PACS PRE-QUALIFICATION QUESTIONAIRE1.doc - RCR Imaging Informatics

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					PACS PRE-QUALIFICATION QUESTIONAIRE version 1

1. Following Realtime Synchronization of patient demographics & ADT Information
with PAS is required ---
Name
DOB
Sex
NHS No.
PAS No.
Current Patient Location
Current Responsible Consultant

a. Does the PACS support Patient Information Reconcilliation Profile of IHE?
b. Describe how the PACS will ensure that all demographics & ADT information as
above will be kept in sync with PAS (which is the PMI), even if PAS was not PIR
compliant?


2. Clear display of Patient Banner Information—7 items need to be displayed to the
patient banner in a clear & consistent way:
Does the PACS allow for a clear & consistent display of patient banner information
below?
Name
DOB
Sex
NHS No.
PAS No.
Current Patient Location
Current Responsible Consultant


3. SEARCH FACILTY
a. Does the PACS have a good search facility for a single or group of patients for the
following data items?
b. Is the PACS unable to search against any of the below data fields—single or
combination?

Name
DOB
Sex
NHS No.
PAS No.
Current Responsible Consultant
Requesting Responsible Consultant
Current Patient Location
Operator
Reporter
Workflow Status of study (see section--)
Modality
Exam Description
Exam Room
Date or date Range (for exams)


4.CLINICALLY RELEVANT DATA DISPLAY
a. Is the PACS able to display the following clinically relevant metadata alongwith
images ?
b. Is the PACS unable to display any of the below data fields—please clarify?
A. PATIENT DEMOGRAPHICS
Name,
DOB,
Sex,
PAS No.,
NHS No. (CHI number for Scotland)—NHS number may not be present in
100%exams sent to PACS
B. REQUESTER
Name of Requester
Grade of requester
Contact number of requester
Requesting **Responsible Consultant/GP (Team)—(Also RECIPIENT)
Requesting Speciality/Department/GP surgery
Requesting Institution
Date & time of request made
C. IMAGE DOCUMENT
Modality
Exam Description---(National Exam Codes & Descriptions)
Date & Time image acquired on modality
Date & time of image sent from modality
Date & time received on PACS
Exam Room (where the exam has been performed)
D. OPERATOR/IMAGE CREATOR
Name of Operator
Grade of Operator
Contact number of Operator
Performing Responsible Consultant
Performing Department/Speciality--Radiology
Performing Institution/NHS Trust
E. REPORTER
Name of Reporter
Grade of reporter
Contact number of reporter
Reporting Responsible Consultant
Reporting Department/Speciality
Reporting Institution/NHS Trust
Date & time report verified
   F. WORKFLOW data fields
                       a. Workflow status
                       b. Workflow priority
5. WORKFLOW STATUS SYNCHRONIZATION
Is the PACS able to keep the following workflow status of synchronised with RIS

a. Arrived (RIS)
b. Exam started (RIS)
c. Exam Completed (RIS)
d. Report Dictated (RIS)
e. Unauthorised report (RIS)
f. Authorised/Verified Report(RIS)
g. Amended Report (RIS)
h. Report Viewed (Ordercomms/RAS)
i. Report acknowledged (ORDERCOMMS/RAS)
j. Review requested (Ordercomms)
k. Housekeeping (RIS)


6. CULLING OF IMAGES BASED ON LOCAL POLICY
Unnecessary managed storage of images is costly. Vendor must describe how image
culling will be supported.
a. Describe how the PACS will support culling of images based on local policies with
a rules based logic applied.
b. Does the PACS have these 2 data fields--- a patient level date of deletion & an
exam level date of deletion?


7. 3 SEC DISPLAY OF IMAGES
Clinical display standards is 3 secs display on Diagnostic reporting workstations.
a. Does the PACS vendor feel capable of delivering this requirement?
b. What network requirements are required to be fulfilled by the Trust?
c. What hardware display specification needs to be fulfilled by the Trust?
d. Does the display hardware need to be bought from the PACS vendor or can it be
bought in open market competition?
e. Will the workstations be restricted in their use? If yes what will the restrictions be?


8. DICOM MODALITY WORKLIST
In a standard implementation DICOM Modality Worklist is provided by RIS to
modalities.
a. Is the PACS vendor able to work in this standards based environment with the RIS
providing the DMWL?
b. Will the PACS vendor insist on deploying their PACS Broker?


9. CONSISTENCY OF QUALITY FROM MODALTY TO PACS
There must be no loss of image quality, annotations, zooming etc that maybe applied
on the modalities by the radiographers during the transit from modalities to PACS.
a. Does the PACS solution support consistent presentation of images profile of IHE as
image manager & Image Display actors?
10. DESKTOP INTEGRATION with RIS
When a episode is picked up for reporting on RIS, due to desk-top integration the
current image must be displayed on the middle monitor on PACS & relevant prior
must be displayed on the right PACS monitor. (see OBS for full functional spec)
a. Is the PACS vendor capable of desk-top integrating with any RIS & also is it
capable of automatic display of relavent prior as described above.?


11. BASIC IMAGE DISPLAY & MANIPULATION TOOLS
Clinical users need some minimum display with manipulation tools.
a. Does the PACS Solution support Basic Image Display profiles of IHE?


12. ON-CALL REQUIREMENTS
CT is the commonest modality used by NHS radiologists on-call.
a. Does the PACS solution allow for smooth scrolling of 500-1000 images (after
initial loading) over a slow bandwidth connection---2mbps etc?


13. MDCT MPR REQUIREMENT
a. Does the PACS solution allow for automatic & seamless loading of MPRs?
b. Does the PACS solution allow for synchronised scrolling in 3 planes?


14. PLUG-IN integrations (3D, CAD, CT Vessel analysis, CT Cardiac analysis, CT
Colonoscopy, Ortho-templating etc)
a. Which plug-ins are part of the standard solution at no extra cost?
b. What are the optional extra plug-ins & at what cost?
c. Does the PACS vendor allow for integration of plug-ins from other vendors? If yes,
what is the requirements and costs.
d. Does the PACS solution support DICOM supplement 118 for standardised
integration for plug-ins?


15. NUCLEAR MEDICINE DISPLAY
a. Is the PACS capable of storing & displaying nuclear medicine images adequately?
b. Does the PACS solution support the Nuclear Medicine profile of IHE as Image
Manager & Image display actors of IHE?


 16. MAMMOGRAPHY DISPLAY
a. Is the PACS capable of storing & displaying mammography images adequately?
b. Does the PACS solution support the Mammography profile of IHE as Image
Manager & Image display actors of IHE?


17. RADIOLOGY REPORT DISPLAY:
a. Is the PACS capable of receiving reports from RIS in HL7v2 format?
b. Is it able to display reports alongside images for a clinical user—report & image on
the same PACS screen?
c. For future proofing, is the PACS capable of supporting Displayable report profile
of IHE and receive reports in CDA format?


18. IMPORTED IMAGES
a. Is the PACS solution capable of keeping imported images sent from other hospitals
in an ―unverified folder‖ or a similar entity?
b. Is the unverified folder visible to clinical users?
c. Can this act as a temporary store of images so that according to local policies/needs
the Trust can choose to verify them, and or keep them long term or decide to delete
them after a short time?


19. PACS as PART of EPR
a. Is the PACS XDS-I source & consumer actor for Cross Enterprise Document
Sharing of IHE. The is important for future proofing.


20. SHARING INFORMATION BEYOND IG BOUNDARIES
Does the PACS solution support the following current sharing solutions
a. IEP (Basically a DICOM Push connection to Burnbank solution)
b. Direct DICOM push (cost must be clear for each connection)
c. Encrypted CD creation & import
d. Does PACS support XCA-I profile of IHE to support sharing in future?


21. TEACHING FILE CREATION:
a. Does the supplier support TCE Profile of IHE (Teaching Files & Clinical Trials
Export Profile) as export selector & export manager actors?


22. AUDIT TRAIL/VIEW LOG:
a. Does the PACS record an audit trail/view log ?
b. Is this visible to the clinical users
c. Does PACS support the ATNA profile of IHE?


23. RADIATION DOSE MONITORING
a. Does the PACS support Radiation Dose Monitoring Profile of IHE as image
manager actor?


24. DATA MINING
Does the PACS solution allow for following data is easily available for System
Administrator/PACS Managers—
a. time of image creation to arrival on PACS,
b. number of exams of a modality per room
c. time from image arrival on PACS to verified report etc
25. PACS HARDWARE:
a. Clear specifications for server & storage hardware must be provided
b. Does the hardware need to be bought from the PACS supplier?
c. Workstation hardware—Clear specification need to be provided to achieve
diagnostic display.
d. Does the workstation hardware need to be provided by PACS supplier?
e. Will the workstation be restricted to PACS use only? Clarify if there is any
restrictions to use of other software on the workstations.


26. PACS CLIENT SOFTWARE
Does the PACS client software conflict with any other software that maybe required
to run on a PACS workstation---RIS, VR, DD. Other software etc


27. PACS STORAGE VOLUMES--COST
Local policy based image retention is described. This allows for the PACS supplier to
make an assessment of storage requirements for the solution.
a. PACS supplier must provide clarity on how additional cost of storage will be
charged--- if the storage volume or image numbers exceed the initial assessment.


28. ADDITIONAL MODALITY CONNECTION
PACS supplier must provide clarity on cost of attaching a new modality or replacing a
modality once the initial deployment phase is complete both for the
a. connection changes for a modality &
b. additional storage cost for a new modality .
Clarity is required for both DICOM & non-DICOM modalities.


29. PRIVATE DICOM TAGS:
As far as possible PACS vendors should use standard DICOM tags. Private DICOM
tags should only be used only temporarily when standards tags are not available.
a. Please confirm PACS suppliers must convert private tags to standard tags when
they become available.


30. END OF CONTRACT DATA HANDOVER FOR MIGRATION:
6 months prior to end of contract the PACS vendor must provide support for
migration of PACS data:
a. PACS DICOM Image database. The database must be handed over in standard
DICOM part 10 file format—so it can be ingested by incumbent PACS vendor.
b. PACS relational database—Clinical metadata as described in question 4 must be
transmitted.
c. Vendor must agree to support the IHE Profile/DICOM standard for bulk migration
when it becomes available.
d. Rate of migration of data out of the database must be 1TB per day at the end of
contract.
31. TESTING & TRAINING SYSTEM:
a. PACS vendor must provide a separate testing & training system for testing of
integration & provide a training environment prior to roll out into live system.


32 USER ROLE CONFIGURATIONS
It should be possible to have local configurations of users roles with functionality. For
example
a. Clinical Users: All medical users –view images & reports
b. Radiologists & Radiographers—View images & reports + transmit images for on-
call to neurosurgical units etc
c. System Administrators—delete images, correct attributes, audit logs etc


33. SUPPORT
a. Will 24/7 support be provided
b. Is there a single phone number must put the PACS manager to a qualified PACS
engineer who is able to perform diagnosis & identify problems—network, software,
server etc?
c. Will there be Online tracking of support calls with transparency of response times
provided.
d. Monthly report on support calls with response times must be provided transparently
e. Both an onsite & remote support capabilities must be provided.
f. Response time for remote & onsite support must be clarified.
g. Support must include integration to 3rd party systems.
h. Please clarify the number of qualified PACS engineers in the support team.


34. BUSINESS CONTINUITY & DISASTER RECOVERY
a. There should be no need for planned or unplanned downtime—please confirm
b. Please provide a disaster recovery plan.



35. SOFTWARE STABILITY:
a. Single client software with consistent & stable display must be provided. Confirm.
b. Software errors or ―bugs‖ must be corrected within 6months with a software
update.
c. Please identify the number of qualified WTE software developers in the PACS
development team.


36. USER GROUP MEETING BASED PRODUCT DEVELOPMENT
a. Please confirm that user community have input into product development? Is there
an electronic forum for suggestions. Do users get to vote on product development?
b. Please identify history of PACS product development for vendor. How many
releases & updates have been made since the initial deployment of product with dates.
c. How many product development days are allocated to each customer—for which
the customer body has voting rights?
d. How is the next release of the product rolled out. Is there any cost for the software
upgrade. Within what timeframes will the next version of the product be provided to
each customer.
e. Will there be any input from a qualified software developer at the user group
meetings/electronic forum discussing the suggestions for product enhancement?


37. PACS HOUSEKEEPING
a. Images from modalities may reach PACS after the ―workflow status‖ has changed
from exam completed to dictated, unauthorised or authorised. This is a patient safety
issue. How does the vendor deal with this issue?
b. Images sent to PACS after authorised status for post-processing –Ortho-templating,
MPR/3D etc. How does supplier deal with this?


38. PET_CT DISPLAY
a. Does the standard PACS support storage & display of PET-CT images? Is a
separate plug-in required for PET-CT display?
b. Does the PACS support DICOM Blending Presentation State?
c. Is MIP for PET & MPR for PET & CT supported?
d. Does it support triangulated navigation?


39. PACS SLAs
a. Business Continuity Model for PACS is required. Enterprise wide downtime
(planned & unplanned) is unacceptable for clinical practice.
b. Any enterprise wide unplanned downtime attributable to PACS lasting for more
than a certain duration will invoke penalty and this will need agreement between both
parties. What kind of agreements does the supplier have with existing customers.
c. What kinds of SLAs does the PACS vendor support & what is the cost for each
time of SLA. Please use simple language to describe SLA.


40. PACS COSTS
Supplier must provide a breakdown of deployment charges & revenue charges as
below
A. DEPLOYMENT CHARGES
a.. Migration from old PACS
b. Modality integration--as per DMWL---(based on number of modalities provided in
appendix 1)
c. Back end HL7 data fields integration with RIS (list of RIS fields in Question 4)
d. Desk-top Integration with RIS (spec provided in OBS)
e. ADT HL7 integration with PAS (as per Question 2)
f. 3 MP colour monitor workstation hardware costs
g. Server & Storage hardware costs
h. Integration with existing or new plug-ins from 3rd party--Advanced visualization
plug-in, Ortho-templating plug-in, CAD plug-in etc
i. Training--System Admin, Training of the trainers, etc
j. Supplier end Project Management
k. Software Deployment Charge
l. Optional Plug-ins provided by the PACS vendor
m. Any other deployment costs not included in the above breakdown
B. REVENUE CHARGES for a defined Service Level Agreement:
Please define the SLA and the associated service charges:
a. Support & Maintenance charges for PACS for different types of SLAs if supplier
provides different types of SLAs to customers:
i PACS Software support & maintenance
ii. Integration support to RIS, PAS, 3rd party Plug-ins, etc
iii. Workstation Hardware support per workstation (if provided & supported by PACS
vendor)
iv. Storage Area Network Support---(If provided & supported by PACS vendor)
v. Application Server Support
vi. Any other support changes that may have been omitted. PACS supplier to clarify.
b. PACS Licensing--there are various types of licensing provided by different PACS
vendors--some are based on total number of users, some total number of concurrent
users, others based on number of images stored, some based on number of images
retrieved for display, others the total volume of data stored etc---it is useful to get
clarity of the software revenue charges as they will differ with each vendor
c. Licensing for plug-ins if provided by the PACS vendor-- (Ortho-templating, 3D,
CT colon etc)
d. Any other regular revenue charges
C. ADDITIONAL OPTIONAL COSTS
a. Software upgrade charges when it is available--some charge others include it in
overall revenue
b. Plug-in software upgrade costs
c. Pre-Term contract exit costs:
d. End of contract handover of data in DICOM part10 format charge
e. ANY OTHER CHARGES---not covered above.


41. EXAM LAUNCHED VIA a url.
Is it possible to launch the relevant images from a system which contains the report
(like an Ordercoms—Results Reporting System) through a url which contains the
accession number within the url.

Compiled by Dr. Neelam Dugar
Consultant Radiologist
Chairman of RCR Imaging Informatics Group
01/09/11

Acknowledgement to all members of RCR Imaging Informatics Group who
participate & contribute to the meetings & forum discussions and also contributed to
the development of the Group PACS Specification Document. This document would
not have been possible without their input.

				
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