© PACS Implementation ©

All PACS implementations should start with a business plan. This is the summation of many small plans and also summarizes the global goal. The plan should be segmented into smaller separate plans for cost justification, resource utilization, technology assessment and integration, product evaluation for purchasing, and the last consisting of an implementation plan.

The one thing to remember: if you can think of a PACS application that will enhance your competitive standing your competition will too!!

• Cost justification - Divided into three parts, hard dollar expense reduction, soft dollars and the opportunity for new revenue and system expansion.
• Hard dollar expense reduction should not immediately include staff salary reduction and in some instances may not ever include this. FTE's may be reduced but the dollars associated with this will most likely be taken by the higher paying job of a PACS network administrator either within radiology or Information Systems.
• Soft dollar reduction will include decreased waiting time for ED patients, decreased time physicians spend away from patients, patient goodwill by not having to transport films to doctors, less physical interaction needed to maintain physician needs, and potential increased productivity of staff.
• Revenue enhancement can be experienced by setting up new services for the radiologists as a profit sharing venture. This can be realized because there is no longer the physical boundary of geographic location. Services such as providing over reads for other facilities and providing ED readings for small hospitals are now possible.

• Resource utilization - Taking stock of what you have.
• Evaluate equipment or modality that need integration, check for age and upgrade capability.
• Evaluate personnel needs: IS help, personnel assignment, radiologist help for implementation. Evaluate technology education level of all personnel.
• Compile a list of imaging equipment, computer equipment, network equipment, vendors, and training capabilities.
• Check with local phone company regarding services available in the area.

• Assessment & Integration - What is needed.
• Assess your resources and evaluate if they meet your current needs.
• Determine what current resources can be utilized.
• Assess the future needs.
• Integrate around available resources, present a plan that incorporates future resource needs.

• Evaluation - This is the hardest part because now a decision is needed.
• It is easy to go on site visits and view the latest installation of a any vendor because it is always to the most impressive. Most sites will readily reveal what problems were encountered with the installation, education and acceptance by physicians. There are not many locations that are going to admit to making the million dollar mistake.
• One way to select site visit locations is to ask the participating vendors where the competition has installations. Make the phone call to theses sites to balance out the perfect sites.

• Implementation - Decide critical functions.
• The most important part of the implementation plan is where to start first. I believe in starting with basics, selling the concept, implement the system and re-evaluate continually. I recommend selling it to the clinicians and radiology staff as soon as you have a viable business plan. The physicians and staff are the heaviest daily users. This could occur months in advance through clinical inservice and talking to key players on the medical staff. One point of caution is not to over state the system. Do not paint a PACS as the panacea to all problems. As hard as the selected vendor sold you on their company and technology benefits, you must sell the concept to your institution.
• Selling the concept and benefits to the radiology staff is a must, as you know the weakest link is what breaks the chain. Film librarians can be sold on he ease and the possibility to grow technologically. Technologists will need an approach of better quality and less frustration.
• Clinicians are key personnel who must not only buy into the theory but the physical product as well. They are best sold on job ease and the potential increased ability to see more patients. The images must be available in the office via communications network rather than manual retrieval. Clinicians are the first to realize manual film handling is wasted time for them and their patients due to film availability and transport.
• Implement PACS in phases.
• Phased implementations allow the process to stop at any point for adjustments.
• The completion of one phase does not mean that the next must follow immediately. Phases may be months or even years apart.
• Each phase, upon completion, allows the next phase to be implemented with a lessons learned approach. No two phases, like institutions, are alike. Every phase incorporates new people and services that are likely to have different needs than others
• Reevaluation is a must in any process.
• Reevaluation is a process that should begin from the very beginning. Technology changes so quickly that it is hard to keep up with the changes. What holds true today may not for tomorrow.
• The business plan may need to be thoroughly re-evaluated on a continual basis due to changes in costs. The implementation plan that was good three months ago may need to be changed to accommodate a technology advance or even loss.

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