PACS System Selection Methodology Rex Osborn 2004 Project

PACS System Selection Methodology Rex Osborn 2004

Project Methodology We support a full spectrum of project activities. Plan • Readiness Assessment • Strategic Benefits • Total Value Calculation / Financial Planning • Executive Education • Budget Approval Integrat e Optimi ze • Requirements: Technical, Functional, Integration, & Process • Implementation Planning • Administration • Implementation and Integration • Reinvestment • Clinical Scenarios • Process Improvement Baseline • Process Improvement Measurement Architect • Maintenance • Technology Selection and System Design • Vendor Contracting Redesign Optimize

Planning Plan Archite ct Step 1. Assessment and Financial Planning Integrate Operate

Plan Link to Strategic Direction Clinical Quality Enable Growth Service Excellence Physician Partnership Community Service Employer Of Choice Improve Patient Care and Satisfaction ü ü ü Efficiently Read Multi-Image and Serial Studies ü ü Increase Involvement in the Care Delivery Process ü ü ü Eliminate Unread Studies ü ü ü ü Improve Report Turnaround Time ü ü Provide Concurrent Access to Diverse Image Information ü ü Easily Find Any Image, Anywhere Throughout the Healthcare System ü ü Improve Physician Satisfaction ü ü Integrated with EHR ü ü Project Objectives Reduce Lost and Misplaced Films ü ü ü ü

Plan Integrate with Overall IT Plan Many organization’s Vision is to provide their clinicians an integrated, “content-rich” point of care environment that transcends departments on a common workstation enabling timely access to a patient’s comprehensive clinical information for optimum diagnoses and treatment. Imaging is a significant portion of the required clinical information.

Plan System Readiness Planning Focus Area Planning Steps Executive Leadership Committed to a structured approach: e. g. enterprisewide planning, multi-year investment, policy that no departments can opt out. Physician Acceptance Physician project champions working with site coordinators who help educate the physician community on the benefits of PACS. Enterprise Connectivity Network enhancements are budgeted to provide an enhanced, reliable network and storage. Clinical Integration plans and system acceptance testing procedures. Data Confidentiality Systems planning for user log-ins and passwords integrated with the EHR. Technology Obsolescence Contractually bind the vendor to upgrade PACS hardware and software - purchase workstation, network and storage separately from existing vendors System Implementation Have a dedicated project management and train PACS administrator's.

Identify Success & Risk Factors Factor Risk Level Executive Leadership Lo w Medium Contractually bind the vendor to upgrade hardware and software to keep the system current. Purchase workstation, network and storage separately for your existing vendors. h Hig Lo w Enterprise systems support user log-ins and passwords and may be integrated with the EMR. h Hig Medium Have dedicated project management to deliver a successful implementation. Medium Lo w Have a solid contract with the vendor for system acceptance; bind system acceptance to final payment. h Hig System Implementation h Hig Technology Obsolescence h Hig Data Confidentiality Incremental network enhancements are budgeted to provide an enhanced, reliable network and storage. Medium Clinical Integration Sustained commitment to a structured and disciplined approach against plan: program management, funding, purchasing, operating procedures. No departments opt out. Identify a physician project champions and site coordinators who will help educate the physician community on the benefits. Medium Enterprise Connectivity Steps h Hig Physician Acceptance h Hig Lo w Medium Lo w Plan

Plan Establish High-Level Implementation Plan

Calculate Financial Impact Plan Outflows n Capital q n q q q n Computed/Digital Radiography Modality Upgrades Infrastructure Upgrades System Integration Renovations Vendor Services Re-investment q q Support Staff DI/PACS system maintenance CR/DR maintenance Network equipment maintenance Incremental network cost Capital q Core / Back-office User Equipment Operational q n DI/PACS System n q Inflows Potential increase revenue n n n Reduction in missed billings Increase in utilization Operational q q q Labor Film processing Supplies Storage space Courier / Transportation

Plan Sample-PACS Financial Model

Architect the Solution Plan Archite ct Integrate Step 2. Architect: Vendor Selection Operate

Architect Determine Priorities

Architect Selection - Sample Goals & Objectives To arrive at a well-designed n To mitigate your risk during the vendor selection and contract negotiation process n n To ensure the selected solution meets requirements n n Provide investment protection to ensure investments in the solution are properly timed and aligned with an overall strategic vision To develop a comprehensive contract that will set a strong foundation for both a successful implementation and long-term relationship between Bassett and the vendor n To shorten the time-tocontract with the vendor n Guarantee Integration to Enable Digital Workflow solution with preferred digital imaging vendors

Architect n n n Approach: Leverage the IHE* Standards Allows for focus on workflow solutions, not connectivity issues Lowers integration costs – implementation durations Minimizes custom interfaces – clearly defined interface owners Vendors representing 90% of the digital imaging market participate - RIS, CVIS, PACS, Modality, Web, Reporting, 3 D Workstations, Voice Recognition Systems You get integrated information systems vs. information islands ADT RIS *Integrated Healthcare Enterprise MPI HIS PACS Display Modality

Architect Example: Selection Criteria n Functionality Weight 25% Definition § § n Technology 15% § § n Cost 15% § § § n Experience 15% § § n Integration Vision § 30% § § Source Functionality Coverage Detailed Scenario Ratings Overall Scenario Ratings Application Maturity § Technology Assessment, Ownership Cost of Ownership Technology Risk Assessment Number/ Complexity of Integration § Preliminary Cost Models Implementation /Benefit Timing Cost of Ownership § Customer Service Implementation Depth, Methods R&D Expenditures Annual Contracts § Alignment with Vision Shared integration approach Vendor track record, IHE, CCOW § § § § § RFP Response Demonstration RFP Response Clinical Site Visit Evaluation RFP Response Vendor - Cost Benefit Models (RFP) References RFP Response Clinical Site Visit Evaluation References RFP Response Clinical Visit Evaluation

Architect Example: Workflow Enablement Guarantee Proof of Concept Scorecard

Architect n Examples of Final Contract Exhibits, System Configuration, and Bill of Materials: q q q n n What’s in a Contract and Why Terms and Conditions Bill of Materials License Software Module Schedule System Requirements Compliance Matrix from RFP Specifications and Acceptance Testing Protocols Payment Schedule Service Agreements Project Milestones Escrow Agreement User Documentation Original RFI/P/Q Response and Subsequently Issued Requirements & Specifications Works in Progress Agreements Ensure common understanding and agreement to cost, performance, capacity, and scalability Minimize client risk associated with vendor terms and conditions, solution offerings, costs, and future product direction.

Architect Project Initiation Technology Selection Process Organize Selection Teams Develop Requirements Workflow Analysis Prepare and Distribute RFP Vendor Responses Requirements Session Analyze Vendor Responses Down Select to 2 Vendors Assess Against Current Vendors; Identify Benefits Prepare Scripted Scenarios Final Approval Executive Presentation and Approval Recommend Vendor(s) Of Choice Conduct Reference Calls Conduct Vendor Demos

Using Standards in Selection Architect n For enterprise systems to be successful, standards are critical q q q Guarantee information flow which allows the organization to focus on workflow solutions, not connectivity issues Less integration complexity and lower costs shorten implementation durations Minimize custom interfaces and clearly define which vendor owns each integration boundary *Integrated Healthcare Enterprise

Prenuptials for Partnerships Architect n Terms and Conditions Referencing Exhibits: q q q q q n Service Levels Bill of Materials Schedule of Software Acceptance Testing Procedures System Requirements and Performance Specifications Project plan and Statements of Work Links to Payment Service and Maintenance Agreements with Uptime Guarantees Training Materials, Schedules and Documentation The Original RFP Response Product Roadmaps Goals q q Ensure agreement - costs, project scope, system performance, capacity, and scalability Understand mitigate risk associated new product offerings and future product direction

Integrate Plan Archite ct Integrate Step 3: Integration & Implementation Operate

Integrate Improvement Example "After organizing work flow to take maximum advantage of the capabilities inherent to PACS, we saw the number of steps involved in scheduling, producing, reading, reporting and billing a single chest radiographic study decrease from 59 to nine" "Clinicians are now able to quickly retrieve diagnostic images-in full fidelity with imaging reports at workstations we've deployed throughout the medical center, " says Siegel. "Because we're saving them time, clinicians are able to focus more attention on patient care, delivering care that's of higher quality than ever before. " – VA Hospital Baltimore

Integrate Driving Accountability

Integrate Resource Optimization

Project Timeline Integrate Modality/ DICOM Assessment FCG Engaged Current Environment Assessment RFI Released Implementation Team Resource Checkpoint Contract/Re-quote Released PACS RFP Released CR Network Workshop Assessment Workflow Redesign Network Preparation Facilities Preparation Board Approval for PACS Staff Interviews PACS Planning Softcopy Reading PACS Web Distribution Subnetwork “Live” PACS Training Kickoff Acceptance Test Complete Archive Installed Interface Design Site Visits and Reference Checks. PACS Vendor Contract Selected Complete Negotiations Modality Integration “GO” Database Preparation GO LIVE Implement, Operate, Optimize DI Architecture, Selection Pre. Implementation Planning 12 - 16 Months

DI Transformation – Operate Plan Archite ct Integrate Operate Step 4. Operate: Transform & Operate