Once you say “yes” to PACS, what’s the next step?

Selecting and acquiring a picture archiving and communication system (PACS) are not trivial matters, nor is the financial responsibility associated with acquisition of such a system one to be taken lightly. The most important aspect of PACS selection and acquisition can be summed up in one word: process. Although thorough research regarding the functionality of your PACS has to be a priority, the steps necessary for successfully negotiating with vendors to acquire a PACS are just as important.

Create the process you want
Once you decide that a PACS is right for your practice, make sure you have the business process in place to make the selection and acquisition just as successful as the initial needs assessment. The Iowa Orthopaedic Center regularly uses a Request for Information/Request for Proposal (RFI/RFP). Both are practical tools that can be used either separately or together to get your practice the PACS information you need, in the form you need it, and in a timeframe acceptable to your decision-making process.

An RFI usually precedes an RFP and may confirm information you already have. The RFI is often an open-ended document—it can outline a business problem or function and give vendors latitude to interpret the situation and provide a perspective on how they think they might solve the problem.

An RFP, on the other hand, is prescriptive in nature—a specific request from you to a vendor asking for a solution that fits your needs. Normally, the RFP directs a vendor to a particular set of circumstances or needs, outlines all the details you want, spells out exactly what your practice is looking for, asks relevant questions of the vendors, and seeks a price for the solution they would propose.

For example, an RFI tells builders you want a new roof that will last 40 years and asks that they propose the best solution for your review and consideration; an RFP tells builders you want a heavy-duty, asphalt shingle roof, with extra reinforcement to the rafters, and asks for their prices.

Remember: You are the customer
Once you issue an RFI/RFP, vendors will seek to identify specific characteristics of your practice so they can respond with appropriate information and proposals and position themselves for a sale. Don’t allow yourself to be swayed by factors unrelated to the business at hand. Remember that you are the customer.

Use particular care in responding to questions from vendors about your practice’s purchase decision-making process or the specific factors that may be involved in such decisions. Be prepared for questions such as the following:

• How much money does your practice want to spend on a PACS?
• When do you plan to buy a PACS?
• Who participates in the decision-making process?
• How hard will I have to work to get this sale?

Because PACS are complex technologies and because most orthopaedic practices are unfamiliar with this level of technology discussion, members of the practice may want to enlist outside help. Make sure the technology advocate you select is knowledgeable about the technology under consideration.

Anticipate obstacles to decision-making. Only a robust process that is outcome driven will result in a successful PACS selection and acquisition. The online version of this article includes a list of obstacles and some practical advice on potential solutions.

Start with a plan, create a flexible process that supports that plan, and follow an outcome-driven approach to getting the PACS that is right for you.

Before you sign
Just as PACS themselves often are discussed in a complex, technology-oriented language that may be unfamiliar to most practice members, so too may be the legal language of contracts. Ask for help and hire experienced outside counsel to review the contract documents. Make sure the attorneys you retain are familiar with the Uniform Commercial Code, because once you sign a contract, you will have to live under its terms.

No PACS vendor should ever tell you that you shouldn’t or don’t need to have a lawyer review the contract, just as no PACS vendor should ever be opposed to a technology evaluation of his or her system by an outsider. If anything, the vendor should take the opportunity to review again the terms of the agreement with you and validate the commitment to being your PACS partner into the future.

In the final analysis, once your practice has determined that a PACS makes sense, it is up to your practice leadership team to designate someone to be in charge of the PACS selection and acquisition process, to put in place the appropriate processes and controls, and to ensure they are followed by the vendors and practice staff involved.

Craig R. Mahoney, MD, is a member of the AAOS Practice Management Committee. He can be reached at iowamahoneymd@aol.com

Kevin Ward is chief executive officer of the Iowa Orthopaedic Center. He can be reached at kward@iowaorthopaediccenter.com