1. A Successful PACS Implementation Monte Clinton, CRA Dartmouth-Hitchcock Medical Center Brian Phelan IDX Corporation

2. Disclaimer This presentation is about a PACS implementation at one facility (DHMC) with one vendor (IDX) and is being given as an example of a successful PACS implementation Other facilities and vendors can do a similar PACS implementation using this partnering program and methodology DHMC does not endorse IDX or any other vendor’s products and services

3. Why Install a PACS? Save money – Increase reimbursement Reduce medico-legal risk Eliminate Film and processing costs Reduce Film Library staff Improve billing collections Reduce medico-legal exposure

4. Why Install a PACS? Improve staff and imaging room productivity Increased staff productivity Reduction in the number of staff Increased imaging room productivity Eliminate imaging rooms

5. Productivity Benefits of DR Source: Philips Medical System

6. Why Install a PACS? Improve service to your customers Single set of film images limits collaboration Minimize lost studies and revenue Minimize treatment delays Speed service to referring clinician and patient

7. DHMC’s Steps to Justify PACS Internal justification – The major players Large capital or operating cost impact requires multiple levels of approval – at DHMC this was: –Radiology –Information Systems

8. DHMC’s Steps to Justify PACS Internal justification – Institutional leadership –Administrative leadership –Finance Committee –Board of Trustees – final go or no go

9. PACS: Getting Started Outside experts – PACS consultants Institutional experts Radiology Information Systems

10. PACS: Getting Started Educate yourself about PACS Ask your colleagues about their experiences Attend meetings such as this one Vendor discussions and demonstrations at trade shows - AHRA, RSNA, SCAR

11. PACS: Getting Started Request for Information (RFI) Invite selected vendors to respond to RFI Get a list of their customers to contact How would their system fit into your facility RIS and PACS compatibility

12. Interface or Integrate The critical relationship between the RIS and the PACS Have the RIS and the PACS vendors worked together before? Which vendor has primary responsibility or are you expected to do problem triage?

13. PACS: Getting Started Request for proposal (RFP) Invite a limited number of vendors to bid Vendor clarification meetings RFP review and analysis Site visits at working clinical sites Final negotiation – Purchasing and Vendors

14. Paying for a PACS Capital Purchase or Operating Expense Capital purchase –Major capital expense – compete for funding –Cost to upgrade and remain technologically current –Ongoing service and maintenance cost Application Service Provider (ASP) –Costs are an operating expense –Always kept technologically current –All inclusive ASP charges fluctuate with revenue

15. The PACS Timeline Develop a realistic implementation timeline with buy-in from all affected stakeholders Radiology – all levels Information Systems Institutional Leadership Referring Clinicians PACS Vendor

16. DHMC’s PACS Timeline Phase 1 1-2003 Archiving started in CT, MR, US 4-2003 Live in CT, MR and US – stop printing film Phase 2 9-2003 Archiving started in DX 12-2003 Live in DX – stop printing film Phase 3 4-2004 Archiving started in Angio and NM 4-2004 Upgrade the RIS 4-2004 Live in Angio and NM

17. Partnering with PACS Vendor Agreement with the vendor on the timeline and implementation phases Appoint key staff from each stakeholder This must be a win – win endeavor

18. Planning the Implementation Weekly meetings of the PACS Working Group Radiology Director Radiology PACS Administrator Radiology Clinical Operations Manager Radiology Asset Manager IS Director IS Liaison

19. Guiding the Implementation PACS Implementation Team bi-monthly meetings Chairman of Radiology Chief Information Officer Vice President of Clinical Operations The Six Working Group Members

20. Before and After Implementation Ongoing follow-up Weekly calls - Radiology and vendor Updates to the clinical departments Regular updates to the Board of Trustees Monthly updates to the Radiology faculty Weekly updates to the Radiology staff

21. Selecting the Hardware Involve the end user in equipment selection Radiologists given a choice of monitors Referring clinicians given a choice of monitors Specialty sections given choice of monitors OR selected from 5 large flat panel monitors ED selected the best monitor for their use

22. Reading Room Design Radiologists given a choice of layout DHMC rejected the modular systems Radiologists preferred two image monitors Room lighting critical Calculate room temperature requirements Gradual phase out of alternators

23. The Archive DHMC’s PACS Archive In-house dual servers maintained and remotely monitored 24/7 by vendor External archive backed up daily to vendor’s San Diego archive facility DHMC’s failsafe back-up archive -- DVDs burned daily and stored at DHMC

25. Training of the Radiologists Vendor provided 1 to 2 hours of one on one training 2 to 3 days before activation Return visits after activation for more training if needed Give them all the time and training they want Ask radiologists and residents to offer suggestions for enhancements

26. Keep Your Staff Informed Being upfront about what is happening and when it will impact the lives of staff will head off rumors Publish a PACS phase in plan – DHMC 1 year Stop hiring permanent full time Film Library \employees a year before implementation Work with HR to find jobs for displaced staff

27. Contingency Plans Referring clinicians demanding film Acceptance of CD copies by other facilities Urgent results reporting Special requests System failure – power failure, virus, etc.

28. Partner With Your Vendor Clear objectives spelled out in the contract Agree on timeline, payment and penalties Clearly define facility - vendor responsibilities Track progress with regular reports Make the PACS implementation a win – win program for both your facility and the vendor

29. What DHMC Did Right Developed and used a workflow analysis Piloted PACS with 15 referring clinicians Had a close relationship with the PACS vendor Integrated modalities in advance Integrated RIS/PACS with electronic medical record

30. A Chairman’s Perspective “ Never in my 29 years as a chairman have I made a decision that has received such universal acceptance from both the radiologists and the referring clinicians” Peter Spiegel, MD Chairman – Radiology

31. Contact Information Monte Clinton, CRA Dartmouth-Hitchcock Medical Center Monte.Clinton@Hitchcock.org www.dhmc.org/dept/radiology Brian Phelan IDX Corporation Brian_Phelan@IDX.com