Divorcing PACS vendor brings on new headaches

Changing PACS vendors after a long relationship can provoke nearly as much stress as the original courtship. A morning session at the Society for Computer Applications in Radiology meeting in Orlando detailed factors to consider in an impending breakup and prenuptials to prepare for the next marriage.

"A PACS divorce has repercussions on every level from hospital administration to the medical staff, particularly if you were an early adopter," said Maria Elissa E. Blado, PACS manager at Texas Children's Hospital.

TCH severed its 13-year relationship with its first PACS vendor in September 2004, largely because the disaster recovery and long-term archiving needs could not be met.

As a 1991 PACS adopter, TCH began to encounter problems associated with the growth of the archive in 2000. The hospital was ahead not only of new PACS customers but also of the original vendor's development timeline.

"Unlike a general hospital, TCH has a legal requirement to maintain images until the age of majority of patients, plus the statue of limitations, which totals 23 years," Blado said.

The change in systems caused ripples throughout the enterprise. Web users, referring physicians, technologists, radiologists, PACS analysts, and IT had all become completely dependent on the original PACS.

Retraining was an immediate concern.

"It was not acceptable to turn off the switch on the current PACS without a functioning replacement in place," Blado said. "Smooth transition, minimal downtime, and the least workflow disruption were the minimum expectations of our users."

The change focused the attention of the entire hospital on the PACS project.

"The pressure of meeting the heightened expectations and requirements of both users and hospital administration was magnified," she said.

TCH PACS analysts had assist 1300 users with "unlearning" the old PACS, while helping them learn and understand the new one at the same time.

Blado considers the switch a financial success. The cost of the first PACS to the 750-bed facility was about $6 million per year, not counting service support. The second PACS, which was installed on a per-study basis, is expected to result in an approximate 40% savings per year.

Blado said maintaining a working relationship with the old vendor is critical.

"We're continuing to migrate approximately 13 years of image data, amounting to 13 TB," she said.