PACS System Selection Methodology

1. PACS System Selection Methodology Rex Osborn 2004

2. Plan Architect Integrate Optimize • Readiness Assessment • Strategic Benefits • Total Value Calculation / Financial Planning • Executive Education • Budget Approval • Requirements: Technical, Functional, Integration, & Process • Clinical Scenarios • Technology Selection and System Design • Vendor Contracting • Implementation Planning • Implementation and Integration • Process Improvement Baseline • Administration • Maintenance • Reinvestment • Process Improvement Measurement Redesign Optimize Project Methodology We support a full spectrum of project activities.

3. Step 1. Assessment and Financial Planning Planning Plan Architect Integrate Operate

4. Plan Link to Strategic Direction

5. Integrate with Overall IT Plan Plan Many organization’s Vision is to provide their clinicians an integrated, “content-rich” point of care environment that transcends departments on a common workstation enabling timely access to a patient’s comprehensive clinical information for optimum diagnoses and treatment. Imaging is a significant portion of the required clinical information.

6. Plan System Readiness Planning

7. u u u u u u u e e e e e e e d d d d d d d i i i i i i i M M M M M M M m m m m m m m w w w w w w w H H H H H H H o o o o o o o i i i i i i i L L L L L L L g g g g g g g h h h h h h h Plan Identify Success & Risk Factors

8. Establish High-Level Implementation Plan Plan

9. Plan Calculate Financial Impact Outflows • Capital • DI/PACS System • Core / Back-office • User Equipment • Computed/Digital Radiography • Modality Upgrades • Infrastructure Upgrades • System Integration • Renovations • Vendor Services • Re-investment • Operational • Support Staff • DI/PACS system maintenance • CR/DR maintenance • Network equipment maintenance • Incremental network cost Inflows • Capital • Potential increase revenue • Reduction in missed billings • Increase in utilization • Operational • Labor • Film • Film processing • Supplies • Storage space • Courier / Transportation

10. Sample-PACS Financial Model Plan

11. Step 2. Architect: Vendor Selection Architect the Solution Plan Architect Integrate Operate

12. Architect Determine Priorities

13. To mitigate your risk during the vendor selection and contract negotiation process To ensure the selected solution meets requirements Provide investment protection to ensure investments in the solution are properly timed and aligned with an overall strategic vision Guarantee Integration to Enable Digital Workflow To arrive at a well-designed solution with preferred digital imaging vendors To develop a comprehensive contract that will set a strong foundation for both a successful implementation and long-term relationship between Bassett and the vendor To shorten the time-to-contract with the vendor Selection - Sample Goals & Objectives Architect

14. ADT RIS MPI HIS PACS Display Modality Architect Approach: Leverage the IHE* Standards • Allows for focus on workflow solutions, not connectivity issues • Lowers integration costs – implementation durations • Minimizes custom interfaces – clearly defined interface owners • Vendors representing 90% of the digital imaging market participate - RIS, CVIS, PACS, Modality, Web, Reporting, 3D Workstations, Voice Recognition Systems • You get integrated information systems vs. information islands *Integrated Healthcare Enterprise

15. Weight Criteria Definition Source • Functionality • Functionality Coverage • Detailed Scenario Ratings • Overall Scenario Ratings • Application Maturity • RFP Response • Demonstration 25% • Technology Assessment, Ownership • Cost of Ownership • Technology Risk Assessment • Number/ Complexity of Integration • RFP Response • Clinical Site Visit Evaluation • Technology 15% • Cost • Preliminary Cost Models • Implementation /Benefit Timing • Cost of Ownership • RFP Response • Vendor - Cost Benefit Models (RFP) 15% • Experience • Customer Service • Implementation Depth, Methods • R&D Expenditures • Annual Contracts • References • RFP Response • Clinical Site Visit Evaluation 15% • Alignment with Vision • Shared integration approach • Vendor track record, IHE,CCOW • References • RFP Response • Clinical Visit • Visit Evaluation • Integration Vision 30% Example: Selection Criteria Architect

16. Example: Workflow Enablement Guarantee Architect Proof of Concept Scorecard

17. Architect What’s in a Contract and Why • Examples of Final Contract Exhibits, System Configuration, and Bill of Materials: • Terms and Conditions • Bill of Materials • License Software Module Schedule • System Requirements Compliance Matrix from RFP • Specifications and Acceptance Testing Protocols • Payment Schedule • Service Agreements • Project Milestones • Escrow Agreement • User Documentation • Original RFI/P/Q Response and Subsequently Issued Requirements & Specifications • Works in Progress Agreements • Ensure common understanding and agreement to cost, performance, capacity, and scalability • Minimize client risk associated with vendor terms and conditions, solution offerings, costs, and future product direction.

18. Project Initiation Prepare and Distribute RFP Vendor Responses Analyze Vendor Responses Develop Requirements Workflow Analysis Organize Selection Teams Requirements Session Down Select to 2 Vendors Assess Against Current Vendors; Identify Benefits Prepare Scripted Scenarios Final Approval Executive Presentation and Approval Recommend Vendor(s) Of Choice Conduct Reference Calls Conduct Vendor Demos Architect Technology Selection Process

19. Using Standards in Selection Architect • For enterprise systems to be successful, standards are critical • Guarantee information flow which allows the organization to focus on workflow solutions, not connectivity issues • Less integration complexity and lower costs shorten implementation durations • Minimize custom interfaces and clearly define which vendor owns each integration boundary *Integrated Healthcare Enterprise

20. Prenuptials for Partnerships Architect • Terms and Conditions Referencing Exhibits: • Service Levels • Bill of Materials • Schedule of Software • Acceptance Testing Procedures • System Requirements and Performance Specifications • Project plan and Statements of Work Links to Payment • Service and Maintenance Agreements with Uptime Guarantees • Training Materials, Schedules and Documentation • The Original RFP Response • Product Roadmaps • Goals • Ensure agreement - costs, project scope, system performance, capacity, and scalability • Understand and mitigate risk associated new product offerings and future product direction

21. Integrate Plan Architect Integrate Operate Step 3: Integration & Implementation

22. Improvement Example Integrate "After organizing work flow to take maximum advantage of the capabilities inherent to PACS, we saw the number of steps involved in scheduling, producing, reading, reporting and billing a single chest radiographic study decrease from 59 to nine" "Clinicians are now able to quickly retrieve diagnostic images-in full fidelity with imaging reports at workstations we've deployed throughout the medical center," says Siegel. "Because we're saving them time, clinicians are able to focus more attention on patient care, delivering care that's of higher quality than ever before." – VA Hospital Baltimore

23. Integrate Driving Accountability

24. Integrate Resource Optimization

25. Implementation Team Resource Checkpoint Modality/ DICOM Assessment Contract/Re-quote Released RFI Released Current Environment Assessment PACS RFP Released FCG Engaged Workflow Redesign CR Workshop Network Assessment Network Preparation Facilities Preparation Staff Interviews Site Visits and Reference Checks PACS Vendor Selected Contract Complete “GO” Negotiations PACS Planning DI Architecture, Selection Pre-Implementation Planning Project Timeline Integrate Softcopy Reading PACS Subnetwork “Live” Web Distribution PACS Training Kickoff Acceptance Test Complete Archive Installed Interface Design Board Approval for PACS Modality Integration Database Preparation GO LIVE Implement, Operate, Optimize 12 - 16 Months

26. DI Transformation – Operate Plan Architect Integrate Operate Step 4. Operate: Transform & Operate