducted acceptance
test for the system, where our team was responsible for planning and
running the tests, gaining a lot of experience in this activity. At that
time, our knowledge base spanned through a complete lifecycle of PACS:
from the design board to the final acceptance.
Later
on, when the system was fully operational, we did act as a part of the
maintenance and service team.
In
1998, the hospital succeeded to reduce its films consumption by 60%, a
remarkable success considering the pioneer nature of the project.
From
1999 and on, members of our team, under various contracts, participated in
similar projects in the
US
and
Europe, gaining extensive experience in all aspects
of the services we are offering now.
PACS
Consulting Services – Past experience (Cont.)
HCMC,
USA
HCMC is
a medium-size community hospital in Central
US. It
has about 200 beds and its
annual volume is about 50,000 procedures.
HCMC
was not a “typical” customer; the project was led by a very knowledgeable
IT department ( opposed to the radiology team as usual).
In
2002, HCMC issued a RFP for a hospital-wide PACS. Our challenge was to win
the deal, install the system, and escort the implementation phase and the
operational system during its first production year.
Our
team included a US located sales representative who was also responsible
for the site survey, for analyzing the customer’s requirements and for
managing the implementation project. Another team member was responsible
for system engineering and the solution design, and the third one for the
system installation and acceptance tests. The RFP was created by another
consulting company.
After
creating a winning proposal, a contract was signed between the parties and
the project was launched.
After
the PACS was installed by the vendor, our team had performed the
acceptance test. After creating the proposed acceptance test procedure, it
was approved by the customer and then conducted by the team members with
close supervising of the customer.
The
PACS became operational during 2003. Our team had participated in the
primary training and in the daily assimilation of the system, guiding the
users with the needed changes to the hospital film-based workflow, turning
it into a filmless one. After 6 months, the hospital became completely
independent in the daily operation of the system. The PACS vendor is still
performing post-warranty service including software refresh, hardware
upgrade etc.
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