When Hawaii Health Systems Corp (HHSC), Honolulu, began shopping for a PACS solution for three of its five island regions, newly hired CIO Money Atwal had a few unique issues to take into consideration. Though multisite PACS configurations are increasingly commonplace, most don’t have to cross water in order to work. Atwal needed a solution that could not only connect facilities on the east and west sides of the main island, but could also be shared by HHSC’s Maui location—around 100 miles of Pacific Ocean away.
“First and foremost, we were looking for distributed architecture. We wanted to allow each of the regions to hold some short-term storage, backing up for the long term at a centralized location, but if a region wanted to keep something locally for more than five years, we still needed that flexibility.”
—Money Atwal, CIO
In addition, the remoteness of HHSC’s locations required exceptional customer service from a vendor with the reach and clout to be able to serve a client properly outside the continental United States.
Atwal was hired by HHSC just in time to spearhead the PACS-selection process. He had been through a similar process in his previous position, but while the first facility was bigger, the challenges were less daunting. “It was more difficult at HHSC because of the other regions’ involvement,” he notes. “The other regions have different workflows and personalities to be worked through.” Of course, Atwal was interested in much more than simply finding the right multisite architecture for HHSC’s needs. He was also looking for robust storage, thin-client Web access, CR and mammography integration, and the right image-manipulation tools to keep his radiologists happy.
With such diverse system requirements to meet and so many parties from across the health care continuum invested in the outcome, it was crucial that Atwal appoint the right people to the selection team.
Grassroots-up Decision Making
Atwal’s prior experience with systems selection taught him one thing: decisions cannot be made without the participation of the clinicians who will actually be using the application daily. “We wanted to pick people who would live the software every day,” he says. “It wouldn’t be a true evaluation if it was an executive-level decision. We wanted grassroots-up decision making.”
Picking the right team is easier said than done, however, when multiple, geographically disparate locations are involved. Atwal brought in the same players from each region: the director of radiology, a local IT representative, and one or two radiologists. “Each of the regions was well represented on the selection team,” he says.
In the end, it was the radiologists who had the most to contribute—and rightly so, Atwal says. “The radiologists wanted to be able to stay within the same module while dictating and doing the final report,” he notes. “They needed sophisticated image-manipulation tools. They also pointed out the importance of managing technologist workflow. We needed to be able to see when the patient came in and when the tech started an order to track our productivity better. Scheduling was also very important, as well as the ease of what the technologist would have to do in terms of documenting exams and studies.”
Getting clinicians involved is a strategy that lasts well beyond smoothing out the decision-making process, Atwal notes. There are also benefits throughout implementation and training. “The more grassroots representatives involved, the better buy in and change management go as well,” he says.
Because HHSC had never had a RIS or PACS, some of the team members weren’t sure what questions to ask. Atwal’s solution was to have the group collaborate in developing a single line of inquiry for vendors. “After we sent out our request for proposal (RFP), we read and studied the proposals together,” Atwal says. “From there, we were able to come up with a list of group questions.”
To begin with, Atwal wanted to be sure to meet HHSC’s unique needs, which include a robust distributed architecture and premium customer service. “How supportive is the vendor on the island?” he says. “What’s the response time? Is there support available in terms of technicians or spare parts? These questions were extremely important. We wanted to see which vendors were already live on the island, how their PACS were being used, and how their current customers felt about their responsiveness.”
Atwal and his selection team