This article appeared as an introduction to the PACS comparison chart.
For more than a decade, we have tried to design a picture archiving and communication systems (PACS) chart that allows end-users to compare different features and make informed, objective decisions about which PACS vendors best meet their needs. For the most part, we were successful in providing valuable charts that identified which system has what features.
The problem today is that every system seems to have the same features. Over the years, PACS has gotten to the place where it’s a commodity, and mere product features and even price are no longer product differentiators. The real differentiators must be identified, rather than merely addressed in a simple yes-or-no fashion.
Looking at introductions written for past PACS charts, I found that the 2005 intro I wrote is still apropos today:
“PACS is still a gangly, obstinate, moody teen wanting to make a name for itself, but doesn’t know how because there are so many others out there like it. It wants to be the popular kid, but is just too geeky to be popular.
“Getting the attention they crave is a challenge for vendors and end-users alike. PACS RFPs are a cry for help from hospitals, yet the vendor responses are a cry for help from vendors themselves. Vendors are unsure what the client needs because the client, more often than not, hasn’t adequately expressed needs.
“Each vendor outputs a templated response, hoping they will be close to what the client wants. Finding the uniqueness between systems becomes even more of a challenge, because not only don’t hospitals understand the differences between the templated responses, but often vendors themselves don’t understand what really makes their system unique.”
You would think six years later PACS would have outgrown the teen years. But no. Why? Because as an industry, buyers and sellers alike, we abhor change. Buyers of second- (and sometimes even third-) generation PACS find their replacement systems don’t work any better than the ones they are replacing, because they continue to use their first-generation questions and never learn to ask the questions that will give them the answers they need. The bigger challenge is getting the answers.
When we updated PACS chart specs in the past, we looked at adding “hot” areas, like vendor-neutral archive support and data migration, integration with electronic health records, etc. The problem is that when we ask, “Do you have...?” the answer invariably comes back, “Yes, we do,” from every vendor, and technically they are accurate.
When you say, “Show me,” though, you find Vendor A requires two mouse clicks; Vendor B, six, and Vendor C, nine but also offers a simple macro that brings it down to one. In that case, which is better? You see the complexity.
So how do you evaluate PACS? Most start by looking at survey rankings. Personally, I don’t think this is good because most are limited. Instead, I believe you should base your decision on three words: “Seeing is believing.” In-house demos provide a very good start, but seeing how the PACS operates in a clinical environment as similar as possible to your own is invaluable.
Spend a day at a site and watch how its PACS interacts with the transcription and dictation systems, with other clinical applications, with the radiologists, and then go from there. See how easy it is to pull up priors and related reports, how they use things like CDs to give to patients or the Web to send images to the referring clinicians.
As far as futures, ask for details, even if it requires that you sign a nondisclosure agreement. Don’t accept “third quarter” as an answer, but rather third quarter when? Ask the vendor whether its system will allow a third-party archive in place of its own? Are there any cost savings associated with this? Added costs? What image information would be lost when doing this? There are more questions than answers, and none are easy.
Another factor to consider is that service varies by region. If you are buying a turnkey system, talk to other accounts in your area about service response times. Forget about up-time guarantees. They really don’t mean much, since most “guarantees” have no teeth anyway. How quickly they respond means the most. If buying a software-only solution, talk to those who have used their remote software support. Did they fix the problem quickly? Was it a known or new problem? Ask questions… and lots of them.
Going back to 2005, I added this final word of advice:
“Ask someone who knows PACS to do a ‘sanity check’ before you sign on the dotted line. You’ll be amazed what you forgot to ask that can be crucial to your operation. The sanity check isn’t just for what you may have left out, but what may have been put in as well — is all that is there really necessary?
“Last, but not least, take a long hard look at the contract and get someone who knows what they are doing to look it over. (In 99% of cases, this does not include the hospital’s legal department unless it specializes in IT law, which most don’t.) Once you clinically accept the system, it is yours for at least the next six to seven years. So forewarned is foretold.”
Here’s how the intro ended in 2005, and it remains a good plan of action today:
“Once you’ve done all that, add your gut feeling to the mix and then make your decision. That’s the only way that works and the only way you can feel comfortable that you’ve made the best decision you can.
“In the end, it all comes down to gut feeling. So lead with your mind, listen to your heart and decide with your gut, while using the chart that follows as best you can to help you get there.”
Michael J. Cannavo is president of Image Management Consultants, a Florida-based PACS consulting firm. He can be contacted at 407.359.6575, e-mail at pacsman.ix.netcom or via IMC’s website, pacsman.com.
April 17, 2024 
