Implementing PACS at the Iowa Orthopaedic Center

The Iowa Orthopaedic Center (IOC), a geographically diverse orthopaedic practice of 24 physicians with seven locations throughout central Iowa, first acquired a picture archiving and communication system (PACS) in 2003. Although only a few vendors offered the technology at the time, we believed that a PACS could save physician and staff time, while reducing overhead through higher efficiency and less handling of films.

By midyear, the PACS was up and running. Our vendor drove the process, which was efficient from the standpoint of technology implementation but missed the mark from a business standpoint. Initially, because everything was so new, it was hard to tell whether we were receiving the expected benefits. Staff and physicians were trained, but we still needed daily technical support from the vendor. We assumed this was a shakeout period and hoped that things would improve as our business processes changed and the vendor got the bugs out of the software.

Unfortunately, such was not the case. The stabilization and shakeout period continued, and reliability became more of an issue as the volume of images taken and stored on the new system increased. Instead of having instant access to images, it often took physicians and staff 20 to 30 minutes to retrieve an image, as patients waited and cases backlogged. Morning clinics dragged on into the afternoon; afternoon clinics started and ended later and later.

Making a change
By early 2005, IOC realized that a change was needed. The in-office physician PACS market now included many new vendors, with some consolidation of smaller vendors that had been acquired by large orthopaedic suppliers.

The IOC’s formal request for information covered several areas and focused equally on business and technical aspects of a vendor’s offering. Business questions covered the vendor’s organization, financial information, sales, product mix, references, and the vendor’s authorized negotiator.

Based on our previous experience, we included much more detail in outlining our PACS solution requirements. We asked questions about the PACS’ basic technical functions, about IOC’s business needs, and about how the two would be combined into a solution for the company. We also covered areas such as system audit, security, disaster recovery, purge, record retention, compliance, interconnection, and the overall support infrastructure.

Finally, our choices narrowed down to two vendors. Both offered stable, reliable solutions, and both could tailor a solution to meet IOC’s needs. We initiated negotiations with both vendors, with the goal of signing a PACS system agreement by year’s end.

The deciding issue: A service level agreement
Because both solutions were equivalent from IOC’s standpoint, the vendor selection decision came down to one item—a service level agreement (SLA) that included financial penalties. Our previous experience made it absolutely necessary to ensure that the vendor’s interests aligned with ours.

Our proposed SLA focused on image availability, system stability, and timely delivery of system upgrades and maintenance. Initially, both vendors seemed willing to accommodate us, but as negotiations progressed, we realized which vendor truly understood and was willing to meet IOC’s requirements.

The final SLA specifies a local image-retrieval time of less than 10 seconds; a remote retrieval time of less than 2 minutes; weekly, monthly, and annual image accounting; system and image availability of 99.995 percent; and immediate access to upgrades and bug fixes. The vendor is subject to financial penalties if any of these standards are not met.

IOC implemented the new in-office PACS in January 2006. Our vendor continues to meet the contract terms and to comply with the SLA. IOC is realizing both the business and technology benefits of a robust PACS and is looking forward to keeping the current system for some time.