1. PACS System Selection Methodology Rex Osborn 2004

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

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

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

5. 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. Integrate with Overall IT Plan Plan

6. System Readiness Planning Focus AreaPlanning Steps Executive LeadershipCommitted to a structured approach: e.g. enterprise- wide 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 IntegrationIntegration plans and system acceptance testing procedures. Data ConfidentialitySystems 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. Plan

7. Identify Success & Risk Factors FactorRisk Level Steps Executive LeadershipSustained commitment to a structured and disciplined approach against plan: program management, funding, purchasing, operating procedures. No departments opt out. Physician AcceptanceIdentify a physician project champions and site coordinators who will help educate the physician community on the benefits. Enterprise ConnectivityIncremental network enhancements are budgeted to provide an enhanced, reliable network and storage. Clinical IntegrationHave a solid contract with the vendor for system acceptance; bind system acceptance to final payment. Data ConfidentialityEnterprise systems support user log-ins and passwords and may be integrated with the EMR. Technology Obsolescence Contractually bind the vendor to upgrade hardware and software to keep the system current. Purchase workstation, network and storage separately for your existing vendors. System Implementation Have dedicated project management to deliver a successful implementation. M e d i u m L o w H i g h M e d i u m L o w H i g h M e d i u m L o w H i g h M e d i u m L o w H i g h M e d i u m L o w H i g h M e d i u m L o w H i g h M e d i u m L o w H i g h Plan

8. Establish High-Level Implementation Plan Plan

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

10. Sample-PACS Financial Model Plan

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

12. Determine Priorities Architect

13. Selection - Sample Goals & Objectives To mitigate your risk during the vendor selection and contract negotiation process To ensure the selected solution meets requirements Provide investment protection to ensure investments in the solution are properly timed and aligned with an overall strategic vision Guarantee Integration to Enable Digital Workflow To arrive at a well-designed solution with preferred digital imaging vendors 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 To shorten the time-to- contract with the vendor Architect

14. 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, 3D Workstations, Voice Recognition Systems You get integrated information systems vs. information islands MPI ADT RIS PACS Modality Display HIS *Integrated Healthcare Enterprise Architect

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

16. Example: Workflow Enablement Guarantee Proof of Concept Scorecard Architect

17. What’s in a Contract and Why Examples of Final Contract Exhibits, System Configuration, and Bill of Materials:  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

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

19. For enterprise systems to be successful, standards are critical  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 Using Standards in Selection *Integrated Healthcare Enterprise Architect

20. Prenuptials for Partnerships Terms and Conditions Referencing Exhibits:  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  Ensure agreement - costs, project scope, system performance, capacity, and scalability  Understand and mitigate risk associated new product offerings and future product direction Architect

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

22. 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

23. Driving Accountability Integrate

24. Resource Optimization Integrate

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

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