Do You Really Need Service?

Ms. PACS: From the imaging centers to the radiology groups to the hospitals, money is tight (although I’m not sure how much the healthcare insurance providers are feeling it). Wherever you go these days, people are trying to find a way to save a buck. I bet even the PACSman has considered riding his bike to the store rather than throwing more money at America’s most expensive commodity – gas (technically crude oil). The PACSman may even opt to cut his losses and take a cheap date out on Fridays.

But there are some things you don’t cut corners on and that is PACS service. I realize imaging centers in particular, hit hard by DRA reductions in imaging reimbursements, are looking for ways to stretch their shrinking budgets. But to suggest a radiology group would be better off without IT service is like buying a new car and never getting a tune up. Eventually, you’re not going anywhere.

Like all technology, PACS breaks down, and when it does there better be a hotline where you can call the PACS guy or gal to fix it. No one knows this better than the radiologist trying to get through a cycle when suddenly his PACS freezes up.

This especially makes sense when PACS downtime translates into dollar and cents. And no one knows that better than IT administrators. In the 19th Annual 2008 HIMSS Leadership Survey IT (which included 317 healthcare IT workers), 26% of respondents cited “a lack of budget as the most significant barrier to successfully implementing IT at their organization.” Despite this, they said spending due to growth in the number of systems and technologies would increase throughout 2008, as would the number of FTEs in the IT departments. Obviously they are not all working on PACS – lets hope not – but the point is that even those most affected by the crunch are not going cheap on IT – and that includes PACS.

PACSman: I agree there is a need for service, but by whom and at what cost? You say that “money is tight” and quote the 2008 HIMSS leadership survey that states “a lack of budget as the most significant barrier to successfully implementing IT at their organization.” My survey may be able to beat up your survey but the reality is most software “failures” can be remedied by a simple system reboot about 95+% of the time with known “bugs” that are slotted to be fixed in a future software update constituting the balance of the problems. Does hardware fail? Yes, but it’s cheaper and faster to get hardware service directly from the hardware vendor than pay the PACS vendor an uplift and wait for them to call the hardware vendor on your behalf (that’s how it usually works anyway). And if a system is properly designed, hardware failures can be kept to the bare minimum as well.

My issue isn’t necessarily with service itself but rather the cost of service agreements (or SA’s as they are better known). Most vendors charge between 12 and 18% of list price per year. This equates to 16-24% of system net since most systems are significantly discounted. After four or five years you basically have bought another complete PAC system. And what do you get for your ever-declining dollar? Basically support for something that was defective when you bought it. Cut that cost by half to a third and we’ll talk…maybe….

Vendors love to talk about uptime and response time guarantees, but rarely, if ever, will accept any financial penalties for failure to meet these, so why pay for something you aren’t getting? As for being a “preferred customer” and getting preferential service because I have an SA…puleaseeee!!!! If I’m spending $1M or more with you, I better damn sure be a preferred customer…with or without an SA.

Now there is one strong reason to have an SA and that is because you can’t get updates (bug fixes) without one. Most vendors don’t even have a mechanism for buying a software update without a SA in place if you wanted to… and that is a sad but true reality. True, it may have been broke when we sold it to you, but without an SA we won’t fix it...and with few exceptions most vendors charge extra for system updates that provide you with added functionality so… what’s the big deal here? At least Robin Hood gave something back to his merry men…

Sorry, Ms. P, but my bike is in the shop so my ‘98 Jeep with 150K miles gets the privilege of carrying my fat bootay all over East Jesus at a whopping 15 mpg (21 highway). As for the dating arena, I’ve opted to cut my losses there too and don’t even bother dating - be it a cheap date or otherwise. They are too much like an SA- what is covered you don’t want, what you do want isn’t covered, and the ROI basically sucks (which is more than most dates I’ve had did…) And so it goes…