RSNA: Divorcing your PACS vendor

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CHICAGO—Thorough planning and prenuptial agreements with PACS vendors can palliate what will be an unavoidably painful, but potentially valuable, switch of PACS vendors, according to research presented today at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

Corporate or hospital decisions are common causes for changing PACS vendors, but radiology departments can reap benefits from electing to switch to more innovative or technologically advanced and integrated PACS systems. Moreover, alternative vendors may offer radiology departments, imaging centers and healthcare providers the opportunities to expand and increase the volume of studies and patients while reducing system errors and enhancing workflow, suggested Steven C Horii, MD, from the Hospital of the University of Pennsylvania in Philadelphia.

"It's a painful process at best," admitted Horii, who has been part of three PACS-vendor switches at Penn's Hospital. While cost is a relatively straightforward limitation for most practices considering a vendor switch—it's either affordable or not—Horii cautions all practices that the process will cost substantially more than vendors estimate. Selling your outdated PACS online can help redeem some of these losses, he claimed.

Database migration is unequivocally the greatest challenge in divorcing your PACS vendor, according to Horii. For one switch, the department of radiology at Penn. encountered 40,000 mismatches of patient information out of more than a million studies. Uncertainties of how to interpret mismatched data ("Is Homer Simpson the same patient as Homer J. Simpson?" Horii questioned), as well as omitted information and mislabeled studies present onerous challenges. Horii was able to reduce the department's 40,000 mismatches down to 1,200 unsolvable cases by using IT professionals to identify common problems and uniform approaches to solve them.

Thorough planning is the most important way to counter the challenges of switching vendors; in Horii's words, "Negotiate a prenuptial agreement." First and foremost, ensure that your institution has guaranteed access not only to all your PACS data but also to the structure and coding system of your vendor's systems, as migrating data can become dramatically more difficult if proprietary information is not detached or explained during the transfer.

Keeping in mind that added costs and longer-than-expected migrations are inevitable, negotiating month-to-month contracts with initial vendors and pre-negotiating charges for system failures are essential. Because both PACS models will have to run simultaneously throughout the migration of data, which Horii says usually takes one to two years, create a migration schedule that will not backup workflow and slow systems. Hiring independent database migration surveyors and establishing contingency plans for errors and delays can also help alleviate the process and speedup migration time, Horii recommended.

Overall, switching PACS vendors can provide tremendous value for radiology practices, including costs. "Divorcing your PACS vendor will be painful," Horii concluded, "but with thorough planning you can ease this pain."