The adage about comparing apples to oranges accurately describes the challenge you face. PACS quotes can be complicated and cryptic, with vendors providing pricing in their own proprietary formats that make it difficult to compare across categories, components, or specific line items.
You have just received request for proposal responses from five PACS vendors, each binder thicker than the last. The first section you instinctively locate is, of course, the pricing; but what is behind each of these enormous bottom-line numbers? Are the vendors quoting comparable packages? Are there hidden costs, or have critical components been omitted? How can these quotes be effectively compared?
The adage about comparing apples to oranges accurately describes the challenge you face. PACS quotes can be complicated and cryptic, with vendors providing pricing in their own proprietary formats that make it difficult to compare across categories, components, or specific line items. Some vendors provide bottom-line pricing with little detail, while others bundle hardware and software components separately. Additionally, there may be future cost implications depending on the licensing model utilized by each vendor or on the structure of the extended maintenance agreement. Let's also not forget about "options" that are truly not optional for your organization.
To achieve an apples to apples comparison and decipher PACS price quotes, consider the following 10 tips:
In developing the standardized pricing form, create separate sections for hardware, software, and options and request pricing to the line-item level. A well-written RFP should include a definition and functional specification for each line item. Also, be sure to specify required quantities for each line item, as you do not want to allow the vendors to make guesses on quantities in the quote. For example, the RFP should identify the number of workstations, including type and location; modalities to be connected to PACS; projected exam volume; and storage requirements.
The trend in the industry is toward the exam volume model, in which annual exam volume is projected over a five-year period and the vendor determines the software licensing price based on that volume, regardless of the number of workstations or concurrent users. If the volume exceeds a preset threshold, the vendor typically charges an incremental software licensing upgrade fee.
The per-seat model, in which every workstation has a software license, has fallen out of favor, replaced by the concurrent users model. In the latter, software pricing is dependent upon the peak number of simultaneous users logged into the system at any given time. The final model, ASP, involves an annual operating fee and does not require an upfront capital investment. With an ASP, the site does not technically own the system and instead pays an annual fee for its use.
Another area where variances are often observed is in system redundancy configurations. For example, one vendor may include a back-up server configuration as part of the base quote, while another vendor lists this as an option.
Variances in storage capacity are also typical. It is not uncommon for vendors to quote storage capacities that are different from the estimates provided in the RFP. In addition, even when you specify that preexisting storage infrastructure will be used (such as an enterprise SAN), vendors will often still include storage in their quotes. When variances like these are identified in the quotes, make sure they are not in the core quote price and move them to the optional items section of the spreadsheet model.
Two final areas that typically involve variances include specialty workstations and interfaces. Be aware that variances in the level, price, and deployment of workstations are a near certainty when comparing one vendor with another. Similarly, differences among vendors in interface solutions, such as modality, laser printer, radiology information systems, and electronic medical record, should also be anticipated and carefully reviewed.
One example is redundancy configurations, including clustered servers, particularly for the database management application, and backup servers for either cold or hot backup. These configurations keep the system up and running and thus are not really an option for most enterprises. A second example is 3D image processing. With the continued evolution of cross-sectional imaging, 3D is becoming more of a necessity than an option.
The first category to examine is project management and staffing. In evaluating each vendor's RFP response, clarify the presence and level of onsite project management, length of time the project manager will be engaged, the number of clients he/she is supporting simultaneously, the budgeted number of project management hours, specialists who will be involved (e.g., service engineers, integration specialists, applications specialists), and hourly rates for time that exceeds budget.
The second category is support and troubleshooting. Examine each vendor's guaranteed response times. If these specifications are inadequate for your enterprise, determine the cost of purchasing premium coverage that provides the required levels. Look at onsite response versus phone response times, off-hours coverage, and whether onsite response times exclude nonbusiness hours. Uptime guarantees also vary from vendor to vendor. Be sure to document what each vendor is offering and how uptime is defined. Last but not least, be aware that obtaining a higher uptime guarantee will typically require greater redundancy options purchased from the vendor.
The final category is training. Each vendor provides a set amount of training in terms of number of days and people, broken down by type (onsite or offsite) and user (technologist, PACS administrator, or radiologist). The vendor should also provide the price for purchasing additional days/hours of training. This will allow you to adjust quantities and pricing in the spreadsheet model to normalize training services among vendors and achieve a comparable basis of costs.
The training strategy proposed by each vendor must also be understood, as it may include a combination of several alternatives including one-on-one training of end users; train-the-trainer sessions to create one or more superusers who in turn train others; or classroom training, which is typically offered only to PACS administrators and is almost always offsite.
Hardware coverage is the second component of extended maintenance that requires decoding. Clarify whether the vendor has in-house technicians or if it outsources its hardware support, as the latter is becoming more typical. Make sure you clearly understand guaranteed response times, the proximity of each vendor's nearest field office to your site, and what personnel the vendor actually has in the area to provide onsite coverage. Off-hours coverage will typically involve phone support, and guaranteed response times will be longer. Don't forget to compare the fees charged for off-hours/weekend emergency on-site response coverage.
Two final considerations involve storage and hardware upgrades. The current trend is to make all images available in the online storage, which consequently increases the storage requirements as the size of the archive grows. But the cost of storage continues to decline rapidly, so avoid overbuying storage upfront. Instead, buy it as needed and include the cost in your five-year projection.
Deciphering the cryptic and varied language of PACS pricing is within your reach. Invest the time and effort in planning and defining the requirements of your organization prior to soliciting quotes, and you will be rewarded with a significantly more efficient and effective evaluation process.
Mr. Panzarella is manager and Mr. Schweitzer is chief technology officer at RCG Healthcare Consulting in Boston.