Learn the keys to buying medical imaging technology

Importance of defining requirements

Acquiring a medical imaging informatics system can be enhanced by properly defining system requirements and making sure there's a match with vendor capabilities. The first step is to obtain consensus within the organization on requirements. In today's cost-constrained healthcare environment, acquiring medical imaging technology should not be done in a vacuum. If, for example, radiology is contemplating a new picture archiving and communication system (PACS), justification should be predicated on the uniqueness of requirements, and any potential overlap with other imaging service lines. Should, for example, cardiology already have its own PACS, the question is, how much overlap is there between service lines, and how relevant might common functionality be? 

This might be the perfect opportunity to consider shared functionality, such as a vendor neutral archive (VNA) or common viewing technology, instead of dedicated PACS componentry. So, while budget approval might be just for radiology, the likelihood of approval might be enhanced if the case can be made for broader capability across service lines.

The greater the detail you have about your organization's needs, the better the chances are of selecting the right medical imaging technology. For example, having a clear definition of required storage capacity requirements will enable vendors to more accurately size a medical imaging informatics system. Having a clear idea of the number of particular workstation licenses needed will provide leverage in negotiating whether individual or site license alternatives are more favorable. The benefit of a VNA is that it can grow in capacity to handle additional service areas as they are needed. Identifying the correct number of workstation licenses may minimize overlap should another service line also have viewing requirements.

There are multiple factors relevant to a medical imaging technology purchase decision.

Scope

As outlined in the previous section, part of the definition process is setting the correct scope for a system acquisition. A simple PACS replacement is fairly limited, as would be simply replacing the archive for an existing PACS. Whereas implementing a common image storage and viewing environment for the enterprise would have a larger scope, potentially extending across multiple service lines for an enterprise solution.

The more accurately one can define the scope, the more likely proposed medical imaging technology vendors are to meet it. For example, suppose the medical imaging informatics system is intended to be an enterprise application, and the storage capacity requirement is defined for the identified services. If any significant service is overlooked, it could have substantial consequences for the implementation. In one PACS replacement situation, a hospital grossly underestimated the annual storage requirement, resulting in the PACS exceeding its database storage within the first year. Due to some system changes caused by some components being out of date, the vendor required a significant database server upgrade, costing the site an additional six figures in unexpected expense.

Content

A simple PACS replacement might address only those medical imaging informatics systems that require DICOM image formats. Expansion beyond classical imaging areas might involve alternative image formats such as JPEG, BMP or TIFF, thereby requiring a broader content functionality such as that provided by cross enterprise document sharing (XDS). Understanding the extent of content to be handled by the system can be helpful in assuring that the medical imaging informatics system properly matches specific needs.

Another benefit of understanding content is the intended clinical use. Many VNAs can manage data in what is known as clinical content management, whereby a clinician query of the system will produce all known stored content for that patient, making it more efficient and effective for the clinician.

Single or multiple vendors

There may be extenuating circumstances that warrant a single-vendor system. Alternatively, it may be best to consider stand-alone tools from multiple vendors. For example, many vendors that provide VNAs for storage also offer their own universal viewer applications. It is important to source these components from the same vendor to review their interoperability. 

Facility requirements might favor the archival capabilities of one vendor and the viewing capabilities of another vendor, based on particular needs. If the viewer offered by the VNA vendor only supports certain devices, or formats, using a viewer from another vendor may better meet requirements. This may be particularly important when interfacing the viewer to a particular electronic health record (EHR), if the VNA vendor has not interfaced with that vendor previously, and if another vendor is known to have a tight integration.

Single or multiple facilities

In today's environment of consolidation, it is likely that multiple facilities and quite possibly multiple business entities are involved in the process of purchasing a medical imaging system. In such situations, requirements may be more complex, such as the need to incorporate XDS registries and multiple repositories, or the ability to accommodate multiple EHR applications.  

Providing a medical imaging system across multiple entities may require a solution that can match patients across multiple EHR environments. Many systems incorporate some form of a patient matching algorithm that can match the same patient from multiple systems to achieve a unified view.

System configuration

Today, most medical imaging technology support virtualized environments. There may be exceptions, however, such as the need for specialized graphical processors within a display rendering server. Similarly, healthcare organizations should take into account the type of operating system the application employs. If the IT department is predominantly a Microsoft Windows shop, and the server for the particular application is Linux-based, it may be an important factor in selecting one vendor over another.

Many medical imaging informatics systems are now hardware independent, meaning that a facility has more flexibility in selecting a compatible hardware environment, thereby lowering the cost. A site may have a preference or vendor relationship with a particular display vendor and may be able to achieve a better cost, as well as support capability.

Considering on-premises versus remote deployment can be important, particularly in remote or third-party considerations where there might be public versus private servers. Sensitive patient information is best stored on private servers unless the third party can provide assurances that the data is secure.  The role of cyberattacks on healthcare organizations may also come into play, in that a larger third-party entity may be less vulnerable to attacks than a smaller private entity that doesn't keep pace with the latest security and operating system updates.

Interoperability and vendor synergy

A significant challenge facing the healthcare industry today is assuring the interoperability between systems. Whether it is a simple PACS replacement or a complete enterprise-scale system, it is important to assure that it operates with existing information systems. A system intended to provide enterprise-wide image enablement of an EHR will need to be able to interface with the available EHR. Similarly, a simple PACS replacement will need to interoperate with the existing PACS at the same or better performance and price. Depending on scope, it will be important to select a medical imaging system that best matches the existing environment. In the case of medical imaging technology, this may mean close association with the imaging equipment to capitalize on potential interoperability. Or, it may be more important for the system to interoperate with the EHR to provide seamless image access across the enterprise. As facilities increase their data warehousing capabilities, imaging integration may be an important factor for analytics accessibility.

Key decision-makers

Imaging has long been the purveyance of imaging services, but with the advent of enterprise applications associated with EHRs, IT organizations are playing a greater role. As stated earlier, no imaging IT decision should be made in a vacuum. Therefore, key decision-makers should include the imaging department, clinical, chief medical or technical officer and IT staff, to assure the needs of all are best met.