Post on 17-Dec-2015
Project MethodologyWe support a full spectrum of project activities.
Plan Plan Architect Architect Integrate Integrate Optimize Optimize
• Requirements: Technical, Functional, Integration, & Process
• Clinical Scenarios
• Technology Selection and System Design
• Vendor Contracting
• Readiness Assessment
• Strategic Benefits
• Total Value Calculation / Financial Planning
• Executive Education
• Budget Approval
• Implementation Planning
• Implementation and Integration
• Process Improvement Baseline
• Administration
• Maintenance
• Reinvestment
• Process Improvement Measurement
OptimizeOptimizeRedesignRedesign
Planning
Image volumes: Priorities based on image volumes and users who need access
to them
Operational readiness: Experience with and willingness to use digital images
Support staff readiness: Dedicated resources in the imaging departments and in Information Services
Clinical systems readiness: Common patient and study indexing schemes and interfaces between the clinical information systems and the enterprise imaging system
Equipment readiness: Standard configurations and adequate space for all components
Network readiness: Adequate bandwidth, redundancy, security and performance
PlanPlan ArchitectArchitect IntegrateIntegrate OperateOperate
Step 1. Assessment and Financial Planning Step 1. Assessment and Financial Planning
Link to Strategic DirectionProject Objectives
Strategic DirectionClinical Quality
Enable
Growth
Service Excellence
Physician
Partnership
Community Service
Employer
Of
Choice
Improve Patient Care and Satisfaction
Efficiently Read Multi-Image and Serial Studies
Increase Involvement in the Care Delivery Process
Eliminate Unread Studies
Reduce Lost and Misplaced Films
Improve Report Turnaround Time
Provide Concurrent Access to Diverse Image Information
Easily Find Any Image, Anywhere Throughout the Healthcare System
Improve Physician Satisfaction
Integrated with EHR
Reduce Operational Costs
PlanPlan
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.
Integrate with Overall IT Plan
PlanPlan
System Readiness PlanningFocus Area Planning Steps
Executive Leadership Committed to a structured approach: e.g. enterprise-wide planning, multi-year investment, policy that no departments can opt out.
Physician Acceptance
Physician project champions working with site coordinators who help educate the physician community on the benefits of PACS.
Enterprise Connectivity
Network enhancements are budgeted to provide an enhanced, reliable network and storage.
Clinical Integration Integration plans and system acceptance testing procedures.
Data Confidentiality Systems planning for user log-ins and passwords integrated with the EHR.
Technology Obsolescence
Contractually bind the vendor to upgrade PACS hardware and software - purchase workstation, network and storage separately from existing vendors
System Implementation
Have a dedicated project management and train PACS administrator's.
PlanPlan
Identify Success & Risk FactorsFactor Risk Level Steps
Executive Leadership Sustained commitment to a structured and disciplined approach against plan: program management, funding, purchasing, operating procedures. No departments opt out.
Physician Acceptance Identify a physician project champions and site coordinators who will help educate the physician community on the benefits.
Enterprise Connectivity Incremental network enhancements are budgeted to provide an enhanced, reliable network and storage.
Clinical Integration Have a solid contract with the vendor for system acceptance; bind system acceptance to final payment.
Data Confidentiality Enterprise systems support user log-ins and passwords and may be integrated with the EMR.
Technology Obsolescence
Contractually bind the vendor to upgrade hardware and software to keep the system current. Purchase workstation, network and storage separately for your existing vendors.
System Implementation
Have dedicated project management to deliver a successful implementation.
Medium
Low High
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Medium
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Low High
Medium
Low High
Medium
Low High
Medium
Low High
PlanPlan
Implementation Phase and Activities
Phase 0 - Pre-Implementation MA
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PACS PlanningPACS Internal Marketing and Approval ProcessVendor SelectionContract NegotiationsImplementation Planning
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Network Improvements and UpgradesBuild/Implement HIS/RIS InterfacesImplement Back-Office EquipmentBegin Acquiring/Archiving Images from all Modalities
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PACS trainingImplement Diagnostic Workstations in all Reading AreasPACS TrainingImplement Clinical Review Stations in ED & Critical Care AreasPACS trainingImplement Enterprise-wide Web Image Access on hospital campus
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Implement Enterprise-wide Web Image Access to remaining remote sites and physician offices/homesPACS trainingExpand PACS services to ORs
Hospital USA PACS Implementation Roadmap2003 2004 2005
Phase 1 - Implement PACS Infrastructure and Digital Modalities
2002 2003 2004
Phase 2 - Implement PACS Review Stations
2002 2003 2004
Phase 3 - Expand Web Image Access
2002 2003 2004
Establish High-Level Implementation Plan
PlanPlan
Calculate Financial Impact
PlanPlan
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
Sample-PACS Financial Model
PlanPlan
Radiology PACS Summary Costs
PACS Component Baptist LR Baptist NLR ArkadelphiaHeber
Springs MRI OP LR MT1 OP OP NLR TOTAL
PACS Workstations 858,000$ 177,000$ 90,000$ 90,000$ 130,000$ 65,000$ 130,000$ 1,540,000$ PACS Core/Back Office 1,590,000 539,000 189,000 189,000 135,000 27,000 27,000 2,696,000 Computed Radiography 1,080,000 540,000 428,000 428,000 - - - 2,476,000 Radiology Information System 1,456,000 1,456,000 DICOM Upgrades 40,000 80,000 60,000 100,000 - - - 280,000 Network Upgrades 488,000 116,000 33,000 33,000 28,000 15,000 29,000 742,000 Data Center Renovations 50,000 50,000 Radiology Renovations 200,000 200,000 Third Party Services 429,000 107,000 536,000
TOTAL CAPITAL (10% disc) 6,191,000$ 1,559,000$ 800,000$ 840,000$ 293,000$ 107,000$ 186,000$ 9,976,000$
Potential Add'l PACS Disc (15%) (529,200) (188,400) (106,050) (106,050) (39,750) (13,800) (23,550) (1,006,800) TOTAL CAPITAL (Discounted) 5,661,800$ 1,370,600$ 693,950$ 733,950$ 253,250$ 93,200$ 162,450$ 8,969,200$
PACS Reinvestment (15% every 3 yrs, thru 2013 ) 1,101,600$ 322,200$ 125,550$ 125,550$ 119,250$ 41,400$ 70,650$ 1,906,200$ TOTAL CAPITAL INVESTMENT THROUGH 2013 10,875,400$
Possible Operating Expense Reductions & Avoidance (cumulative thru 2013) (21,768,269)$ Incremental Operating Expenses (cumulative thru 2013) 11,071,339$
(10,696,930)$
Baptist Health FacilityHealth System USA
Hospital A Hospital B Hospital C Hospital D OPC 1 OPC 2 OPC 3
Radiology PACS Summary Costs
PACS Component Baptist LR Baptist NLR ArkadelphiaHeber
Springs MRI OP LR MT1 OP OP NLR TOTAL
PACS Workstations 858,000$ 177,000$ 90,000$ 90,000$ 130,000$ 65,000$ 130,000$ 1,540,000$ PACS Core/Back Office 1,590,000 539,000 189,000 189,000 135,000 27,000 27,000 2,696,000 Computed Radiography 1,080,000 540,000 428,000 428,000 - - - 2,476,000 Radiology Information System 1,456,000 1,456,000 DICOM Upgrades 40,000 80,000 60,000 100,000 - - - 280,000 Network Upgrades 488,000 116,000 33,000 33,000 28,000 15,000 29,000 742,000 Data Center Renovations 50,000 50,000 Radiology Renovations 200,000 200,000 Third Party Services 429,000 107,000 536,000
TOTAL CAPITAL (10% disc) 6,191,000$ 1,559,000$ 800,000$ 840,000$ 293,000$ 107,000$ 186,000$ 9,976,000$
Potential Add'l PACS Disc (15%) (529,200) (188,400) (106,050) (106,050) (39,750) (13,800) (23,550) (1,006,800) TOTAL CAPITAL (Discounted) 5,661,800$ 1,370,600$ 693,950$ 733,950$ 253,250$ 93,200$ 162,450$ 8,969,200$
PACS Reinvestment (15% every 3 yrs, thru 2013 ) 1,101,600$ 322,200$ 125,550$ 125,550$ 119,250$ 41,400$ 70,650$ 1,906,200$ TOTAL CAPITAL INVESTMENT THROUGH 2013 10,875,400$
Possible Operating Expense Reductions & Avoidance (cumulative thru 2013) (21,768,269)$ Incremental Operating Expenses (cumulative thru 2013) 11,071,339$
(10,696,930)$
Baptist Health FacilityHealth System USA
Hospital A Hospital B Hospital C Hospital D OPC 1 OPC 2 OPC 3
Health System USA
Hospital A Hospital B Hospital C Hospital D OPC 1 OPC 2 OPC 3
Step 2. Architect: Vendor SelectionStep 2. Architect: Vendor Selection
Architect the Solution
Technical, Functional, & Process Requirements:
Priorities based on diagnostic, clinical, and technical needs of the organization
Clinical Scenarios: Developed to demonstrate DI capabilities and evaluate vendors ability to deliver functionality and workflow improvements
System Design: Based on Vision & Guiding Principles, Requirements, Standards, Technology,
Vendor Selection: Selection approach aligned with organizations goals & objectives
Contract Negotiation: Standard configurations and adequate space for all components
PlanPlan ArchitectArchitect IntegrateIntegrate OperateOperate
Determine PrioritiesArchitectArchitect
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Angiography CT C-Arm Computed Radiography Diagnostic (X-ray) Digital Radiography Fluoro MRI Mammo Nuclear Medicine PET Tomo Ultrasound Cardiac Catheterization Echo/Doppler EEG EKG Fetal Heart Monitoring Holter TEE
Image Viewers
OtherClinical Specialties
Ima
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Image Intensivists
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Selection - Sample Goals & Objectives
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
ArchitectArchitect
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
MPI
ADT
RIS
PACS
Modality
Display
HIS*Integrated Healthcare Enterprise
ArchitectArchitect
Example: Selection Criteria
References RFP Response Clinical Visit Visit Evaluation
Functionality
Technology
Criteria Weight Definition
Cost
Experience
Integration Vision
Source
RFP Response Clinical Site Visit
Evaluation
References RFP Response Clinical Site Visit Evaluation
RFP Response Vendor - Cost Benefit
Models (RFP)
RFP Response Demonstration
Functionality Coverage Detailed Scenario Ratings Overall Scenario Ratings Application Maturity
Alignment with Vision Shared integration approach Vendor track record, IHE, CCOW
Customer Service Implementation Depth, Methods R&D Expenditures Annual Contracts
Preliminary Cost Models Implementation /Benefit Timing Cost of Ownership
Technology Assessment, Ownership Cost of Ownership Technology Risk Assessment Number/ Complexity of Integration
25%
15%
15%
15%
30%
ArchitectArchitect
Example: Workflow Enablement
Guarantee Requirements
Proof of Concept Approach Vendor X Vendor Y Comments
Image Acquisition PerformanceTime First Image is acquired to first image read (lossless display) demonstration/site visits Need to conduct measurements
Review Workstation UsabilityDesktop Defaults configurable by user demonstration/site visits Need usability feedback
Defaults include, applications accessibility, User defined hanging protocols
demonstration/site visits Need usability feedback
Global Worklist and image Availability demonstration/site visits Images and past reports were easier to access on Vendor X
Key Filmless Workflow Cath Lab demonstration/site visits Referring demonstration/site visits
Vendor X 3D package does not allow for integration with 3rd party SW
ER/Trauma demonstration/site visits
Need templating software from 3rd party vendor Measurement tools better on Vendor Y
Cross Domain Complex Study site visits
Does not identify if images are on film only
Fault ToleranceNo single point of failure design review
Vendor X is a SW only approach Vendor Y provides true disaster recovery
Continuous operation in degraded mode design review
Site Integration ExpectationsRapid Deployment Capable site screen Multiple Imaging Sites site visits
RIS/CVIS IntegrationIntegration w/ADT,ORM,ORU demonstration/site visits Patient Care Inquiry demonstration/site visits
Modality Integration & SupportDICOM C-STORE, SC, MWL, PPS site visits
Vendor X will not be ready until future release
Integration Experience with modality vendors site visits Expedient Process to resolve integration issues process review Need process review
Proof of Concept Scorecard
ArchitectArchitect
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.
ArchitectArchitect
Technology Selection Process
ProjectInitiation
ProjectInitiation
Organize Selection
Teams
Organize Selection
Teams
Prepare and Distribute
RFP
Prepare and Distribute
RFP
RequirementsSession
RequirementsSession
Develop Requirements
Workflow Analysis
Develop Requirements
Workflow Analysis
Assess Against Current Vendors; Identify Benefits
Assess Against Current Vendors; Identify Benefits
PrepareScripted
Scenarios
PrepareScripted
Scenarios
Analyze VendorResponses
Analyze VendorResponsesVendor
Responses
VendorResponses
Conduct VendorDemos
Conduct VendorDemos
ConductReference
Calls
ConductReference
Calls
RecommendVendor(s)Of Choice
RecommendVendor(s)Of Choice
ExecutivePresentation and Approval
ExecutivePresentation and ApprovalFinal Approval
Final Approval
Down Select to 2 Vendors
Down Select to 2 Vendors
ArchitectArchitect
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
Using Standards in Selection
*Integrated Healthcare Enterprise
ArchitectArchitect
Prenuptials for Partnerships 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
ArchitectArchitect
Integrate
PlanPlan ArchitectArchitect IntegrateIntegrate OperateOperate
Pre-Implementation Planning:
Detailed Program Plan built to align all resources and steps necessary for successful implementation
Process Improvement: Further define specific DI transformation objectives, establish baselines metrics
Implementation Management: Establish DI Program Manager, team, tools and processes
Organization Training: Develop and conduct training based on system functionality and transformation objectives and processes
Implementation & Integration: Implement and integrate according to Program Plan
Step 3: Integration & ImplementationStep 3: Integration & Implementation
Improvement Example
Patient arrives
Films are printed
Trauma team ispaged
Exam is performed
Tech hangs theimages on ER
rotator
Wet readperformed by ER
clinician
Radiologistoverreads or readsthe stat images (if
necessary)
ER enters order inTDS with a stat
note
ER Workflow
Receptionistarrives patient
Patient informationfrom TDS is
printed out andgiven to radiology
TDS printsrequisition with
patient information
Technologistcompletes order
on Maxifile
Trauma No
Yes Exam is performedRadiologist reads
examClinical decision
rendered
Paperwork printedand given to tech Tech allocated to
patient
Tech gets patientX-ray cassette
taken to ERprocessor
File room stripsthe rotator - every
2 hours
Films filed in thefile room
Priors requested Contact file roomER process
continues withoutfilms
Film on site
Yes
No
SimultaneousProcess
Dispatch tech toread film
Patient checked outof ER - noted on
ER board
Tech takes patient back to ER - patient checked
back in on board
(Before 5 pmONLY)
Tech brings filmback to radiology to
be read
(Before 5 pm ONLY)Radiologist reads film
Note - Highlighted areas can be eliminated with PACS
"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
IntegrateIntegrate
Resource Optimization
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10%
20%
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Transform Implement Operate (Six Months)
Facilities
Administration
Consultant
Modality Vendor 2
Modality Vendor 1
PACS Vendor
IT Department
Rad/Card Departments
Rad/Card Groups
IntegrateIntegrate
Project Timeline
Implement, Operate, Optimize
Board Approval for
PACS
PACS Training Kickoff
Softcopy ReadingPACS
Subnetwork“Live”
Interface Design
Modality Integration
ArchiveInstalled
Database Preparation GO LIVE
Acceptance Test Complete
RFI Released
Negotiations
PACS RFP Released
CR Workshop
Contract/Re-quote Released
PACSVendor
Selected
Site Visits and Reference Checks
DI Architecture,Selection
Contract Complete
Workflow Redesign
Network Preparation
Facilities Preparation
ImplementationTeam Resource
Checkpoint
Pre-Implementation
Planning
“GO”
Web Distribution
IntegrateIntegrate
PACS Planning
FCG Engaged Network
Assessment
StaffInterviews
Modality/DICOM
Assessment
Current EnvironmentAssessment
12 - 16 Months
DI Transformation – Operate
Operations: Daily diagnostic and clinical operations
Maintenance & Administration:
System performance, capacity, availability, vendor support, system administration
Process Improvement: Measure performance improvements against baseline and DI Transformation objectives; further refine processes to gain additional benefit from DI Transformation
Reinvestment: Plan for and reinvest in DI systems and architecture as appropriate
PlanPlan ArchitectArchitect IntegrateIntegrate OperateOperate
Step 4. Operate: Transform & OperateStep 4. Operate: Transform & Operate