Choosing next PACS gets complicated, especially where RIS is concerned

Heated debates are not restricted to political circles. One debate currently flourishing in the imaging informatics community is whether to go with single or multiple vendors when purchasing or replacing a RIS or PACS.

PACS have been around long enough that many hospitals are upgrading legacy systems to newer generations. An important consideration is whether to replace the RIS at the same time. Continuing with an outdated RIS often leads to disappointment in the new acquisition because an older RIS can interfere with improvements offered by newer PACS.

"Keeping an older RIS will limit workflow," said Joseph Maune, director of project management in Carestream Health's Healthcare Information Solutions division.

If both RIS and PACS are to be upgraded simultaneously, the question becomes whether to go with single or multiple vendors.

A single-vendor approach has several advantages.

"The attraction of single-vendor RIS/PACS is one-stop shopping," said Christopher Henri, executive vice president of business development at Intelerad Medical Systems.

Customers work with one company to resolve issues, avoiding the risk of finger-pointing inherent in dealing with multiple companies.

"Servicing is simplified with single points of contact, and maintenance is far more flexible since component updates are engineered and validated within the total solution, allowing timely, worry-free implementation of emerging functionality," said Bob Craske, global marketing manager of imaging informatics at Agfa HealthCare.

Single-vendor solutions are also believed to provide more efficient workflow. Radiologists want an integrated desktop that combines RIS, PACS, and dictation, yet standards for full integration are not well established.

"As a result, multivendor integrations are complex and rarely achieve the functionality of a fully integrated single-vendor RIS/PACS," Maune said.

Single-vendor solutions may also cost less.

"There may be economies of scale when implementing single-vendor solutions," said Martin Håkansson, Sectra's vice president of marketing.

Also, implementation is often faster and easier when dealing with one vendor.

A single-vendor disadvantage is that customers sometimes must compromise on features or functionality and may find flexibility reduced in future negotiations. Also, many single-vendor RIS/PACS solutions are single-vendor in name only.

"Many so-called single-vendor systems represent an acquisition of a smaller RIS by a bigger PACS vendor and were not developed in unison and aren't part of the same corporate culture," said Dr. Greg Mogel, chief of informatics in the radiology department at the University of Southern California.

Historically, few manufacturers sold both RIS and PACS and of the few that did, it wasn't uncommon for the systems to be developed under different Windows/Unix, client-server, or web-based architectures.

"Single-vendor RIS/PACS are not all the same due to these architectural differences," said Jim Morgan, director of network systems for Fujifilm Medical Systems.

Morgan said the real question to ask when evaluating RIS/PACS is whether they have a single architecture type.

One advantage of a multivendor approach is that customers are free to select best-of-breed solutions. This leads to the selection of vendors with niche expertise and single-focus products.

When sites are not bound to a single vendor, they have the ability take an evolutionary approach to system changes or upgrades and to negotiate price points for lower upgrade costs.

Scripps Mercy Hospital in San Diego has found that with a multivendor RIS/PACS configuration, they can opt to change one system at a time as business requirements mandate.

"This enables us to take smaller upgrade budget hits," said Roger Anderson, the hospital's PACS/RIS administrator.

There's another advantage to selective system changes.

"Avoiding forklift upgrades of all systems at once facilitates the adoption of new technologies, such as computer-aided diagnosis, 3D imaging, and advanced visualization," said Janine Broda, vice president and general manager of the medical solutions division at Compressus.

The best-of-breed approach, however, may not be the best choice if components can't be tightly integrated. Close integration creates an efficient workflow with automated tasks that enhance convenience and productivity for users.

Another risk of a multiple-vendor choice is that vendors may not play well together. When considering separate RIS and PACS, customers should closely examine vendor integration track records. While PACS providers have largely complied with DICOM and other industry standards, most still wrap their data in proprietary formats to protect their business, making it difficult for users to change systems.

"If you've done your homework, you'll have chosen vendors with good system integration records who are staunch supporters of industry standards and are active participants in the Integrating the Healthcare Enterprise initiative," Henri said.

Still, with multivendor solutions, customers have multiple systems to manage and maintain and multiple contracts to negotiate.

Mogel said most facilities will not face a pure choice between single-vendor and multivendor options, but will find their hands forced by financial, political, and administrative realities.

"As usual, it's more about people and leadership than technology," he said. "Vendors, radiologists, technicians, and IT personnel need to realize that neither success nor failure is inherent in the approach, but rather in how those involved understand the goals and how they approach the process."