RIS/PACS (Picture Archiving and Communication System) implementation at SGRH
: Process of vendor selection
EXECUTIVE SUMMARY
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A Picture archiving and communication system is a medical imaging technology which provides economical storage of ,and convenient access to, images from multiple modalities such as X ray, CT, MRI etc.
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Presently, our hospital HIS is capable of storing the imaging reports, though not in a secure environment. It lacks storing and retrieval of medical images for future reference.
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The budget is already sanctioned for the PACS project.
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Initially, nine vendors were asked to submit their proposals out of which five vendors were shortlisted for further evaluation based on their client site visits.
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Finally, only three vendors have been shortlisted for further evaluation.
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Based on evaluation so far and respective visits, FUJI’S PACS/RIS is recommended to be chosen as proffered vendor and solution. The respective solution is ranked highest among the evaluated and shortlisted vendors and solutions in all technical and functional aspects.
INTRODUCTION
Sir Gangaram Hospital has a very good HIS system where most of the clinical and back office activities are being taken care of; but the hospital s not having the Medical Image and archiving solution and hence medical images like X-Ray, CT, MRI, etc. are not being stored for further reference.
In view of above there was a requirement of implementing a PACS(Picture Archiving and
Communication System) solution to facilitate not only the storage of a medical images but also to make them available hospital-wide for reference and further processing.
A PACS consisted of four main components: the imaging modalities, a secured network for the transmission of patient information, workstations for interpreting and reviewing images, and archives for the storage and retrieval of images and reports. Combined with available and emerging web technology, PACS has the ability to deliver timely and efficient access to images, interpretations, and related data and it breaks down the physical and time barrier associated with traditional image retrieval, distribution, and display.
For the purpose, IT department was instructed to evaluate the requirement and recommend the suited PACS solution for SGRH.

PACS
A Picture archiving and communication system(PACS) is a medical imaging technology which provide economical storage of, and convenient access to, images from multiple modalities such as X-ray, CT, MRI, etc. on computers, within the hospital as well as in doctors clinics and homes.
It is meant to be used in addition to the HIS.
For the Indian PACS market the key drivers are:
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The need for film-less environment leading to film reduction
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Cost savings
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Better workflow through accessibility and availability
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Centralized storage
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The need for Tele-radiology services
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Increase in medical tourism
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Increasing competition among hospitals
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Increasing awareness and demand for quality healthcare
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Increasing productivity
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Faster transcription
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Reduced rates of repeated imaging.
OBJECTIVES
1) To study the process of vendor selection for PACS at SGRH.
2) To determine the advantages of PACS to clinicians and the imaging departments.
3) To assess the expectations of SGRH from PACS.
METHODOLOGY
The information about PACS and its advantages to various departments is obtained through-
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Interviews
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Observation
People interviewed were- Head IT, Head medical informatics, FUJIFILM’s representatives,
Head of radiology department.
And the workflow of the radiology departments was observed to come to conclusions.

PROCESS OF VENDOR SELECTION
In the process , department of IT along with department of radiology initiated discussions, meetings and demonstrations with recognised vendors of the domain and based on the outcomes prepared a series of RFPs and shared the same with the mentioned vendors for submission of the technical and commercial specifications/proposal.
The submitted responses to RFP were evaluated and based on the same five vendors were shortlisted for further evaluation.
Encouraged by the observations made, it was recommended to visit the functional sites of each shortlisted vendor to evaluate the authenticity of their submitted proposals. The objective was to understand the user feedback related to the respective operations along with the services and support being offered by the company and to observe the performance related issues, if any, in live environment.
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Preliminary demonstrations and discussions with various vendors in India to understand current technological trends – attended by Director Medical, Head of
Radiology, Head of Medical Informatics and Head of IT.
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Request for proposal prepared based in discussions and after studying RFPs of other institutions. This RFP had all technical and functional specifications.
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The RFP was sent to 9 vendors.
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Proposals received were compared. The proposals were found to be not comparable since some vendors had included hardware and database licenses in their cost while others had not.
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A second RFP, solely for commercial purposes, was then floated. This mandated hardware and all database licenses as within the commercial proposal. Many other factors were frozen to ensure that commercial quotations were for similar systems.
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An initial evaluation was done based on :
-Functionality provided
-Number of installations and support base in India
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4 vendors were excluded after the initial evaluation
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A team of 4 experts went for site visits.
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Method of evaluation :
-Each hospital was visited for about 4 hours. The hospital team was accompanied by a member of the PACS provider company.
-A four page questionnaire was used to ask questions from the hospital staff. The following were met:
1.
Head of IT/ PACS administrator

2.
Radiologist
3.
All meetings were held in confidence, excluding the PACS representative
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Stress was placed on :
Professional attitude of the company
The implementation
The functionality provided
The support provided
PACS has many advantages for SGRH, which are listed below:-
ADVANTAGES TO THE IMAGING DEPARTMENTS
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Better radiologist reporting accuracy will be possible due to available image comparisons with previous films and with images obtained from other modalities like
X-Ray, CT, MRI, etc.
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Currently the imaging department machines are able to store their imaging records for a few days only before the capacity of the machine is filed up. The data is deleted after that. The only record remains on the printed film which is given to the patient.
Once PACS is available, the imaging data can be stored for the lifetime of the hospital.
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In MLC case, when hospital is asked to provide eh imaging records, the hospital sometimes has none. With PACS system hospital will be able to print out fresh copies of the previous image as and when required.
ADVANTAGES TO CLINICIANS
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Clinicians themselves can alter image contrasts, brightness, window levels, magnification, etc. on the viewing computer, allowing tm to detect finer details which would otherwise not be visible on a printed X-ray film, improving clinical decision making.
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It will allow different images of the patient to be viewed side-by-side on the computer monitor for the purpose of side-by-side comparison, by the clinicians himself.
 Patient’s images like CT scan, MRI, etc. can be seen/accessed by the clinician from wherever he is, at whatever time. For example if a clinician can give an opinion on the
CT scan of a patient in the casualty while he is in the operation theatre. Alternatively

he can give opinions from home and make rapid decisions and save patient’s lives.
This is especially valuable for neurosurgeons that make decision on more on what they view in the film than the radiologist’s report.
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The orthopaedic department can use its inbuilt computerisation (Trauma CAD) for advanced planning of hip replacements, deformity corrections trauma surgery, limb lengthening, spinal surgery, etc. This will be far more accurate and produce better results, than the currently used manual methods. The operative time will be significantly reduced in such cases. On a given day, with a fixed number of operative hours, a larger number of patients can be operated. This may increase the revenue of the department and the hospital.
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Neurosurgeons can use the inbuilt computerised measurement facilities to guide their stereotactic and robotic systems to that brain lesions can be operated upon with greater accuracy.
COST SAVINGS
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Patients can be issued with a whole series of x-rays, CT scans, MRIs, etc. on a single
CD without having to print them. This could lead to substantial cost savings.
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In the ICU where most patients get daily X –ray done, rather than print each film separately and send it to the ICU daily , images can be viewed via the IU doctors on their monitors without the need to print films daily. At the time of discharge al the
ICU x-rays can be contacted by the packs, and printed on a singer x-ray film and provided to the patient. This will save the hospital printing costs of many films.
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Manpower requirement to carry films from one location to another will be reduced once PACS is available.
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As mentioned earlier, more operations will be possible by orthopaedics department due to computerised surgical planning techniques.

DISCUSSION
There are several reasons for choosing Fuji PACS. It is better than other company’s PACS in many ways :-
Fujifilm India Pvt. Ltd is a large multinational company having very good local and global backing.
Fuji PACS as well as Fuji RIS are highly reputed amongst top PACS/RIS companies in the world and ranked high by international standards and hence very good reputation as a
PACS/RIS provider.
As per KLAS evaluation, Fuji ranked second place in RIS and third place in PACS, which is very rare.
Selling PACS in Indian market : 3years (10+ years globally)
Hospitals evaluated: Shri Satya Sai Hospital, Bangalore, Rajeev Gandhi Cancer Institute,
Delhi.
Feedback from hospitals :
1.
Very positive
2.
Professional approach and installation
3.
Good functionality
4.
Very good support and services
5.
Covers almost all aspects of PACS
6.
Seamless and quick integration with HIS