Hospital opts for go-slow implementation approach

Not long ago, vendors suggested that PACS implementations should take months or even years. Today, the same vendors claim implementation can be achieved in a matter of weeks.

One Canadian enterprise formed by the merger of three hospitals located within a 2-km radius initially contemplated a big bang horizontal approach to PACS implementation, targeting modalities in all three hospitals at the same time. But for logistical and technical reasons, Centre Hospitalier de l'Université de Montréal (CHUM) eventually settled for a steady-state hospital-by-hospital approach.

"This approach allows us to concentrate all our personnel (for technical support and training) in one place," said Dr. Luigi Lepanto, a professor of radiology at l'Université de Montréal.

The danger with a longer planning period, however, is that it encourages changes in the final configuration (number of workstations, number of DICOM interfaces, CR needs), he said.

CHUM identified three crucial steps in planning its PACS project:

?Assemble a team to steer the project. CHUM's team included the chief of radiology and two hospital directors, although most project work was delegated to a coordinating committee representing radiology, nuclear medicine, the medical corps, biomedical engineering, IT, and finance.
?Identify prerequisites - site visits, review of literature, RFI.
?Establish a vendor-evaluation process.

While PACS is an enterprise-wide project that requires a multidisciplinary approach to planning and implementation, a large coordinating committee uncorks personality and political clashes.

"These difficulties are inevitable in such a large undertaking but are worth the risk to ensure that the project has buy-in of the greatest number of participants," Lepanto said.

He cautions to never underestimate the impact of PACS outside the radiology department.

"Remember that a PACS project has ramifications that go well beyond the borders of radiology, and any number of individuals or groups, if not consulted at the outset, can impede the project," he said.

Another caveat Lepanto offers is to adopt an integrated approach to IT implementation, since PACS is but one component of the digital hospital.

"If different projects (RIS, central dictation, HIS, ADT) are addressed independently, the result may be a tower of Babel with little interaction and an operational disaster at the user level," he said.