AuntMinnie.com: How has the PACS purchasing process changed over the last few years? Is cost-justification still a challenging issue? What implementation trends are taking place (i.e. more interest in large-scale, enterprise-wide digital image management)?
Tucker, Agfa: We’re seeing a healthy mix of both large and small healthcare institutions interested in buying PACS. One of the biggest challenges, however, in converting to a filmless environment is how to handle enterprise distribution and access to images and reports. Therefore, we’re still seeing a large number of customers who want to start small, but are very interested in the scalability and reliability of the system for future enhancements.
In a related trend, we’re seeing what you might call the return of modality miniPACS. Customers are finding PACS easy to cost-justify for connecting a couple of modalites.
Of course, we’re also seeing interest in integrating multiple radiology departments and hospitals within an integrated healthcare network (IHN). These customers want to consolidate those resources, and also use PACS to integrate other clinical departments with radiology.
Mason, eMed: Large-scale PACS purchases consistently follow a long and arduous sales cycle including RFPs, site visits, and committee decision-making. There is a growing trend towards CFOs and CIOs carrying more influence in the buying decision than radiologists. Purchasing decisions are increasingly based upon ROI, expected variable cost reduction, and expected productivity gains. Implementation is becoming far more phased in order to meet with budget constraints and to mitigate risk.
Gary Larson, Kodak: PACS purchases are not as purely radiology-driven as they were in the past, although it still is handled that way at some institutions. As PACS systems have matured into enterprise-wide image and information workflow tools, this decision is being shared by the Information Systems group as well as the broader healthcare provider community -- referring clinicians, specialists, and the like. So, more and more we are seeing radiology playing a key role as a participant in the decision, often holding "veto power" but without full authority.
Cost-justification remains a large challenge. While many industry participants have studied and attempted to quantify some of the more obvious cost savings (such as reduction of manpower and film usage costs), understanding and quantifying the value of the improved service to the customers of radiology, the ultimate patient care providers, is still quite immature.
Perhaps one of the most difficult benefits of PACS to quantify is the improved service to radiology’s customers. What is the true value of a one-day reduction in report turnaround time that provides a more rapid path toward patient treatment and a reduction in hospital stay? What is the value of a reduction in lost prior films? These are some of the burning questions which, when answered, will help all of the players in the industry better understand the true value of automated, digital image and information management systems.
Hullihen, Marconi: The overall knowledge base in the customer world has been rising over time, and that’s decidedly good news. We’re finding customers who are comfortable and confident in their own capabilities for assessing technology-based proposals as solutions for their requirements. There is also still a segment of the market that is pursuing PACS in a more classic IT way, however, with RFIs, RFPs, and consultants.
Quite a few people choose a phased approach. They’ll step into a solution deployment by choosing individual modalities and/or parts of their department that are already mostly digital. The tradeoff there is that the time to realized cost savings gets stretched out compared with, say, a site that says 'we think we understand how this works pretty well, and we’re going to do a department-wide deployment right away.'
We see a mixed bag of implementation approaches, often depending on the vision of the department leaders. All of these projects have internal champions, and the implementation type is often driven by the vision and energy level of the internal champion.
Next page: How successfully have small and mid-sized hospitals adopted digital image management?
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