Lessons learned (continued)
No. 4: The best option isn't always the most expensive -- or the least
Buying too much is as great a sin as not buying enough. The answer is simple: Do a needs assessment and figure out if software will help fix the problem, a simple change in process is required, or both.
If the solution involves software, find out what options will work with your current provider and conduct a baseline return-on-investment (ROI) analysis that includes all savings, from time to costs. Once you've done that -- and only after you have done that -- you implement.
Keep in mind when considering price that you can always buy the oats a little cheaper if you don't mind them going through the horse first. Buying a product that meets today's needs at a great price may seem to be a great deal. But if the standards change and you need two or three upgrades over the life of the product, you may be better off buying a product that costs a bit more upfront but addresses issues now and includes upgrades in the support costs. Good solutions aren't cheap, but they are usually worth the added costs.
No. 3: Products do not equal solutions
All too often, a vendor will present a new razzle-dazzle technology that they feel you must have. One thing I could never get used to is going to a site and finding software that was purchased that was either not used or rarely used. Why? Because they were told they needed it.
Look closely at your operation and ask, "How will this help me achieve goals?" If the answer doesn't jump out at you immediately, think twice. Always look at the big picture. A vendor will often have more than one product in its portfolio to meet a particular solution: 3D image processing immediately comes to mind, although there are usually several others. Get what you need, not what others tell you you should get.
No. 2: Information does not equal knowledge
We live in a world where data is king, and terms like "big data" are used to describe the massive volumes generated daily. But having information is not the same as having knowledge.
Information is acquired data; however, knowledge is the application of data to solve a problem. Knowledge comes from obtaining a thorough understanding of problems, possible causes of the problems, and possible solutions for them. It's looking at every aspect (operational, financial, support, etc.) and then making a judgment using facts on the best option(s).
No. 1: You only know what you know
Nearly all of the information an end user gets regarding clinical imaging systems comes from his or her sales rep. And where do the sales reps get their information? From product marketing. And where does product marketing get theirs? From a variety of sources.
While most of this information is fairly accurate, none is very specific. When you're looking at a solution, you need to be specific and accurate. The competition for dollars is fierce, and with Obamacare threatening to shave facilities' ever-slim margins even thinner, justifications have to be made for the purchase of new products and services. Most reps know the products fairly well, but positioning and justifying the purchase isn't exactly their forte, nor is ensuring that the solution they recommend is properly positioned for the right problem.
Felix the Cat only has so much in his magic bag of tricks to sell, and what he has might not provide the answer you need. That is typically the job of a consultant to discern. Many companies have their own internal consultants who can come in and take a look at operations, what has been recommended, and how it all fits together with what they have. They also know your products and services, especially if you have a facility that employs multiple products from the same vendor. Independent consultants can usually do the job equally well and can offer objectivity as a bonus if they know what they are doing. Choose wisely.
What's changed?
So what has changed in two years? Everything ... and nothing.
Technologically, the changes have been minimal relative to PACS itself. VNAs offered great promise a few years back, but their role has changed from what many initially thought it would be. While the concept of a single central archive for multiple clinical systems where information is maintained in a standardized format was warmly embraced, the ever-decreasing costs of short-term storage have relegated VNAs to a role that is primarily one of a deep archive storing data in a vendor-neutral format.
The biggest changes in PACS relate to software add-ons for specific applications. There are two key drivers behind many of these requirements: the time it takes to document processes manually and legal concerns.
With California and Texas both mandating documentation of medical radiation dose and several other states close on their heels, automated dose-management software has become a hot ticket. Nearly a dozen vendors now offer add-on or integrated solutions to address this need. This is also an area that is expected to grow quickly.
Critical results
Critical-results reporting is another area that has sparked interest, especially at corporate levels. This highly manual task can now be accomplished in minutes using specialized software to identify areas of concern, including compliance, liability, quality improvement, effective communication, revenue, and productivity.
Often critical-results reporting software is paired with emergency department (ED) discrepancy software, enabling departments to track correlations between ED physician and radiologist interpretations. Because ED physicians usually send CT, ultrasound, and other related studies via teleradiology to radiologists or a nighthawk service for interpretation and focus on general x-rays, the correlations are usually very high. Most discrepancies usually relate to ancillary findings, but these still must be tracked and reported.
Peer review is mandated by the American College of Radiology (ACR) and is required in many areas, including accreditation under the Mammography Quality Standards Act (MQSA). Required routine monitoring of current competency for all medical staff members can be a laborious and time-consuming task for radiologists and administrators. With increased emphasis on patient safety and provider accountability in today's healthcare environments, facilities are relying on peer reviews to mitigate losses stemming from medical errors and to improve the quality and safety of care.
VNA decisions
The buying decisions for VNAs have also changed from the cost savings associated with supporting multiple disparate archives to reducing a facility's medicolegal liability. Having a single central archive is a great concept, but given the cost and time associated with data migration, combined with much longer retrieval times than from local cache (an issue associated with DICOM protocols), it's often cheaper just to expand the existing local storage to hold three or four additional years of storage.
Most sites maintain a minimum of two years of local cache anyway, so this is not a big stretch. It has also been recognized that a VNA without image or information lifecycle management (ILM) is basically just a storage device. While there is no one single clear-cut, universally accepted definition of all that ILM incorporates, most would agree that it addresses retention and deletion policies. This is also what most are interested in anyway. Getting rid of x-rays and associated reports after the legally mandated time frame significantly reduces a facility's overall liability, and that is crucial to those in corporate management.
One thing that doesn't seem to have changed is the comfort level of customers in making decisions and the amount of information they have to make those decisions. Using lessons from the dark side to help you see the light, one hopes that as we go forward with this series, you will be given the information you need to make informed, objective decisions.
Michael J. Cannavo is known industry-wide as the PACSman. After several decades as an independent PACS consultant, he spent two years working as a strategic accounts manager with a major PACS vendor. He has now made it back safely from the dark side and is sharing his observations in this Straight Talk From the PACSman series. He can be reached at [email protected] or by phone at 407-359-0191.
