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Goldilocks and the three PACS

February 17, 2020
Health IT PACS / Enterprise Imaging
From the January/February 2020 issue of HealthCare Business News magazine

So what do you look for in a new PACS? it’s sorta like Goldilocks and the Three Bears. The one you really like best is nice but you can't afford it so it gets disqualified. Sadly none of the people selling it are creative enough to know how to overcome a price objection which is about the easiest objection to overcome if they are creative. This second PACS really doesn't meet all your needs other than being cheap enough, so you hesitate to buy it. Anyone who has bought on price alone knows that oats that have been through the horse once are a bit cheaper… And then you find your dream PACS — the one that is juuuust right. You are ecstatic until you finally get around to signing the contract and the company you chose has been sold to one of the big six vendors and put into limbo indefinitely until they can figure out just what to do with it.

So how do you start? Forget the PACS. Now I know you want to drug test me to see what I’m on but the PACS is the least important part of the system. I see the vendors stoking the very same fires that once took care of Joan of Arc, Basil the Physician and hundreds of others for heresy, but hear me out. The most painful part of the transition from the existing PACS to the new PACS isn’t the implementation of a new system but the migration of the data from the existing proprietary archive that most have to a vendor-neutral archive (VNA). The cost of this VNA and the migration can easily equal at least half of the total cost of the new PACS, and sometimes doubles the projected cost. Because of this you really want to only do this once. It is painful? Beyond painful, very costly and typically abysmally slow as well. But once you have done it and have all your data in a VNA; in theory, all you need to do on your next PACS replacement is to disconnect the VNA from your current system and reconnect it to the new system. Now I say that it’s “in theory” because it’s never quite as simple as that but it’s nowhere close to the agony (and cost) you go through migrating from the existing vendor-based archive to a vendor neutral archive. In the end the ecstasy of having data that can go anywhere and that you can do anything is definitely worth it.

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Now what about the PACS? There are differences between all the vendors that go well beyond price. That said, nearly every vendor out there has a hammer, 2 screwdrivers (regular and Phillips-head), a pair of pliers, both electrical and duct tape, and other basics on their workstation. Most also have advanced software packages available like orthopedic templating, mammography packages, 3D reconstruction, artificial intelligence, and more. These add-on applications are the things you should look at closely after you evaluate the basic system operation, how easy it is to use, and how it addresses your existing workflow. You also need to look at things like a company’s service and support reputation, which is crucial. When the system is up and fully operational things are great. When it is down you will wish you were on vacation on a cruise ship with no communications at all. How quickly a company can diagnose and rectify a problem WITHOUT POINTING FINGERS is one of the delineators that you need to look at closely.

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