Image Management PRocurEment SyStem
A POISE based procurement process.
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Contents:
Part
Section
Description
1. Background
1. A
Introduction
1. B
European Legislation
1. C
Product and Market Information
1. D
Integration and interoperability
2. A
Role of the Business Case
2. B
Strategic Outline Case (SOC)
2. C
Outline Business Case (OBC)
2. D
Full Business Case (FBC)
2. E
Project Management (PRINCE)
3. A
Overview of process
3. B
Placing the OJEU Advert
3. C
Outline Requirements – SON and short listing
3. D
Detailed Requirements – DSON, evaluate and shortlist
3. E
Invitation to Negotiate – Tender
3. F
Evaluate Tender Responses
3. G
Indicative Award – Preferred Supplier, Draft Contract
3. H
Contract Award – Acceptance
3. I
Post Award
3. J
Risk Guide
3. K
FAQ’s
2. Business Case
3. The Procurement
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Contents: (continued)
Part
Section
Description
Version
4. Appendices
4. A
The Business Cases (OBC/FBC)
BCPv1.0
4. B
Template OJEU Advert
4. C
Services Directive – 92/50/EEC
4. D
Generic DICOM Wording
GDW1.0
4. E
Template Statement of Need (SON)
SONv1.3
4. F
Template Evaluation Sheets for Presentations (PES)
PESv1.4
4. G
Template Score Sheets for PES
4. H
Template Evaluation Sheets for Site Visits (SVES)
4. I
Template Score Sheets for SVES
4. J
Template Detailed Statement of Need (DSON)
4. K
Template Score Sheets for DSON
4. L
Template PES/SVES Summary Score Sheet
4. M
Template Tender
4. N
Template Offer Schedules
4. O
Template Offer Evaluation Sheets
4. P
Standard Contract Terms and Conditions (MSCON)
4. Q
Guidance notes for MSCON (March 2001)
T&CGv1.0
4. R
Template OJEU Award Notice and Letters
EUAWv1.0
4. S
Template Project Timetable
Projv1.1
4. T
Acknowledgements
AKSv1.0
4.U
Glossary of Terms
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EUADv1.0
NegProv1.0
PESscorev1.0
SVES1.4
SVESscorev1.0
DSONv1.4
DSONscorev1.0
PSscoreSUMv1.0
ITNv1.0
OffSCHEDv1.0
OffEVALv1.0
March 2001
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Section 1. Background
1.A
Introduction.
Purpose:
The IMPRESS guide is designed to provide the latest guidance for NHS bodies when purchasing
Image Management Systems, in particular; Picture Archiving and Communications Systems
(PACS). The guidance contained within this document has been developed by the NHS Purchasing
and Supply Agency (NHS PASA) in conjunction with PACSnet, NHS Executive, NHS Trusts and
suppliers within this market. Whilst the guide sets out to standardise the procurement purpose for
PACS, it is.
Audience:
IMPRESS is designed to guide the purchaser through the process starting with the business case,
through the procurement and the contract award. As well as guidance, templates for evaluations,
specifications, tenders and contracting are provided within the appendices. Whilst the target
audience are project, Radiology and IT managers with NHS Trusts in England. The guide is
designed for use by any public health organisation involved in such procurements. As such this
guide sets out the best practice for NHS bodies.
How to use this guide:
The IMPRESS guide is split into four main parts:
1. Background. This part consists of four sections covering an introduction to this guide, EU
legislation guidance, product and market information and integration and operability.
2. Business Cases. This part provides detailed guidance on all three stages of the business case
process and their synergy with the procurement process. The relevant templates are provided in
the appendices.
3. The Procurement. This part contains detailed guidance on the procurement process including
usage of the standard templates, identifying risk, evaluation of potential offers and awarding the
contract
4. Appendices. This part contains all the templates, some reference material and a glossary of
terms.
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1.B
European Legislation.
Background:
It is the aim of the EU member states to create a single European market void of all trading
restrictions and barriers in which all businesses have an equal opportunity to compete.
The EU regulates and monitors all public sector procurement through EU directives covering the
supply of goods, services and works. In the UK, the directives apply to all NHS contracting
authorities, including health authorities and NHS trusts.
As a member of the European Union and a signatory to the World Trade Organisation (WTO)
agreements, the UK is governed by the following legislation as far as public procurement is
concerned. The current and proposed legislation that forms the basis of mandatory procedures to
be adopted for procurement in the public sector in the UK is vast and includes:
The Treaty of Rome
The Consolidated Supplies Directive
The Services Directive
The Works Directive
Government Procurement Agreement
The Compliance Directive
The Public Supply Contracts Regulations 1995
EC Decision 87/95
The information provided below should not be read in isolation or used as a substitute for legal
advice. Copies of each directive are available if required.
However, for the procurement of PACS solutions, you should only be concerned with The Services
Directive. Any mention of EU legislation throughout the procurement process refers to this directive
only. A copy of this directive is available in Section 4.C
Application of the regulations
EU regulations apply to all contracts for the supply of goods or services whose overall value
exceeds the following threshold excluding VAT:
£100,410.00 (excludes VAT but applies to TOTAL contract value).
Please note that this threshold is subject to change and advice should be sought as to the latest
figure.
OJEU advertisement:
If the value of any contract exceeds this threshold the contract must be advertised in OJEU and
allow the minimum prescribed times for suppliers to respond. The recommended process is the
Negotiated Procedure as PACS contracts are solutions based and as such are the purchase of
primarily a service as opposed to just goods.
A template advert is available in Section 4.B.
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A minimum of 37 days must be allowed for expressions of interest before suppliers are short
listed/vetted based on the criteria stated in the advert. When PaSA issues adverts, pre-qualification
of the major suppliers will have been conducted along with the vetting of new suppliers on behalf of
the Trust.
The information on OJEU is repeated on a dial-up database called Tenders Electronic Daily (TED).
Many commercial intelligence services and trade magazines also copy it. A link to some useful web
sites is below.
Inviting competitive offers:
In this procedure, the regulations (both Services and Supply) state that at least three suppliers must
be selected to negotiate with, where sufficient suitable responses are received. They also state that, in response to
a notice under the Services Directive, an offer may not be rejected on the grounds that it would lead to a supply
contract (and vice versa, an offer received under a Supply Directive notice). Although there is no set
time period for the procurement (or tender), guidance is given in Section 3.A
Contract award:
Within seven days of award of a contract the Authority must inform the unsuccessful suppliers that
a contract has been awarded. A contract award notice must be placed in OJEU within 48 days of
informing the successful supplier. A template is provided in Section 4.L along with sample letter.
The trust is not obliged to publish information which would be ‘contrary to the public interest’ or
‘might prejudice fair competition between suppliers’ but that does not mean that it can routinely
conceal contract values. I.e. approximate values can be supplied.
Debriefing suppliers:
Authorities are obliged to debrief suppliers on request to say why they have not been invited to
tender or have not been successful with their bid – this must be done after each stage of short
listing and after the contract has been signed for suppliers that were issued Invitations To Negotiate
(Tender). Whilst there is no defined time period, good practice dictates that it should be conducted
within working 15 days of the request or award of contract
Pre-contract clarifications:
As procuring PACS is solution based, a central feature of IMPRESS is that it uses the negotiated
procedure so that the Trust’s requirements and the supplier’s offerings do get discussed in as much
detail as is required before the formal tender stage. Therefore by this stage there should be little
ambiguity left however, it is inevitable that clarifications will be required prior to contract signing and
are encouraged as early as possible.
The over-riding purpose of the Directives is to insure that all suppliers are treated fairly and
equitably.
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1.C
Product and Market Information.
Definitions:
Advances in digital technologies, particularly in the fields of computing, imaging and in
communication, have progressed to the point that it is now possible to acquire medical images in
digital form, archive them on computer systems, and display them in diagnostic quality. The display
monitor used to display the images can be at an adjacent or distant location to the original point of
acquisition. Indeed, there can be multiple monitors at multiple locations, since once the ‘master’
image file is archived, it is only ever a copy of the data that is transmitted for display.
There is no universally agreed definition of what a “PACS” is or does. A Picture Archiving and
Communications System (PACS) typically comprise data storage devices, image display devices,
database management software and links to image and/or image data acquisition devices,
connected by computer networks. There may, in addition, be network connections to other
information systems such as the Hospital Information System (HIS), Patient Administration System
(PAS) or the Radiology Information System (RIS). For the purposes of this document, a PACS is
considered to include image display devices, data storage devices, database management
software, film printers and digitisers, and computer networks. Excluded from this definition of a
PACS are other information systems (e.g. HIS or RIS), image data acquisition devices - modalities
(excepting film digitisers), and teleradiology systems. PACS is a fast developing technology, which
is blurring with other technologies such as EPR.
A “mini-PACS” generally refers to a small-scale PACS, usually limited to one imaging modality or
department. In a typical mini-PACS installation, one or more image acquisition devices of the same
modality are connected to a local digital storage device, and one or two workstations are attached
to the storage device, allowing retrieval and display of stored images.
Although there are many parallels between PACS and teleradiology, and in the equipment used to
create PACS and teleradiology systems, there is a fundamental difference in the ultimate aim of the
two systems: a PACS is designed to store image data and to transmit that data for display within an
institution; a teleradiology system transmits image data to a remote location for diagnosis, but may
or may not include an element of archive storage.
Commercial and clinical implications:
The basic drive behind digital imaging and PACS in comparison to conventional x-ray film,
processing and archiving include:

Reduction in patient dose for “plain film” reporting due to the ability to pre-scan images, high
sensitivity of detection plates (both CR and DR) and the ability to post process images, thus
reducing the number of retakes

Potentially greater patient throughput and greater percentage of reported cases by Radiologist
due to quicker acquisition and quality testing of images and more efficient treatment of patients
due to easier access to patient information by all clinicians and reduction in patient travel

Removal of x-ray film, processing and consequential waste management, removing the need for
a COSHH environment
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
Handling, communicating and storing all radiology image data and related demographics, thus
eliminating duplication and improving workflow

On average it is estimated that approximately 18 – 37% of x-ray films are lost or miss-placed.
PACS essentially eliminates this loss rate and subsequently reduces the amount of exposure by
patients to ionising radiation by reducing the number of re-takes.

Many trusts are unable to comply with the current guidelines on the storage of x-ray images
where patients have been exposed to ionising radiation due to the lack of on-site storage space
and the subsequent expense of off-site storage and retrieval. With PACS, once the initial
hardware has been purchased, the storage costs are relatively inexpensive and dependent on
the archive media chosen

Installation of a PACS gives the opportunity to re-evaluate the workflow within the radiology
department. Rather than merely mimicking an existing, paper-based, system, a carefully
planned PACS implementation can encourage improved workflow, i.e. the more efficient flow of
information, images and patients through the department.
The main drawbacks of purchasing PACS are the initial high capital costs and the on-going high
maintenance costs, providing high whole life costs. Typically, the year on year maintenance costs
(after the initial warranty period) are between 8 – 15% of the capital costs of the system, depending
on the level of support acquired. The migration to a PACS is rarely revenue neutral unless there is
substantial capital investment upfront and subsequent investment for technology “refreshes”.
Due to the IT nature of the hardware, the life span of many components is relatively short and with
the continued pace of development, systems can be considered “old technology” soon after
installation. The most common acquisition method in the NHS market seems to be through a
managed service with an incremental rollout of the system during the life of the contract, thus
allowing the installed components to be as up to date as possible and to introduce an element of
“risk-sharing” between the two parties.
Types of PACS:
Although every solution is tailored to the individual customer, there is a trend to move away from
proprietary to industry standard hardware and solutions leading to three distinct types of PACS.
Details of terminology and acronyms can be found in the glossary in Section 4.O
1. Distributed. This where a system distributes the image data to ensure minimal loading upon
the network. Pre-fetching and Auto-routing of images, overnight, to specific workstations is
used.
2. Centralised. This is where the system (pre-) fetch’s the data from an (archive or) acquisition
device to a central hub such as a RAID. Individual workstations then pull data from the
central hub.
3. Images On Demand (e.g. EOL). This where the system stores all data on the short-term
archive (RAID) from which, the individual workstations pull images. A long-term archive such
as a DVD Archive may be used as a back up.
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A typical PACS system consists of several distinct sets of components:

Image acquisition devices. These may be digital modalities such as CT and MR or digital plain
film devices such as CR or DR.

Database server. This device holds all the patient information/demographics and details with
which the PACS locate images on the archive(s).

Web server. This device holds and distributes reported data to workstations using web browser
technology, effectively acting as a mini-database server and RAID.

Reporting (and viewing) equipment. Reporting equipment are exclusively dedicated
workstations using high-resolution monitors. Viewing equipment can be dedicated clinical
workstations or PC’s within web based solutions.

Image Archive. In their simplest forms, there are effectively two types.
1. Short/Medium-term. The most common form being a RAID where data is held on-line
for a relatively short period of time for rapid retrieval
2. Long-term/Permanent. This where data is held either near-line or off-line for
infrequent retrieval. The most common forms being DVD or DLT.
Marketplace:
The NHS’s annual non-pay spend is approximately £7 Billion and it is said that up to 2.6% of Trust
revenue is spent on IM&T with up to 20% of capital allocated to IM&T. Whilst this is not readily
quantifiable, it does demonstrate the importance of IM&T in NHS spend, of which PACS is an
important part.
The PACS market can be divided in to four distinct categories:
Film Suppliers:
Modality Manufacturers:
Agfa Gevaert
Ferrania
Fuji Film
Kodak
Konica (CR only)
G.E. Medical Systems
Philips Medical Systems
Siemens Medical Solutions
Toshiba
IT Companies:
Distributors:
Cerner
Insignia Medical
StorCOMM
TOREX
Laser Lines (I&M)
X-Ograph
NOTE
The suppliers listed above are as examples and do not constitute an “approved list”.
There are many other potential suppliers hence a full OJEU tendering exercise should
always be conducted. It is estimated that there are currently up to 187 PACS and PACS
component suppliers’ worldwide.
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Conclusion:
With the inexorable drive towards digitisation in Radiology, PACS is a rapidly expanding market.
Whilst conventional x-ray film (in particular laser) is here to stay for many years, the traditional film
suppliers see this market as their natural progression along with the modality manufacturers for
whom PACS enables them to provide a complete radiology solution. With greater standardisation of
hardware and the move away from proprietary platforms, the main discriminator between rival
products, is the system architecture and the functionality of the software. This has allowed IT
solution providers to develop PACS on industry standard hardware, further diversifying the solutions
available.
Within the UK market, PACS is mainly considered when replacing “old” conventional processing
systems, inline with EPR strategies as defined by “Information for Health” or during “new builds”.
The lack of capital funds compiled with the experiences of earlier installations has seen an increase
in the managed service approach. This not only introduces an element of “risk sharing” between the
two parties, but also allows an incremental approach to PACS with revenue savings being used to
partially fund the transition.
(Website address for info for health)
When considering PACS, NHS trusts should not only focus on the functionality of the systems, but
the whole life costs, along with expandability/upgradeability and the required changes in working
practices, in order to achieve the full benefits. In addition, connectivity with existing systems and
modalities along with a suitable network infrastructure are crucial to the success of PACS. The
move to PACS is not only a technological progression, but also a cultural change.
In order to assist Trusts with the technical aspects of PACS, the MDA has established a national
evaluation centre – PACSnet. More details on their activities can be found on their web site:
www.pacsnet.org.uk or contactable on 020 8725 3315.
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1.D
Integration and interoperability.
Integration1:
Integration can be defined as the process of enabling two or more separate information systems to
share information. Integration within PACS commonly occurs with the Radiology System (or the
Hospital Information System (HIS)/Patient Master Index (PMI) and the imaging modalities that
provide the patient image data. Hence the PACS must manage a variety of data from patient
demographics, scheduling data to patient imaging data. Integration with other systems such as
pathology presents a further set of data.
Interoperability1:
Interoperability can be defined as the ability for two or more systems to accept data from one
another and perform the requisite with no loss of functionality. This depends not only on the
physical connection but also a shared and equal understanding of the data. Most commonly there is
a level of partial interoperability where, for example; when the first system allocates a single field to
the patient name and the second has separate fields for first and surname. It would not be possible
to search on last name with certainty when moving the date from the first to second system.
Integrating Healthcare Enterprise (IHE)1:
With the drive towards digital acquisition and storage of radiology information and the vast array of
potential suppliers, integration is an essential factor in moving to a PACS. Although industry
standards such as DICOM and HL7 are established standards for data communication,
interconnectivity is a major consideration. To this end the Integrating the Healthcare Enterprise
(IHE) was formed in 1998. The IHE brings together healthcare professionals and imaging and
information system providers who work in volunteer committees under the direction of the
sponsoring bodies of IHE, Radiological Society of North America (RSNA) and the Healthcare
Information Management and Systems Society (HIMSS). The technical and planning committees
were formed in October 1998 since which they have met and conferred regularly. The IHE does not
set new standards but defines specific implementations of existing standards such as DICOM and
HL7. These become the basis of transactions between Hospital Information Systems (HIS),
Radiology Information Systems (RIS), Modality devices (CT, MRI, CR, and DDR etc), PACS,
Diagnostic workstations and Printers. The purpose of IHE is to optimise the exchange of information
between different digital systems in a hospital, thus increasing efficiency for better patient care. This
is described in a series of integration profiles, which provide a more precise definition of how the
standards are utilised.
The currently there are seven standard profiles (subsets of IHE provisions) to support radiology
information management:
1.
2.
3.
4.
5.
6.
7.
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Scheduled workflow
Patient information reconciliation
Consistent presentation of images
Presentation of grouped procedures
Access to radiology information
Key image notes
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These profiles have been profiles have been tested and implemented by more then 30 suppliers
throughout Europe and the USA.
IHE integration consists of ‘transactions’ between ‘actors’. There are currently 30 defined
transactions. Each transaction bears a unique name and number and passes specific information
between actors. PACS for example might include the following actors: image manager, image
archive, image display, report manager, report repository and the report reader.
It should be noted that the IHE only specifies the requirements for actors and transactions covering
information flows, not the function of individual products.
Purchasers can use IHE integration profiles to help organise their own integration priorities and to
better communicate their requirements to suppliers. In addition, the implementation of IHE will
eliminate the duplication of effort, cut down on the likelihood that medical data will be lost or
misplaced and reduce the time and manpower needed to move data from one place to another.
In order to provide an appropriate UK response, the British Institute of Radiology (BIR) has set up a
special group called the BIR IHE UK Implementation Group that works under the direction of the
BIR Industry Committee to produce documents and to provide feedback from the UK on the IHE
process.
The Implementation Group includes representatives from relevant professional bodies as well as
Radiologists, Radiographers, Physicists and Industrialists plus representation from the MDA – and
its evaluation centre PACSnet, PaSA and other interested parties.
More information is obtained from the BIR (Nicholas Brown – Chair of Implementation Groups, Alan
Budge – Chair of Industry Committee or Adrian Laws – Permanent BIR Secretary) on 020 7580
4085).
1
– BIR IHE Implementation Group. With special thanks to Nicholas Brown, Chair.
The PACS Broker:
To allow for efficient communication between an external information system and a PACS, it may
be necessary to use an interface engine. An interface engine is a computer system, which sits
between two (or more) information systems, and reformats the output from one system into a form
readable by the receiving system.
In a PACS implementation, this interface engine is generally referred to as a “PACS Broker” and it
typically receives information on patient demographics, examination bookings from a RIS or a HIS,
and passes this data on to the PACS following appropriate reformatting by the broker. Data can
also flow from the PACS to an external system should the external system have the ability to use
data from the PACS, for example information from an imaging modality regarding the acquisition
status of an examination. The PACS broker may maintain its own database of information derived
from information acquired from the attached devices.
Integrating other hospital information systems with a PACS has several advantages:

A single point of entry for data means consistency, and avoids duplication of effort

Access to scheduling information aids image data storage management. Information on
scheduled clinic visits or radiological examinations can be sent from the HIS or the RIS to
the PACS; the PACS can then use this knowledge on which patients will be attending the
healthcare institution to ensure that all relevant images for those patients are available in online storage in time for their attendance

Access to patient location information allows for filtered worklists. PACS can obtain
information on patient status and location from the HIS, and use this information to present
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useful worklists to radiologists and clinicians, for example a list of examinations for all
patients on a particular ward can be created.
The DICOM Gateway:
There may be occasions when imaging acquisition devices that are not DICOM-compliant will be
required to send images to a PACS – for example, following the installation of a PACS in a hospital
that has existing, non-DICOM, imaging devices that are not due for replacement.
Under these circumstances, it can be possible to acquire images from such non-DICOM compliant
devices onto the PACS by use of a “DICOM gateway.” Similar to the manner in which a PACS
broker allows information flow between a PACS and external information systems, a DICOM
gateway can allow image data to flow from imaging devices to the PACS by either converting data
or “frame-grabbing” individual images.
DICOM:
Typically, a modern imaging department will contain imaging equipment sourced from a variety of
manufacturers, and it is likely that any installed PACS will be required to accept image data from
many, if not all, of these disparate sources. Historically, transfer and interpretation of image data
acquired on one system to a second system has been problematic, since there was no commonly
agreed set of rules to define the format of the data files, what information the data should contain,
and how the data should be transported.
To help ease the problem of data transfer between different manufacturers’ systems, the DICOM
(Digital Imaging and Communications in Medicine) standard has been established. This
standard defines a set of rules, which remove many of the problems involved with the transfer of
data between different systems, and is the standard adhered to, by all the manufacturers selling
image acquisition devices and/or PACS.
Standard DICOM (DICOM 3.0) is object driven, such that each DICOM Object (e.g. an image)
contains at the same time, information (e.g. patient name, number of pixels etc) and the functions,
which this information must undergo. Processing DICOM information consists of pairing the DICOM
Object with a specific function or Service (e.g. print). The combination of Service and Object is
called a Service Object Pair (SOP). Thus, essentially;
An Image + Its Impression = a DICOM service.
The information and service parity is the basic principal of conformity to DICOM. For a unit to
conform to a SOP Class, it must be able to manage a particular type of image and carry out a
specific type of processing (Service) corresponding to the definition of this Service Class.
In addition to the SOP, the Service Class must define if the Service is used as a Service Class User
(SCU) or as a Service Class Provider (SCP)
In summary, DICOM defines Service Classes (Store, Print etc) and Object Classes (CT Images,
Worklists etc) which are combined in Service Object Pairs (SOPs) for which each device may be
one or both of Service Class User (SCU) and Service Class Provider (SCP).
WARNING
Trusts must identify the DICOM classes available on any modalities/systems that they
wish to connect to the PACS. Guidance in the form of generic questions for the
modality/system vendor are provided in Section 4.D
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In Medical Imaging:
There are three major reasons for using the DICOM 3.0 standard in medical imaging:
1.
Autonomous Image. The DICOM standard allows for each individual image (e.g. within a CT
series) to have specific information associated with it. Thus the image is autonomous, if it is
reproduced it is always possible to identify its origin, the patient, the date, the series it came
from, parameters of acquisition etc. The format is not rigid as though there are several Unique
Identifiers (UID) automatically generated by DICOM modalities, some are mandatory and others
optional. The four mandatory UID’s are:
UID
SOP Class
Study Authority
Series Authority
SOP Authority
Service Class
Storage
Query/Retrieve
Identifies a whole examination, in time and
place
Identifies a series of images within an
examination
Identifies the image associated with the file
2. Independent Format. The DICOM standard is applied at the software level thus it is
independent of the hardware and communications protocols.
3. Controlled Vocabulary. The DICOM standard ensures that from one unit to another the
vocabulary used is identical and thus identifies the data in the same way
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Section 2. Business Cases
2.A
Role of the business case.
The role of the business case is to allow the Authority (usually the trust) to objectively evaluate what
it would like to achieve and how it proposes to do so. In writing the business case, the Authority
must look at the risks and benefits involved in any particular option, to look at the “what ifs” and to
develop an appropriate management structure for the project.
It is important within any business case that there is a concise and structured source of information
upon which a “value for money” evaluation can be conducted. This must include documentation for
the analysis and decision making process.
The business case should be a “live” document, being generated well before and after approval has
been sought. The process of risk identification, evaluation and management must continue
throughout the procurement and be reflected in the business case.
Users of IMPRESS need to be aware of and use other information and guidance relevant to
procurement and the approval of business cases, namely:

local standing financial instructions and standing financial orders

current Health Service Guidelines (HSG)

current Executive Letters (EL)

current Finance Director Letters (FDL)

EC procurement rules and regulations

Capital Investment Manual (CIM)
IMPRESS is
designed to effortlessly “dove tail” with the business case process, and provide the
source of information required for final approval. The evaluation documents provide a clear audit
trail of the decision making process throughout the procurement.
A flow sheet overleaf, provides a graphical representation of the synergy between procurement and
the business case process.
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The inter-relation between IMPRESS and the business case process.
Business Plan
IM&T Strategy
Strategic
Outline
Case
(SOC)
Define strategy
Establish steering group
Planning
for the
procurement
Identify resources
Conduct initial research
Develop strategy
Seek approval of SOC
Projects IN a Controlled Environment - PRINCE
Information
Outline
Business
Case
(OBC)
Establish project team
Prepare
for the
procurement
Risk transfer
Conduct market research
Costs & benefits
Map procedures/workloads
Seek approval of OBC
Issue OJEU
advert
Information
Evaluate suppliers
Develop and issue SON
Establish
initial
requirements
ssususuppliers
Evaluate and create short list
Develop and issue DSON
Evaluate solutions
Establish
detailed
requirements
solutions
Full
Business
Case
(FBC)
Issue if value > £100,410
Evaluate and conduct visits
Short list for tender issue
Evaluate risks
Issue Tender
Documents
Changes to DSON highlighted
Formalisation of offer
Evaluate costs/benefits
costs/benefits
Evaluate tender responses
Evaluate
responses
Conduct clarifications
Draft contract
Agree contract structure
Indicative
award
Conduct connectivity testing
Seek approval of FBC/Trust board approval
Award
contract
Final approval
Sign and implementation starts
Issue award notice and debriefs
Perform the contract
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2.B
Strategic Outline Case (SOC).
As standard, SOC’s are not part of the approval process in the Department of Health (DoH). The
emphasis however is upon good practice (although some Regional Offices such as North West had
made them mandatory).
The purpose of the SOC is to provide a first view of the rationale behind the proposed project. The
SOC also:




Helps ensure that the project is initially viable before significant resources are committed
Ensures that the project has the “buy-in” of the key stakeholders
Is in line with the business plan and Local Implementation Strategy (LIS)
Considers the impact upon the wider healthcare community
The SOC must follow the recommended 5-case model:





The strategic case –The reasons for the proposed project and how it will integrate with local
and national policies and objectives
The economic case – What are the options are available along with the financial implications
and methodology for assessment.
The financial case – The affordability of the project along with levels of support available from
key stakeholders.
The commercial case – The attractiveness of the project to potential suppliers along with the
commercial availability of the required solution and options for acquiring them
The management case – The achievability of the project, can the stakeholders deliver and how
would the risks be managed.
The North West Regional Office has produced a template SOC and guidance specifically designed
for PACS projects. Details can be obtained from their website:
http://www.doh.gov.uk/nwro/pacs/index.htm
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2.C
Outline Business Case (OBC).
As with the SOC the OBC utilises the five cases model recommended for all major forms of IM&T
procurement. The OBC sets out to define the scope of the project, level of investment required and
the preferred procurement route. The OBC leads to formal and commencement of the procurement
process.
The OBC consists of 10 key elements:
1. An assessment of the market place, in particular, focusing on the technology and the ability of
suppliers to deliver the proposed solution. The reasoning behind the proposed solution must be
provided
2. An assessment of the PFI/PPP route must be made. In PACS this is more commonly evolved in
to a managed service contract.
3. The impact upon other contracts. Most commonly film contracts and maintenance contracts on
existing kit.
4. The rationale behind the proposed procurement options/strategy.
5. The model used for evaluating options/solutions and the rationale behind the evaluation criteria.
6. The type of anticipated contract along with key objectives and expected lifetime.
7. Initial assessment of risk. How this will be managed, shared and monitored.
8. Any TUPE implications of the project must be clearly identified (if relevant).
9. An outline procurement timetable with checkpoints/milestones must be included
10. And finally copies of the proposed OJEU advert.
WARNING
Trusts should not commence the procurement process before seeking OBC approval.
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2.D
Full Business Case (FBC).
The FBC follows the same format, as the OBC except greater detail is required along with firm
costs obtained from the procurement process.
Essentially the FBC contains the following additional elements:
1. A summary of the OBC along with any key changes – including rationale must be included.
2. Details of the contract form used and compliance with Treasury guidelines along with a copy of
the published OJEU advert.
3. A detailed risk register along with details of how they will be managed, with values, crossreferenced to the contract and economic risk analysis.
4. The payment mechanism methodology which forms part of the contract schedules along
performance monitoring of the contract and details of fines/methods of redress should the
contract not be performed properly.
5. Details of the bids received, evaluation methodology, reasons behind the decisions and the
basis of the selection of the preferred supplier.
Further guidance on the OBC and FBC cam be found in Section 4.A
2.E
PRINCE Methodology.
Projects In Controlled Environments (PRINCE) project management methodology(2) is
recommended for all IM&T projects and it is the recommendation of this guide that all PACS
procurements utilise the PRINCE2 project management methodology and all guidance in IMPRESS
is based upon the use of PRINCE2. Links to a copy of the PRINCE2 manual are given below.

PRINCE standards: NHSnet: http://nww.standards.nhsia.nhs.uk/prince2/index.htm
Internet: http://www.imc.exec.nhs.uk/prince2/
It is widely recognised that effective project management can greatly contribute to the success of a
project. PRINCE2 is flexible and can be used for large or small projects.
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Section 3. The Procurement
3.A
Overview of process.
At the outset of the project a steering group should be established with clear representation from all
stakeholders at the Trust and to have an identifiable board level sponsor for the project. A PACS
procurement represents a major investment. Trusts, Primary Care Trusts (PCT) and Strategic
Health Authorities (SHA) will need to consider the economic impact as well as the impact on quality
of care and delivery of service to patients. The NHS insures that these issues are addressed
through the business case process, which has three distinct stages:
Prior to the commencement of the procurement, the OBC must be completed and presented. The
OBC must include direct cost benefits – money saved on film, chemistry, processing, storage and
staffing, but also on indirect savings such as improvements on speed, efficiency, greater patient
throughput, rapid availability of images, reduction in re-takes and patient exposure. These should
however, be balanced against the costs: the costs of the system, support services, installation and
infrastructure requirement (networks etc) and the costs of additional staff such as a systems
manager etc. It is important that PACS is recognised as a CLINICAL IT procurement.
In order to drive the procurement, a project team should be established to include as a minimum;
the PACS project manager (not just restricted to Radiology), must included representation from IT,
from Purchasing (Trust supplies team), Finance and Users (Radiology, A&E, Ortho’, Cardio,
Theatre, ICU etc).
The procurement is initiated by the placement of the OJEU. The process utilised by IMPRESS is the
Negotiated procedure as PACS contracts are solution based and as such, are purchased as the
provision of services not goods.
The procurement process is essentially broken into 7 distinct stages as follows:
1.
2.
3.
4.
5.
6.
7.
Issue OJEU advert.
Draft initial requirements.
Draft detailed requirements.
Issue Tender.
Evaluate Tender.
Indicative award to preferred supplier.
Award contract
The process has been designed so that iterative short listing occurs in line with the developments of
the trusts requirements. The evaluation templates in Sections 4.F/G provide a quantative audit trail
for the evaluations as required for the FBC.
The flow sheet overleaf provides an overview of this process along with some indicative (minimum)
timescales. These can be amended to suit individual requirements (bar 37 days for the EU advert).
The IMPRESS process is designed to be flexible so that stages may be combined if required.
Guidance from PaSA should be sought before amending any of the stages in
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Image Management PRocurEEment SyS
Stem (IMPRESS)
1. OJEU advert issued
- (If anticipated contract
value > EU threshold of
£100,410 exc. VAT)
1. 2.
Trust drafts initial
requirements
- Initial Statement of
Need (SON)
4.
5. 3.
Services Directive – Negotiated Procedure utilised
Information
Up to
Allow at least 37 days for expressions of interest
6
weeks
Initial vetting of suppliers based on criteria within advert
Suppliers invited to present solutions based upon SON
Evaluate
Up to
Trust evaluate solutions and conduct initial short listing
Suppliers
8
weeks
Trust commences site visits
DSON issued to suppliers with 4/5 weeks for a response
Trust drafts detailed
requirements
Trust evaluates responses on clinical/commercial areas
Evaluate
Up to
This stage may be repeated if project is unachievable
Solutions
- Detailed Statement of
Need (DSON)
15
weeks
Trust completes site visits and short lists for tender
6.
Initial contract negotiations may commence
2.
3. 4.
Changes to DSON to be clearly highlighted in tender
Trust issues Tender
Documentation
Up to
Evaluate
Allow up to 3 weeks for response
Risks
Tender is formalisation of the offer
Evaluate
5.
Trust evaluates
responses
3
weeks
On technical and clinical grounds
Up to
Costs &
On commercial grounds
6
weeks
Benefits
Conduct any post tender clarifications
Agree schedules to contract
6. Trust indicatively
awards to preferred
supplier
Up to
Draft
Agree method of funding and board approval
Contract
10
weeks
Supplier conducts interconnectivity testing
FBC and Trust Board Approval
Contract signed
Up to
7.Contract
Trust awards
Implementation begins
contract to supplier
Signed
7
weeks
Issues award notice and conducts debriefs within 48
days
Procurement conducted in a PRINCE environment.
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3.B
Placing the OJEU advert.
The procurement is initiated by the placement of the OJEU advert. This placed under the
Negotiated Procedure due to the solution based nature of PACS contracts. An advert must be
placed if the anticipated total contract value is to exceed £100.410.00 excluding VAT. The value of
PACS contracts can reach several million hence, and advert must always be placed.
Upon placement of the advert, the trust must allow 37 days for potential suppliers to respond. At
this stage suppliers should be short listed upon the criteria stated in the advert. A template advert
can be found in section 4.B. Alternatively this can be done on your behalf by PaSA.
Potential suppliers are short listed on their ability to perform the contract based on previous
experience and financial ability and on Probity - whether they have paid their taxes and are not
subject to prosecution or in the process of being declared bankrupt. More detail can be found in the
Services Directive in Section 4.C
PaSA has conducted initial vetting of the major UK PACS suppliers (based on the template advert
criteria) however, if trusts issue their own EU adverts, they must conduct their own vetting at
present.
Suppliers who are not included must be provided with a debrief, which good practice dictates be
provided within 15 days of being requested.
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3.C
Outline requirements – SON and short-listing.
Whilst the advert is being issued the project team should start to prepare the initial Statement of
Need (SON). The SON provides both suppliers with the basic background and information on the
Trusts anticipated requirements and will be based on the work done in preparing the SOC and
OBC. A template SON is included in Section 4.E.
The SON will include details on the Trust infrastructure, objectives of the project, and linkage with
other strategies such as EPR, the LIS. The trust may either specify a particular approach or allow
suppliers to present their own solutions. Either way, it must be made clear to suppliers which
approach is required. In addition, the SON must state the DICOM status of current equipment to be
connected to the PACS. To assist trusts in establishing DICOM status, some generic DICOM
wording has been developed and included in Section 4.D. Within the template example questions
are highlighted in red and these along with the tables should be amended to suit the trusts
individual requirements.
This can be used not only for the purchase of new equipment but to establish the DICOM status of
current equipment.
Once the SON is completed and the advert has closed, it should be issued to vetted suppliers.
Presentations should be arranged for the project team. The vetted suppliers will be expected to
present their initial solutions based upon the trusts SON and it is at this stage that the Trust will
conclude it’s first stage of short listing. A site contact must be provided to allow suppliers to conduct
site visits prior to the presentations
The presentations should be used to build trusts knowledge of the products available, the viability of
their requirements and the ability of suppliers to meet them. To assist trusts a template evaluation
sheet has been included in Section 4.F. These have generic heading for areas to be assessed
along with a scoring and weighting.
Although generic headings have been included in the templates, the questions within these
headings should be adapted to the trusts specific requirements.
It is essential that prior to the presentations the project team agree the weighting for each section of
the PES along with any specific questions. This should then be provided to the suppliers, along with
a list of attendees, prior to the presentations so that to their presentations are tailored accordingly.
Although the Trust may commence site visits, it is advised that these are conducted after short
listing so that only viable suppliers are visited. The presentations should be evaluated on technical,
clinical and financial elements.
Weighting in the range 1 – 5 (with 5 being the highest importance) has been highlighted for each
question which will be scored
Responses for each weighted question will be scored in the range 1 – 6 in the following format:
6 = Excellent
5 = Very Good
4 = Good
3 = Satisfactory
2 = Poor
1 = Very Poor
0 = No Response/Incorrect Response
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The score sheets should be completed by each member of the project team (for their relevant area)
and a team average of scores per question (per supplier) be formed. This should be conducted for
each supplier and based on the day unless the team specifically requests follow up information.
However, this should not be necessary, as suppliers will be provided with the criteria/evaluation
questions beforehand. The trust should allow at least 4 clear weeks between issuing the SON and
template score sheets and the presentations to allow suppliers to adequately ascertain the trusts
requirements.
WARNING
The trust should ensure that appropriate members of the project team and clinical staff
are present at the presentations. Should there be a significant number of absentees. The
trust should cancel and reschedule the presentation.
Based on the presentation scores, it is suggested that between 3 and 5 suppliers be short-listed. All
suppliers must now be provided with their individual (team) score sheet. For those that failed to be
short listed, this provides part of their debrief process. It also provides an audit trail for the
evaluation process; the trust must be prepared to justify their decisions and scores.
The trust should now commence site (evaluation) visits. These may be conducted before hand, but
the trust may wish to only visit short listed suppliers commence. Details of these visits should be
evaluated and an evaluation template is proved in Section 4.G.
The template SVES contains generic headings but as with the PES these should be amended in
line with the trusts individual requirements. Prior to the commencement of visits, it is essential that
the project team meet and agree the weighting of each section of the SVES along with any specific
questions to be asked. This information should be provided to the supplier (except the weightings –
which will, evolve) prior to arranging visits to ensure that key members of the project team evaluate
viable sites. At least two weeks notice must be provided to ensure key personnel are available at
the site. Informal visits should also be conducted to corroborate findings.
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3.D
Detailed requirements – DSON and short-listing
In addition to the site visits, the SON should be developed into the detailed statement of need
(DSON) based on the knowledge update acquired by the Trust. The DSON builds upon the SON by
updating requirements, focusing on working practices and the expected outcomes of the solution
(output based specification) and a more detailed cost breakdown and exploration of financial
models such as, managed services.
Within Section 4.H a template a template DSON has been provided. The individual questions
included within section 14 of DSON should be amended and weighted in accordance to the Trusts
requirements.
As with the template SON, example questions are highlighted in red and should be amended to suit
the Trusts individual requirements. The format of the questions in section 14 of he DSON should
not be changed. Any sub-questions, which are not relevant, should be left blank, not removed, to
preserve the order and any additional sub-questions to be added at the end of the standard
questions.
NOTE
Both the PES and SVES, in addition to the SON and DSON provide a clear audit trail of the
decision making process and should be fully completed. In addition, when using email for
the transmission of commercially sensitive information, compliance with the appropriate
trust guidelines should be ensured.
Prior to issue, the project team must agree the weighting of each sub-question. Details on a
suggested scoring and weighting system are found at the beginning of section 14 of the DSON. The
DSON should then be issued to the short listed suppliers for a formal response within four to five
weeks in electronic format (CD-ROM). The responses should be scored and used in conjunction
with the SVES. It is suggested that a 3:1 split be applied between the weight of the DSON scores
and the SVES scores. This process should provide a short-list of no more than three suppliers,
which are to be issued tenders. The project team must specify the format (e.g. Word 2000) that the
response must be returned in.
All suppliers must now be provided with their individual (team) score sheets for the site visits and
the DSON. For those that failed to be short listed, this provides part of their debrief process. It also
provides an audit trail for the evaluation process; the trust must be prepared to justify their decisions
and scores.
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3.E
Tender.
Following the DSON responses the Trust not only short lists but also has the opportunity to re-visit
the viability of the project on both technical/clinical and commercial grounds. It is likely that the trust
will make amendments and these should be clearly highlighted in Document 5 of the tender. A
template tender is provided in Section 4.I.
The short listed suppliers from the previous stage (1 – 3 suppliers) should now be issued the tender
which includes the terms and conditions and schedules to contract along with any amendment to
the DSON following clarifications. Standard terms and conditions are provided in Section 4.J.
The tender is essentially the formalisation of the offer(s) for which up to three weeks should be
allowed (depending on extent of changes to DSON) for the suppliers to respond.
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3.F
Evaluate tender responses.
The tender responses should consist of one hardcopy and a copy on CD-ROM. Suppliers must
complete their responses in the format provided. Any deviations may be construed as noncompliance and render the submission inadmissible.
The offers must be evaluated on the basis of technical, clinical and financial grounds (the majority
of the work will have been done through the preceding stages). Any clarification work must be
conducted before short listing and must be applied equally to all the suppliers. Particular attention
must be paid to the contract schedules in Document 4 of the tender, as these will form the basis of
the contract. NHS PaSA can conduct the commercial summary and provide benchmarking against
previous projects
This will allow the identification of the preferred supplier.
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3.G
Indicative award to preferred supplier.
Once the post tender/contract clarifications have been completed the trust should identify a
preferred supplier with which it should now complete contract negotiations. Whilst it is
recommended that there be only one preferred supplier, the trust may include more if it wishes.
However if contract negotiations are unsuccessful, the trust may reserve the right to return to one of
the other tendered suppliers
Detailed guidance on the drafting of the contract are given in Section 4.K.
Key areas, which must have been addressed by the contract negotiations stage, are:












Maintenance levels/support services
Project management/implementation and timetable (including milestones and controls)
Methods of redress should the system not perform to agreed levels (including persistent failure)
Change control
Disaster recovery
Exit plans/step-in rights
Working practices (particularly when partially funding with film revenue savings)
Expansion of the system in line with future workloads
Upgradeability and “openness” of the system
Cost and payment/financial model
Interfacing requirements/capabilities
Responsibilities of both parties in performing the contract
Connectivity testing and confirmation of DICOM status along with interface requirements (including
costs) must be conformed. The trust should facilitate a tripartite meeting between the RIS (for
example) and PACS supplier before submitting the FBC and seeking Trust Board approval for the
contract.
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3.H
Award the contract.
Once the FBC has been approved and Trust Board approval gained, the contract can be signed
and the purchase order raised. Delivery and implementation can occur in-line with the project
timetable.
Once the contract has been awarded, implementation of the PACS can begin. The project timetable
should have divided the implementation into stages (milestones), with dates set for the completion
of each stage. This allows the project to be broken down into manageable parts, and helps keep
track of progress on the project. It also allows for payment to be made to the vendor at the
completion of each milestone.
Consideration of the infrastructure required for the PACS must occur before the implementation
starts. The various image acquisition devices can have particular room requirements, as can the
reporting rooms where PACS reporting workstations are to be sited, and the more general areas
where the clinical workstations will be situated. Printers and digitisers will all require space, together
with power supplies and network connections. The computer room housing the main PACS servers
and image data archive will have special requirements regarding ambient temperature and humidity
and access control (the room should be easily accessible to the PACS technical support staff, e.g.
the system manager, but should be locked so that unauthorised staff cannot gain access). Detailed
information on PACS infrastructure requirements is available from the NHS Estates Agency
(insert contact details – website, telephone, address etc).
The contract should include an agreement on system availability. This should define the allowed
downtime (both scheduled and unplanned) for the entire system and for individual components. The
contract should also note the requirements for the speed of delivery of images from PACS storage
to display, together with a note of how this speed of delivery is to be tested.
The acceptance testing agreed at the beginning of the contract should be performed immediately
on delivery of the system (or on any part of the system that can stand alone, particularly if this forms
an implementation milestone). Acceptance testing should ensure both that the deliverable conforms
to specification, as defined in the contract, and that the equipment functions satisfactorily under
conditions of routine clinical use. Clinical acceptance may take several weeks; payment for each
stage of the contract should be deferred until clinical acceptance has been agreed.
Implementation of a PACS can cover an entire imaging department (or trust), or can start with
single modalities or clinical areas. A phased introduction of PACS has advantages. The
implementation process can pause at any point, to allow for re-evaluation and adjustment of future
plans in the light of lessons learnt from earlier phases; this approach also allows for advances in
technology to be incorporated into later stages of a PACS implementation project.
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3.I
Post award.
A common pitfall of procurement projects is to assume that the procurement team can be
disbanded once the contract is signed. This sometimes leaves insufficient authority resources to
accept the contract, and more often ignores the need for ongoing resources to manage the contract
– a function that is typically more complex under a managed service-based contract. For this
reason, the planning work should give some thought to the nature of the transition of authority staff
from procurement activities into normal operational running, and the organisation structures that will
be needed at that time. Full time staff to manage large contracts should be considered.
A PACS is a technically complex system, and its management is a specialist task. A PACS systems
manager will be required and be separate from the contract manager. Further support should also
be in place for the system and its components (e.g. networking, storage, workstations, etc), and this
may come from hospital IT staff, the PACS vendor, or from additional staff within the radiology
department.
Quality Assurance of the various components of a PACS system is also a specialist task, and this
work is likely to fall upon hospital scientific support staff, most probably a Medical Physicist. Quality
control and quality assurance tasks that will require scientific support include QA and QC of display
monitors, and, if appropriate, film digitisers and film printers.
Other new tasks that will appear with a PACS include system administration tasks – maintenance of
error logs, management of system user accounts, tidying of databases – and diagnosis of system
faults – investigating any failed communications from the PACS to external systems, and diagnosis
and repair of failed image transfers from an acquisition modality to PACS.
Staff training is crucial to the success of a PACS project, and all staff requiring training should have
an appropriate amount of time allocated as part of their normal working hours for training. Training
should not occur too far ahead of use of the new system, since this can lead to staff forgetting what
they have learnt, and in some cases a delay can lead to disillusionment concerning the new
system. Staff can be trained in a number of ways: direct teaching from a full-time trainer; teaching
from a fellow staff member who will have been assigned to some training duties; or training by
example during the working day.
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3.J
Risk guide.
Risks should be identified and assessed at the very beginning of the procurement. The actual
quantification of risks and the probabilities that they may occur is, to a certain extent, a subjective
process. A quantified risk analysis will therefore be based on a series of assumptions that should
be justified. For each key risk in a project, the following needs to be assessed:

Impact – the assessed value of a risk occurring;

Likelihood – the probability of a risk occurring; and

Period – the timescale over which risk may occur.
The value of a particular risk is the impact multiplied by the likelihood, over the defined timescale,
shown in net present value terms. The final decision on the value for money of a particular option
will be on the basis of risk adjusted net present values.
It is also valid to make an assessment of the non-quantifiable risks associated with any project.
This should be done alongside the quantifiable risks in the form of a weighting and scoring matrix.
The contract structure and in particular the payment mechanism are the key vehicles by which risks
are transferred. Both of these should be summarised in the FBC and this should demonstrate how
risks are transferred.
The assessed impact of risk occurring should take into account any direct financial effects as well
as indirect effects such as the cost of benefits foregone before corrective action is taken. Any
effects of a risk, which occurs having on other risks should also, be taken into account
A risk management strategy should be drawn up for risks retained by the NHS organisation. This
should show how the NHS organisation plans to minimise risk and what action will be taken if
problems occur.
The final contract will detail the risk transfer that has taken place via the procurement. By a series of
contractual obligations the contractor will have taken responsibility for managing many of the risks
that were uncovered at the start of the procurement. There will also be a series of remedies
available to the purchasing organisation in the event of the contractor’s non-performance of his
obligations. The contract should also detail those risks that the purchasing organisation retains
responsibility. These should be drawn from the “risk register”
The risk register:
The risk register is a means of tracking risk throughout the life of the procurement. Risk register
pages are opened for each potential supplier in the procurement, and these are updated as more
information is discovered during the procurement process.
The first information contained in the risk register will come from the outline business case and will
be those risks associated with awarding the contract to any supplier. This will mean that in the very
early stages the risk register will be similar for each of the suppliers. As more information is learnt
during the procurement each suppliers Risk register will begin to fill up with the individual risks that
are peculiar to its own bid.
As well as being a vehicle to record risks the risk register should also be a focus for tracking how
those risks were resolved. Within the risk register each risk should be given an owner within the
NHS project team who will be responsible, as far as they are able, for ensuring that the risk is
resolved. This might be that it is transferred to the contractor, and that there is a binding contractual
commitment that enforces this, or that there is an acceptance within the senior management of the
purchasing organisation that the risk is one that it must continue to own and manage.
Each risk in the risk register will be given a category of high, medium or low, depending on the
probability of it occurring and of the potential impact of any occurrence. This will also guide the risk
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owner to the relative importance of resolving each risk. The categories associated with a risk may
change during the procurement as action is taken that partially or fully resolves it. When this
happens a new version of the Risk Register should be prepared.
The risk register pages that relate to a supplier should be shared with that supplier. This will allow
them to propose solutions that resolve a particular risk.
Types of risk:
Although the risks associated with any contract will be peculiar to that project, there are a range of
generic risks that should always be assessed:

Performance risks – These risks relating to the performance of the system and can cover things
like response times, capacity infrastructure

Availability risks – These are risks such as completion delays or the risk that system
components are not available

Functionality risks – This is the risk of system or components not meeting performance
requirements hence reducing functionality of the system and the potential “knock-on” effects

Cost overruns – That the costs of the project may overrun

User issues – Can include the risks that users will not use the system properly or that in a mixed
solution the conventional may be seen as easier to use

Obsolescence – This is the risk that new technology will become obsolete or that the supplier
will discontinue support and development

Integration issues – This covers the risk of components/systems not integrating properly

Ownership – The costs of maintenance or depreciation (transfer of title)

Expected benefits are not achieved – This covers risks such as not releasing cash or achieving
expected savings (i.e. film reduction) or staff redistribution

Needs identification – This can be the risks of mis-specifying or incorrect evaluations or risk
analysis. It can also refer to suppliers mis-interpreting needs or supplying overly ambitious
solutions
More detailed guidance can be found in the business case guidance in Section 4.A.
For more details please contact:
Tahir Malik, NHS Purchasing and Supply Agency
Tel:
Fax:
Mobile:
Email:
01244 586769
01244 586827
07899 994571
tahir.malik@pasa.nhs.uk or tahir.malik@doh.gsi.gov.uk
Web:
NHSnet:
www.pasa.doh.gov.uk
nww.pasa.nhs.uk
Or the team at PACSnet. More details on their activities can be found on their web site:
www.pacsnet.org.uk or contactable on 020 8725 3315.
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Frequently asked questions (FAQ).
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