RSNA: Practical informatics for rads includes PACS prenup

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CHICAGO--There can be a number of reasons in changing PACS, including the original vendor going out of business, no longer having a product that supports the work being done or a change in administration within a healthcare facility or a corporate decision, according to Steven Horii, MD, in a session titled "PACS Divorce" at the Radiological Society of North America (RSNA) annual conference on Monday.

PACS migration is becoming more commonplace as systems are becoming obsolete very quickly, noted Horii, director of radiology at the Hospital of the University of Pennsylvania in Philadelphia.

According to Horii, while change is inevitable, certain factors can be noted as the most problematic. These include the question of what to do with the old hardware, such as MR machines, database migration conflicts, interface problems, missing the changeover schedule and having migration run too frequently.

“Database migration is the biggest problem we noticed,” said Horii. Names and reports that are matched up incorrectly and duplicate names within the system create conflict because they require manual intervention or additional software to correct, he said.

Interface issues were also noted by Horii as being a potential conflict during PACS changeover. “Your PACS is connected to a lot of different information systems and interfaces, which have to be tested on the new system," he said. “There may be a new round of interface licensing fees involved.” For example, if the RIS and PACS are two separate systems by different companies, a fee would most likely be charged by the existing company to interface its system to the new PACS.

When entering into an agreement with a new PACS vendor, there is the potential for the timed migration estimate by the new vendor to be off-schedule, said Horii. “In their calculation, they assume that they will have access to your whole database 100 percent of the time. You cannot let the migration run 24-hours a day,” he said.

Among the recommendations in easing the PACS migration pain was considering vendor-independent storage solutions, an idea that is becoming increasing acceptable to vendors, said Horii.  “The idea is that you change the other parts of the PACS, but the database only needs minor changes, such as re-mapping database tables,” he said.

Further recommendations included having realistic estimates of data migration time, as well as contingency plans if the time limit is not met, and being prepared for legacy system failure before the implementation of a new system.

“Instating a prenuptial agreement from your PACS vendor” was the central solution offered by Horii.

“You want guaranteed access to your database and your data. You may own the data, but you do not own the schema -- that is, how it is organized. That’s a problem if you are trying to migrate.”

Horii suggested that should a vender go out of business, the database should be obtained for the new vendor and details of all inter-system interfaces must be learned. Additionally, Horii discussed the option to continue service contracts on a month by month basis with the old vendor. However, he noted that the same service terms should be kept as the old system still will be in use clinically.

Moreover, Horii said, “You should get the new vendor to agree to work with the old vendor on the details of how to do the migration.” However, this takes time as it may involve contracts and non-disclosure agreements between the two companies.