Is PACS Better the Second Time Around?

Ms. PACS: Did you ever go out to buy a PC and you knew exactly what you were looking for – 3GB shared dual channel, SDRAM, high resolution, glossy widescreen 17 inch LCD and a 2MP camera. Just when you boot it up for the first time, you get blue screen errors. You try to diagnose the problem, but finally give up and call up customer service. Now you’re on the phone with ‘Bob’ in India who tells you to unplug it again, check the keyboard and mouse and stand on your head, and in the end blame you that it’s your fault because you must have added some software. Now you are about to explode and take the PC with you. Your only recourse is to send a ‘nastygram’ to the head of customer service and “Cc” the president. A day or two later, a States-side ‘service specialist’ calls you, and in a sweet voice says your new PC is on the way and sorry for the inconvenience. You exhale a humble “Thank you” with a sigh of relief – then think, wait a minute, why didn’t you do it right in the first place?!

A similar scenario plays out for many when they buy a PACS for the first time - they submit an RFP, yet the PACS doesn’t meet their expectations. That’s pretty disappointing. So, are you going to make the same mistake twice?

It’s time to roll up your sleeves and start by asking key questions: Does the system archive other objects other than DICOM objects? Can the vendor guarantee data migration to the next PACS? Is it Web-enabled? Should you use a RIS-driven or PACS-driven work list? How is the PACS server configured?
What Data storage methodology is featured? Does the vendor possess the programs and manpower to help you with workflow redesign and technology adoption among the referral community?

Once you have done your homework, if you clearly state your PACS needs in an RFP, include market reports, site visits and peer advice, you can probably identify a good PACS that will meet your expectations and workflow requirements.

If radiology departments that are buying a replacement PACS do their due diligence - ask the right questions - most likely, they will get it right this time around. If not, as they, the second time around, PACSman is ‘shame on you.’


PACSman: Yes, Ms. PACS, I’m all too familiar with the saying that goes “Fool me once, shame on you. Fool me twice, shame on me.” And anyone who watches CSI Miami has heard The Who singing “We Won’t Be Fooled Again” (and some of us are young enough recall when that song first came out on the Who’s Next album back in 1971). But whatever version you subscribe to people are being fooled again and again expecting PACS to be better the second time around. Why? For the same reason >60% of all second marriages fail ….because they keep making the same mistakes.

Buying a PACS the second time around is actually harder than the first time, yet people feel because they have done it once it just has to be easier. It’s not. Just as a second marriage brings kids into the picture- a second PACS brings with it data migration. A second marriage brings with it preconceived notions- so does a second PACS. In a second marriage you feel confident that there is a better partner out there- while the reality is that your expectations may be set too high and need to be better managed. So too it goes with second PACS. In a second marriage you feel like you know what you are looking for since you’ve “been there, done that” but without truly knowing what was wrong (and right) with the first PACS you will probably have the same challenges all over again. Then, of course, you get into those sticky money-related issues - yours, mine or ours, or in the case of PACS whose money and system really is it - radiology’s IT’s or the hospitals? The parallels are frighteningly similar and, as such, carry the same caveats that second marriages do.

This first rule of second marriages and PACS is to make sure you REALLY know who you’re marrying. The PACS might look great at the RSNA or in the demo, but make sure that you cover yourself contractually just in case.

The second rule is to create a check list of issues that led to your last divorce. What did you like or didn’t? What could be changed? What couldn’t be changed?

The third is don’t rush into your second marriage because you’re blinded by “love.” This is primarily a radiologist caveat- they love to say we MUST have this vendor’s system or must have that ones, looking on the surface only without delving deeper. And while radiologist input is crucial to the decision making process, workstation functionality is but one part of the entire system that needs to be considered.

You also need to honestly look at what caused your last divorce. Were there problems you could have addressed, but didn’t? Was there one that was insurmountable? What could you have done differently? Or did you just outgrow your PACS and decide it was time for another?
Lastly, CLEARLY understand your expectations of each other. A replacement PACS or a replacement spouse is just that - a replacement - and doesn’t guarantee success. In PACS a well defined contract pretty much protects you from getting what you want. In life, the best protection is to combine heart and mind together - although having a pre-nup surely doesn’t hurt either.

I have a way to go before I’m ready to try and find love again just as many feel with looking for a replacement PACS. There has to be a better way in finding the right PACS just as there is in finding a better life partner. Looking over 1,275 pretty pictures and paragraphs or answering 436 questions to match 29 personality traits just doesn’t cut it for me…especially since I ended up being matched with over a dozen religious zealots (as if!!). None of them ever wrote back to me either after I said the only time I wanted to hear “Oh God!” or “Sweet Jesus!!” was in the throes of passion…..I tell ya - some people just have no sense of humor at all…