Replacement PACS: How to Plan, Purchase & Put It in Place
Sponsored by an educational grant from GE Healthcare & Dell

Making the decision to migrate to a second-generation PACS raises numerous questions. How to avoid problems associated with previous products while successfully planning for the future? Several facilities that have made the transition share their experience and advice.

Overlake Hospital Medical Center, a 337-bed regional hospital in Bellevue, Wash., has been using Web-based PACS since late last fall. What’s the biggest benefit? Simplicity, says senior systems analyst Tyrone Beal. The medical center is utilizing the GE Centricity PACS-IW system, originally the IntegradWeb solution from Dynamic Imaging which is now part of GE. The Web-based PACS offers accessibility, flexibility, and cost-effective scalability. The facility experienced a lot of downtime with its previous PACS.

Overlake did a lot of comparison shopping and used a simple questionnaire that asked whether the vendor offered a Web-based, single user interface PACS; billing model by volume; and how licensing was structured. The simple, specific questions quickly helped to cull the list.

In the end, Centricity PACS-IW had everything Overlake wanted at the best price. Being Web-based and having a single user interface were the most important elements. “We did not want to play in an environment where each workstation was limited by licenses and users had multiple logins to access the different functions they may need from the PACS.” Having the same look and feel from every access point played into the desire for simplicity. That gave everyone the functionality to edit and display exams from anywhere at anytime. Plus, Beal says the Web-based administrative piece makes it easy to add, monitor and audit users in a single environment.

Beal says the installation was one of his most uneventful, which was achieved by really knowing what the environment wanted and needed.

EPIC Imaging, a three-site imaging center organization based in Portland, Ore., has been live on Web-based PACS since early 2005. The group decided to install a new Centricity PACS-IW because they felt their previous system had lagged in new features, says CIO John Griffith.

The PACS was installed and configured entirely remotely, and the group of 20 radiologists began reading images on the PACS before applications training had been given. “That’s how easy the product was to use,” he says. The radiologists went from a system where they still preferred reading from film to a system that convinced them of the benefits of a digital workflow. The worklist-driven solution “has improved their productivity and efficiency quite a bit over the old system,” Griffith says. 

After more than three years with this system, “we have no compelling reason to even want to take a look at another system,” he says. That’s partly because GE continues to add new features and move to newer technologies to improve performance. “We don’t even have a full-time equivalent allocated to managing this system.”

John T. Mather Memorial Hospital in Port Jefferson, N.Y., has been using the Centricity PACS-IW since late 2006 after replacing its previous PACS due to extensive downtime, says PACS administrator Jeanine Genco. “We were looking for a Web-based solution that was very user-friendly.”

Once they decided on Centricity, they went from signing the contract to going live in just six weeks. Why so quickly? A new radiology group that already knew the system was going to be joining the hospital at the time. The new radiologists were all familiar with the PACS, but “I had not yet received training on the system when we went live. For a system administrator to be able to just go live with no training is pretty fabulous.”

Lessons learned

Those who have replaced their PACS have learned a lot and offer advice for those ready to take the plunge to the next generation:
  • Beal says many organizations engage project management and spend a lot of money [on consulting] to figure out what kind of PACS they need. “I think a lot of these PACS implementations fail because they don’t engage the right people,” namely those affected by PACS.

  • To get more input from a staff affected by PACS,  just use a simple “wish list” form, Beal says. Then, create a detailed, functional document that outlines your facility’s needs. “Use it to decide what you can live without and what you won’t compromise on.” Some examples might be flexible integration, support of industry standards like DICOM and IHE Portable Data for Imaging CDs and consistent user interface for all users.

  • A Web-based solution is the way to go, according to Centricity PACS-IW users. Training on their old system used to take half-an-hour and still resulted in numerous phone calls and questions, Genco says. “It literally takes five minutes to train physicians now,” she says. “The ease of [use of] the system is the most important thing—the rest will follow.”
Kim Baldwin, PACS administrator for South Jersey Radiology Associates with 10 locations and 41 radiologists in New Jersey, agrees. Her practice has been using Centricity PACS-IW since October 2004. “We have over 800 referring users on our system,” she says, a testament to its ease of use. Baldwin used to go out to referring practices for training. Now, they can do it over the phone in just minutes. Word of mouth is so strong in the referring community, numerous referring physicians call daily to gain access to the system.

Breaking up is hard to do

“Splitting” with your current PACS vendor can be a sensitive topic for both parties. One Centricity PACS-IW customer has replacement PACS advice that he can only issue anonymously. Restrictions on discussing past vendors can be well worth the benefits of moving past an outdated system.
  • Transferring data from the old system to the new often is the biggest challenge, this PACS administrator says. “I think a lot of people are surprised by that.” You can either migrate the data or try to get the new system to read the old system’s database. “People think a computer is a computer, but it’s more complicated than it sounds,” he says. He suggests having a future data migration plan in place before signing a contract for replacement PACS.

  • Don’t get fooled by the “fancy stuff,” he says. “The mixture of the PACS and the RIS you’re going to have and whether the two integrate [tightly] is more important.” Look for a system that has numerous different, successful integrations out there, he says.

Time’s not right for replacement?

Depending upon your PACS situation, the timing simply might not be right for your organization. For example, budget may be tight, change is difficult to manage in your organization, or you’ve made a sizable investment in your existing PACS. If that’s the case, work with your vendor to leverage the Web capabilities of your PACS to the greatest extent possible, by demanding anywhere diagnostic reporting for radiologists and robust results review for referring physicians. If achieved with capable Web functionality, this may just be the care plan your organization has been seeking.