Changing PACS vendors is as painful as going through a divorce. That's according to Steven Horii, M.D., who spoke this week at RSNA 2010 in Chicago.

Horii is a member of the radiology department at the Hospital of the University of Pennsylvania. The Philadelphia-based academic medical center has changed PACS vendors three times in the recent past, Horii said. On one occasion, its ultrasound vendor was leaving the business. Another time, the department was obliged to switch to a new picture archiving vendor because of a corporate decision made by the health system in favor of single-vendor relationships. A third switch occurred when the department backtracked after the corporate decision. But in any case, the transitions were difficult and could have been made easier by taking a few precautionary steps, Horii said.

"A pre-nuptial agreement with the vendor" is a must, he emphasized. The contract must address a number of key issues, including access to the database before, during and after switching vendors. "Database migration is the number one problem" of any transition, Horii said. Even though images may be stored in the standard DICOM format, many vendors maintain the database in a proprietary format not easily transferred onto another platform. Horii advised buying a vendor-independent data storage system for long-term archiving of images.

PACS vendor contracts also should clarify ongoing service costs after a system has been retired. A realistic data migration timeline should be specified in the contract, with agreements about which side pays for what in case the timeline is missed, Horii added. Any data migration is likely to reveal large numbers of corrupt and incomplete files, he noted. During one transition, Horii's department identified more than 40,000 problem files, eventually winnowing down the list to 1200 cases, some which lacked any patient identifiers or adjoining studies.

--Gary Baldwin


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