The PACSman Pontificates: Ch-ch-ch-ch changes

By Michael J. Cannavo, contributing writer

October 3, 2022 -- Artificial Intelligence (AI) gets the lion's share of press these days, but within radiology, it's not just AI that needs to be looked at closely. PACS/enterprise imaging systems (EIS) are actually more important, yet few say much about them anymore. Digital image management has been so well integrated into the very fiber of radiology that its mere existence is taken for granted.

The PACSman, Michael Cannavo.

PACS/EIS platforms typically have a life of five to seven years. Some facilities keep their systems active for a few years longer. A few keep them for a shorter period of time, especially if there are significant performance issues.

Usually, about a year or so before the end of a system's life, radiology facilities will begin to look for a replacement PACS. Nearly every site does what they consider due diligence evaluating vendors to replace the existing vendor.

But what about their existing vendor? Are they ever considered? More often than not, the answer is no, or at least not seriously. Most prefer to sing David Bowie's "Changes" ("Turn and face the strange, ch-ch-changes") while evaluating half the PACS/EIS products on the marketplace.

Many start with a list provided by research companies that rank vendors annually. But is this the right way to go?

In some cases, yes. In most, no. Facilities ready to replace their existing PACS/EIS with a different vendor cite reasons ranging from hardware aging out to dissatisfaction with the existing system.

When a system no longer meets the needs of a facility, replacement needs to happen. That's a given. Yet in the absence of system performance issues, replacement often is not needed.

What may be "broken" can often be fixed if communicated to the vendor properly. This can save time, resources, and money in the process. Sadly, it's like a marriage that has run its course where at least one party wants out. Why? "I'm just not happy" is the typical answer given.

It has been my role to find out the "whys" of unhappiness and at least give the vendor a chance to fix the issues before tossing in the towel. Instead, both parties are like a couple at a square dance, so many facilities will often spend an inordinate amount of time and money doing a do-si-do with several potential partners only to find out the partner they already had was one that just needed a few extra dance lessons.

At the last few engagements that I've worked on, we were able to address the concerns my client had with their existing vendor, fix most (but not all) of the problems the facility had, and save the cost and aggravation of migrating from one vendor to another.

Dating other vendors may seem exciting at the time, but trust me, the aggravation is not worth it. Too many facilities also seem to want to throw the baby out with the bath water not realizing what is involved in changing out a PACS system from a financial, time, and resource perspective.

This change can add $100,000 to the cost in even the smallest facility when all is said and done. In a larger facility it is many multiples of that cost and that doesn't include the price of the antacids you will need either.

As unpopular as this statement might be, if at all possible, you should try and keep the incumbent vendor. I realize this statement will be highly controversial and that there may be valid reasons why a different vendor is preferred. In addition to performance issues, rationales can also include a loss of confidence in the system on the part of the radiologists, dissatisfaction with service, and many others.

But instead of heading straight to divorce court or dating others, a knowledgeable intermediary might be your best option. The low cost of an intermediary beats a few hundred grand down the road when you find out you just exchanged one set of problems for another

Regardless of what direction you go in, a solid contract is also a requirement. This holds true if it is a short-term carry-over contract until you replace the incumbent PACS or an extension or replacement of the existing agreement.

Most PACS contracts five years old or older that I have read are abysmal at protecting the interest of the facility. Whatever you do, don't have your legal department read and comment on the agreement, either. They got you into this mess in years past. Instead, have someone who understands PACS operations as well as the legal gobbledygook review the terms and conditions and make suggested changes.

Working on a verbal promise without a written agreement is like knowing you are going to get divorced and asking your soon-to-be ex-wife to cook dinner for you and your new girlfriend. Now, nearly all vendors will be professional, but recognize that they are human beings too. Things will get done but it will be done on their schedule, not yours. You simply aren't a priority anymore.

And if you felt you were never a priority before, just wait till you tell the incumbent vendor they are being replaced. That said, as long as there are no financial penalties involved that will impact revenue recognition, most vendors typically will work with you.

Making a change isn't as easy as simply exchanging one dance partner for another. There is a whole lot more to consider including if a ch-ch-ch change is even needed at all.

Michael J. Cannavo is known industry-wide as the PACSman. After several decades as an independent PACS consultant, he worked as both a strategic accounts manager and solutions architect with two major PACS vendors. He has now made it back safely from the dark side and is sharing his observations.

His healthcare consulting services for end users include PACS optimization services, system upgrade and proposal reviews, contract reviews, and other areas. The PACSman is also working with imaging and IT vendors to develop market-focused messaging as well as sales training programs. He can be reached at or by phone at 407-359-0191.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of

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