Q&A: What to Include in Your PACS RFP

Eddie Moore, HCIS Digital Solutions Architect, Carestream Health

Eddie Moore, HCIS Digital Solutions Architect, Carestream Health

What are the top five things to include in a RFP to best understand a vendor’s options?

  1. Know what you want. Clearly define the scope of the project before you begin writing and making requests.
  2. Be clear and concise. Keep the RFP as short as possible while still being inclusive of your requirements. You’ll receive better responses with clearly defined questions and specifications as opposed to long, rambling documents that leave too much to the interpretation of the responder.
  3. Rank and weight. Try to stick with 5 – 7 categories and relevant sets of questions, making sure they’re ranked and weighted appropriately. You want to ensure all relevant groups/departments are equally represented in the request so that one department doesn’t override or exclude another.
  4.  Understand and communicate. Provide an executive summary at the beginning of the document that includes where you are and clearly defines where you want to be at the conclusion of the process.  Don’t require a scope of features and functions that exceeds the actual needs of the project you’re quoting.
  5.  Include all relevant criteria.  Don’t exclude any specific features or functions unless there is a valid, documented business reason.  Allow the vendors to tailor their solutions to the full scope of the RFP.

What do most purchasers forget to ask in their RFP?

I find that a lot of RFP’s don’t ask questions. What they provide is just a long document of statements without any real questions in there.

I also believe that too many people jump right into RFPs and bypass the RFI (Request for Information). You get responses from everybody, big and small, when you only send out an RFP. It can be very confusing and distracting to sort thru a large number of vendor responses that may, or may not be relevant to the original request.  The RFI can be extremely helpful during the pre-selection process as it allows you to narrow down the potential list of vendors to your specific situation and weeds out the inferior vendors.

When dealing with PACS systems it’s very easy to overlook and miss things. Creating an executive summary equipped with detailed diagrams of your current and future state is critical to ensure you receive appropriate responses.  It acts as a guide by easily separating vendors that don’t suit your needs from ones that match your documented criteria.

What is the best way to evaluate products from different vendors?

I would say there are really three important factors to evaluate before selecting a vendor-of-choice:

  1. Compare apples-to-apples. Don’t let a supposedly unique feature make your decision for you. Make sure you evaluate each vendor equally based on your needs.
  2. Be objective and critical. Rank and weight the responses based on tangible, measurable results.
  3. Be proactive. Don’t make a decision solely based off of a piece of paper. Conduct on-site interviews of each vendor’s proposal.

Lastly, choose a vendor!  This can either be a blatantly obvious choice from your review of the RFP submissions, or require you to do a more in-depth evaluation in a head-to-head environment.  Either way, following these guidelines can provide you with the necessary assistance to select the best suited vendor.

Below is a sample template of a RFP, which can be downloaded here.

This post previously published on Everything Rad provides additional information about tender bids that can help the process.

Four Key Advantages for Radiologists Using Advanced Post-Processing Capabilities

Barry D. Pressman, MD, Professor and Chair, Department of Imaging, S. Mark Taper Foundation Imaging Center, Cedars-Sinai

Barry D. Pressman, MD, Professor and Chair, Department of Imaging, S. Mark Taper Foundation Imaging Center, Cedars-Sinai. He is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends.

Post-processing as part of the workflow is a given with PACS workstations today. These post-processing techniques must be simple and rapid and the benefits are several:

  1. Improved hanging protocols. Post-processing at the PACS station is the most convenient, if it is part of the hanging protocols. This saves the radiologist time by eliminating the manual reordering of images for diagnosis and ensures a consistent presentation of the images for a particular study.
  2. Faster turnaround time. When additional reprocessing is necessary, beyond what the techs provide, time spent calling the techs and the delay in TAT can be obviated.
  3. Reduced tech time. When performed on the PACS as part of the routine hanging protocol, tech time can be minimized and more throughputs of cases may result.
  4. Clarification. Post-processing can be performed on the fly to clarify abnormalities for the reader and to provide demonstrations to clinicians.

I have experienced these benefits in the workplace, further proving my confidence in post-processing workflow in PACS.   Here are two examples:

In the first example, a clinician came by immediately after a CT exam performed for complicated fractures in facial bones. The exam had been performed to clarify the extent of the fractures and to plan the imminent surgery. The 2D and 3D reformats had not yet been performed by the techs. Thanks to PACS post-processing capabilities, we were able to create the 2D and 3D images on the fly, which clarified the presence of a tripod type fracture with a subtle posterior component that was not obvious on the axial acquisition images.

By working directly with the clinician, I was able to quickly generate the views needed to answer his concerns. The clinician was rapidly satisfied that he had all the information necessary to perform the surgery, with none of the delays that would have occurred if the tech was involved.

The second example of success in post-processing involves selective views and measurements related to vascular stenoses (abnormal narrowing of blood vessels) using vessel probe type processing. This is performed by the radiologists on the PACS to clarify questionable findings on the acquisition images and/or the post processed images performed by the techs, increasing our level of confidence.

Post-processing In both of these cases provided our facility with the most efficient and effective workflow possible. Our post-processing capabilities at the PACS workstation have allowed us to make necessary simple and complicated 2D and 3D reformats in a short amount of time making it possible to quickly review procedures and to reach a higher level of confidence with our findings. We believe this has increased our accuracy level, and the confidence of our clinicians in our interpretations.

Medical Imaging is in a State of David vs. Goliath

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

How do facilities measure patient satisfaction and quality of care in the changing healthcare landscape?

Physicians are focused now more than ever on value of care over volume.. One would assume that the largest facilities would be the ones best equipped to provide the highest value to the highest number of patients, however, the evolution of technology and the changing healthcare landscape has armed smaller facilities with the ability to thrive.

Ten years ago, when medical imaging first became digitized, the focus was all on the volume of exams. It was how our work was being measured. As has changed to accommodate the changing health system, the conventional wisdom of volume over value from the pre-EHR, pre-digital days, has become outdated.

To say the U.S. healthcare system is in a volatile state would be an understatement. Hospitals are closing and merging across the country, accountable-care organizations are now the standard, regional health organization systems are uniting health facilities across the country, and the Affordable Care Act is now in full effect.

The state of the David and Goliath in the medical imaging world.

Group size of a health facility is no longer as important as it used to be. Mergers in the U.S. are creating facilities with the size to handle large populations and offer advanced health services, however, with with the mergers come the legacy—technology, infrastructure, bureaucracy, and organizational structure—that often can hold back facilities from adopting disruptive practices and technology.

Meanwhile, small facilities and practices remain agile, able to provide more attentive, high-value care. A small facility with superior technology (integrative non-imaging clinical data, order entry algorithms, and enhanced communication tools) can serve a patient population as well as, or better than, a larger, more traditional system.

The world through the eyes of a David-sized medical facility.

As an example of this, my hospital, Chinese Hospital in San Francisco, is the smallest consultative medical imaging group in the city with two full-time and three part-time radiologists.

By conventional wisdom, we should not exist. We are the last independent hospital in the area with 54 beds, and 200 beds is next smallest facility. Everyone talks about size, and assumes a small facility doesn’t have the expertise. But providing the best care is individualized; we must look at what tools and capabilities each individual possesses. Our facility has continued to thrive because we work in this mindset. We hire the professionals with the appropriate capabilities, and arm them with the tools to do their jobs as effectively as possible.

The unifying question that challenges large and small facilities.

Whether you work for a David or Goliath, there is one common challenge that we all face—what is satisfaction, and what is quality? It’s difficult to say what it is or how to measure it. What the medical professionals say satisfaction and quality mean will likely differ from what the patients say. Did they have a good experience? Do patients look for good bedside manner? Or, do they want the physician to be efficient and effective with little communication?

These are questions the medical professionals and facilities will be working to answer for years to come because the future of our industry depends on it. The groups that adopt and are disruptive—and these can be both small and large facilities—are the ones that are growing the most. These are the facilities that will define satisfaction and quality, and provide the best value of care to its patients.

Three Examples of Vendor Neutral Archives Transforming Healthcare Workflow

Doug Rufer

Doug Rufer, Director Technical Marketing and Clinical Sales Engineering, Carestream

Vendor neutral archives (VNA) can transform workflow across the healthcare enterprise and should be seen as more than an opportunity for IT hardware simplification or consolidation of radiology images. This broad view was explored in Cleveland Clinic presentations at both RSNA and HIMSS about the Imaging Institute’s VNA implementation and enterprise imaging support model.

As one of the world’s largest VNA suppliers, we’ve seen the true advantage of VNA realized time and again when hospitals and health systems look beyond radiology and build an image access and viewing strategy that reaches across departments and deeper into the enterprise.

Looking for proof beyond the Cleveland Clinic?

Consider these three examples that range from a large urban integrated health network to the world’s second largest Health Maintenance Organization:

Rochester General Hospital

When Rochester General Health System was planning updates to their older multi-site, multi-archive distributed PACS, the IT department recognized an opportunity to implement an enterprise architecture across eight clinically integrated affiliates.

Current clinical workflow needs were being minimally addressed, but were not sufficient to support the organization’s evolving needs and growing imaging volumes.

A single, unified Rad/Card PACS was implemented, with a virtualized Vendor Neutral Archive providing long-term online storage for 230,000 studies annually, from two hospitals and four outpatient imaging facilities.

Consolidation of the Rochester Health System infrastructure occurred in conjunction with an assessment of enterprise clinical viewing needs across the enterprise. Clinical viewing consolidation was achieved using a zero-download viewer for enhanced access via the system-wide EMR to the information stored on the VNA. Clinician productivity, decision support and clinical learning have all benefited from easy access to historical information.

Winthrop University Hospital

When planning their PACS infrastructure upgrade, Winthrop-University Hospital determined it would be a good time to leverage enhanced vendor neutrality.

They implemented a cloud-based VNA and migrated existing online and offline diagnostic and interventional radiology, radiation oncology, vascular ultrasound and cardiac CTA studies. Cardiology and Orthopedic data are now being added and include DICOM and non-DICOM studies and scanned JPEG files.

The enterprise view adopted by Winthrop-University Hospital extended to providing clinicians with “universal” workstation access. The goal was to leverage the “neutrality” of the VNA storage infrastructure and single backend interface that was no longer limited by multiple unconnected systems.

Separating clinical storage from clinical viewing is expected to simplify future technology deployments by the hospital and increase the technology options available for future consideration.

Clalit Health Services

A patient-centric approach drove Clalit Heath Services in Israel, the world’s second largest Health Maintenance Organization, to implement a centralized storage architecture for standardized enterprise-reading and clinical-viewing workflow.

Shared worklists and an image-enabled EMR provide 10,000 physicians, across 12 hospitals and 40 imaging centers, access to 5M annual Radiology, Cardiology and Ophthalmology studies.

Dr. Arnon Makori, Radiologist and Director of Imaging Informatics at Clalit Health Services, feels, “The only way to achieve increased quality of care, centered on patient needs, is to provide universal access to clinical information and eliminate independent, site-specific workflows. If the workflow is optimized, then everyone benefits: the patient, radiologist, specialty physicians and IT.”

As these examples have illustrated, success is often driven by an enterprise imaging plan that reflects the organization’s overall needs – and not just those of a single department.

Interested in learning more about VNA? You can download an intro to VNA presentation on Carestream’s SlideShare channel or a quick VNA evaluation checklist here.

Monash Health Benefits from a Vendor-Neutral Archive

As part of its RIS/PACS implementation, Monash Health in Victoria, Australia, has implemented a vendor-neutral archive (VNA) to store, secure, and access its medical images and other clinical data.

Tony Gabbert, operations manager at Monash Health, told us that the facility has many sources of imaging, and that using a VNA provides a better experience for the physicians and the patients. The VNA unites a multi-vendor based infrastructure, bringing the medical images from different departments together into a single depository.

You can watch the complete interview below or on YouTube.

[youtube https://www.youtube.com/watch?v=QHK2B4rc9Z4&w=560&h=315]

Survey: Radiologists are Happy at Work

Liza Haar, Editor, Diagnostic Imaging

Liza Haar, Editor, Diagnostic Imaging

Sixty-eight percent of radiologists told us in our annual Radiology Compensation Survey, they are happy being radiologists. This satisfaction comes even though, not surprisingly, rads are logging long hours (63 percent work 41 to 75 hours a week). Most of the respondents were veterans of the radiology industry, with more than 20 years of experience.

This year, we also found that salaries dipped slightly (the mean salary for 2014 was about $355,000, down from a mean of $400,000 in 2013), but again, all signs point to overall job satisfaction. There is a lot of talk amongst rads about the future of radiology, and whether it is reimbursement, the job market or government policies, rads worry about where their profession is going.

On the other hand, many of today’s radiologists have had the opportunity to see imaging technology change right before their eyes (no pun intended!). While change can be frustrating, being a part of innovation and seeing the beneficial effects it has on your career is a fulfilling experience for rad professionals. Regardless of the state of the industry, rads are still happy in their field and as the radiology industry continues to change, the community continues to embrace that change.

For more results on salaries and job satisfaction among radiologists, technologists and administrators, check out the official survey from Diagnostic Imaging.

Photo courtesy of Diagnostic Imaging

Photo courtesy of Diagnostic Imaging

Photo courtesy of Diagnostic Imaging

Photo courtesy of Diagnostic Imaging

Five Steps to Better Digital Radiography Asset Utilization

JED Armstrong, X-ray Solutions Specialist, Carestream

JED Armstrong, X-ray Solutions Specialist, Carestream

With growing concerns about decreasing reimbursement and lingering low confidence in access to capital for imaging and IT needs, how can radiology administrators identify waste and inefficiencies?

At last week’s AHRA Arizona meeting, we discovered ways to maximize return on investment.

In a CE credit session I had the opportunity to zero in on one department’s approach starting with the single most expensive component in a DR room – the detector.

Idle detectors provide no workflow benefits and slow return on investment.   How can you ensure you are maximizing this asset’s use? Here’s a five step process to test your DR strategy:

Step 1: Inventory Assets

Conduct a physical inventory of x-ray assets across the organization. How many systems from different vendors do you have? Where are the systems in their lifecyle? Which detectors are moveable? Are your detectors wireless or tethered? Create a spreadsheet that details each system, its age, software, maintenance contracts, available upgrades and if it’s in working order.

Step 2: Chart Asset Utilization

For each system capture the image volume, exam throughput and uptime requirements. Indicate if detectors are being shared between systems and if the detector is being used 24/7. Note degrees of required equipment redundancy. Document any staffing considerations for each asset. Is there a technician who only works with portables or specific vendor systems?AHRA graph

Step 3: Develop Growth Projections

Forecast market changes and the potential impact on your volumes. Could a planned closure of a nearby hospital within the year drive up imaging volumes in your ER or trauma center? Will a change in local population demographics drive surgical volumes?

Step 4: Identify Workflow Modifications

Analyze the three data sources collected in the previous steps. What changes to department workflow and/or purchases could lower redundancy, improve equipment utilization and unlock capacity for growth? For example:

  • Move an underutilized wireless DR detector from your DR room bucky to a portable for morning rounds. Then return the wireless detector for peak DR room volume. Finally redeploy the same detector to the ER for the night shift.
  • Use a common CR and DR software interface to ensure all techs can operate all systems and move easily from one piece of equipment to the next.
  • Purchase a second wireless detector for the radiology room second shift to make technicians working alone more efficient.

Step 5: Review Asset Replacement Strategies

Look for modular ways to continually advance your capabilities while still leveraging your legacy technology. Work with your vendor to determine if you need to replace a whole system or if upgrading a component like a detector could extend the life of your investment.

Let’s look at a scenario where changes in wireless DR detector utilization could have a significant impact on the ability to respond to volume growth:

Hospital A has an extremely busy ED / Trauma area. With capital constraints, the most they could afford in the last few budget years was CR technology. Funds this year are limited, but there is money available. An inventory of their x-ray assets finds that they have two full x-ray rooms, one “chest” room and three portable units – all over 10 years of age. The radiology director is projecting a continued an increase in volumes as a nearby hospital has recently closed and ED/Trauma volume is now significantly higher. The hospital determines the best use of funding is to convert one x-ray room and a portable system to DR at the same time. By retrofitting the portable and purchasing two detectors for the x-ray room, the second detector can be shared with the portable during off hours. In the future when parts are no longer available for the rooms, they will upgrade the equipment hardware and continue to use the detectors and software from their initial DR investment.

Your imaging vendor should partner with you to ensure you’re making the most of DR asset utilization and are not missing an opportunity to reduce the cost per image and accelerate the return on investment. Ask your partner to take you through this five step process to build justification models for your administration.

You can find the slides to my AHRA session below:

[Whitepaper] How Can Bone Suppression Improve Chest Radiographic Images?

Helen Titus

Helen Titus, Marketing Director, X-ray Solutions, Carestream

Chest radiography is vital to diagnosing lung diseases. A high signal-to-noise-ratio (SNR) is crucial if an image is to be determined as appropriate for diagnosis, and it becomes the mission of the acquisition system to leave as much noise out as possible.

Bones, specifically the posterior ribs and clavicles, are the usual noise culprits in chest imaging. The ability to decrease that noise can provide radiographers with an improved, well-defined image, and allow the radiologist to make the proper diagnosis.

A tool such as bone suppression software allows the noise of the ribs to be significantly decreased and require no additional procedure or radiation dose. The software is designed to suppress the high-contrast bone structures while maintaining the contrast-detail level, as closely as possible to that of the original images.

Learn more about this technology and the process of Carestream’s Bone Suppression Software (having recently received FDA approval and being part of the Directview v5.7 release) in the whitepaper, Bone Suppression for Chest Radiographic Images.

[Webinar] Image Quality: Does it Matter, and How Should We Define It?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Where is image quality? In the capture device? In the image processing? In the display system? In the brain of the viewer? Is it everywhere, or nowhere in particular?

These questions were answered recently in a webinar titled “Does Image Quality Matter?” by taking a closer look at the imaging chain.

Any imaging chain (also a medical one) contains five distinct functions:

  1. Capture (the creation of the image),
  2. Process (which itself consists of three sub-functions: preprocessing of the captured image, optimization for interpretation/viewing, and processing for the output device),
  3. Display (assuming a human is the viewer),
  4. Storage
  5. Distribution.

The answers depends on which image quality we mean: the objective image quality we can measure, the subjective image quality perceived by the viewer, or, particularly important in medical imaging, viewer performance using the image for some interpretation task.

In modern imaging systems, these three “flavors” of image quality are weakly, if at all correlated, which makes the prediction of one kind of image quality from another rather tricky, but also interesting.

The entire webinar has been embedded below. By the end, the questions asked at the outset should be answered, though the path to get to those answers may surprise you.

Guess the X-ray — April’s Image Challenge

Last month’s image challenge proved to be just that– a challenge! It took two different views of the object, but congratulations to the person who correctly guessed it as a stapler. Below is the image for April’s “Guess the X-ray”.  Please leave your comments below or on our Facebook page. The challenge will run until April30 or until the first person correctly names the item in the image.  Good luck!

Sorry…Carestream employees and their agencies are prohibited from entering.