Medical Imaging & Radiology Systems (PACS/RIS)
Clinical, operational, and financial complexity where patient outcomes, revenue, and compliance all intersect.
Inside this journey
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Radiology Stakeholder Discovery
Align on desired outcomes, decision roles, current PACS constraints (volume, downtime, archive complexity), and success signals.
Discovery Questions
Getting Oriented — a quick snapshot
- Who are you in the radiology ecosystem today (title and primary responsibility)?
- What best describes your organization?
- How many imaging studies do you handle per month (approximate total across sites)?
- Quick win: describe in two sentences the single biggest pain point you’d most like resolved about your imaging infrastructure.
- Who else on your team should be part of this conversation (names and roles), and what will they care about most?
Are you trading time for risk? — when downtime or slow reads cost more than frustration
- How often does poor PACS/viewer performance or unplanned downtime materially disrupt clinical care or reporting workflows?
- Can you give a recent example of an outage or severe performance event: what happened, how long it lasted, and the practical consequences?
- When performance problems occur, who feels the pressure most and what are the downstream clinical or operational impacts you worry about?
- How do these incidents make your team feel—frustrated, burned out, resigned, or mobilized to change? Please describe.
- What temporary workarounds do you rely on during outages (e.g., local caches, paper processes, secondary viewers, teleradiology agreements)?
Where is the current PACS actually holding you back?
- If your PACS could only improve one area immediately, which would create the biggest operational relief: viewer speed, subspecialty routing, archive access, or integration with EHR/ordering?
- How would you quantify the problem today—average viewer load times, percent of studies needing reloading, backlog hours, or days until archived studies are retrievable?
- Which imaging modalities and vendors create the most headaches within your environment (e.g., ultrasound, MRI, legacy CT exports, modality-specific DICOM oddities)?
- Where do you see friction between radiology and other departments (ED, OR, cardiology, referring clinics) tied to your current imaging systems?
- Which of these do you worry about most as volumes grow: storage costs, archive complexity, vendor lock‑in, or migration risk?
Who really decides—and who gets held accountable?
- Thinking beyond procurement, who are the formal and informal decision makers for imaging platform selection, and what does each care about most?
- How does success get measured for the team that will own the new system—what KPIs or outcomes will you be judged on?
- What is your typical decision timeline for enterprise imaging technology—months, quarters, board cycles? Are there hard deadlines driving this project?
- Who controls the budget for a platform replacement or major migration and what procurement hurdles have tripped you up in the past?
- What political or change management risks keep you up at night when contemplating replacing or migrating PACS/RIS/Archive?
What would ‘safe, fast, and seamless’ actually feel like here?
- If a new imaging platform delivered on everything you hoped for, what three outcomes would tell you it was worth the effort?
- Which measurable targets matter most: viewer load under X seconds, 99.9% uptime, migration completion in Y months, or X% cost reduction in storage?
- Who needs to be celebrating internally after go‑live for this to be a clear success—radiologists, IT, finance, clinical leadership, or others?
- How would patient experience or clinical outcomes change in a best‑case scenario? Give concrete examples if possible.
- Which of these would make you comfortable signing a mutual commit: a time‑boxed pilot with objective gates, contractual SLAs, phased migration, or financial protections?
Migration nightmares vs. a realistic plan — how messy is your archive?
- How large and complex is your archive today (approximate number of studies, volume in TB, number of vendor archives/silos)?
- Do you have multiple legacy PACS/archives that must interoperate or be consolidated? If yes, how many distinct archive groups or vendor silos?
- Which constraints make migration tricky for you: retention policies, proprietary formats, bandwidth limits, vendor contracts, or clinical scheduling?
- Have you attempted any migrations before? Tell us what went well, what failed, and how long the biggest data carryover took.
- Which migration approach do you prefer or are most open to: bulk cold transfer, staged/rolling cutover, live proxying, or hybrid?
Integration and workflow — will clinicians actually love it?
- Which EHR(s) and primary reporting systems must integrate tightly with the imaging platform (please list versions if known)?
- How critical is single sign‑on, context linking from the EHR, and teo‑click image launch for your referring clinicians?
- Describe your reading workflows today—are radiologists organized by generalists, subspecialty, distributed teleradiology, or mixed? How should routing change?
- What integrations beyond the EHR matter: RIS scheduling, voice recognition/reporting, analytics, third‑party viewers, or vendor‑neutral archive (VNA)?
- What training, adoption, or governance support will your clinicians need for a smooth transition (super‑user program, on‑site trainers, phased onboarding)?
Risk, SLAs, and what helps you sleep at night
- If we asked you for a realistic SLA that would make leadership comfortable, what targets would you state for uptime, viewer responsiveness, and recovery time (RTO/RPO)?
- How important are financial or contractual remedies for missed commitments (credits, termination rights, remediation plans)?
- What internal escalation and governance structure will you use during the project and after go‑live?
- Which security/compliance standards must be demonstrated: HIPAA, HITRUST, ISO, local data residency requirements, or others?
- What ongoing operational model do you prefer for support: fully managed, co‑managed, vendor support with internal ops, or third‑party MSP?
Pilot, phased rollout, or full switch — how would you like to proceed?
- If you could choose, would you validate with a time‑boxed pilot, a phased departmental rollout, or a single cutover across sites?
- What would be meaningful, objective gates for a pilot to prove you can scale (e.g., X studies/day, <Y sec viewer load, zero data loss during cutover)?
- Who must sign off on pilot success and final go/no‑go decisions (roles, not names)?
- Realistically, what is your preferred project start window and any immovable dates (e.g., contract expiry, fiscal planning, construction/IT refresh)?
- What would success look like at 30, 90, and 180 days after go‑live—list one concrete metric or sign for each timeframe.
Final reflection — what else haven’t we asked that matters?
- What hidden constraints, political dynamics, or legacy vendor clauses should we be aware of before proposing a scope and migration plan?
- If you could pick one thing for a vendor to absolutely do during the first 90 days to prove they’re trustworthy, what would it be?
- Which stakeholders would you like us to engage next (please provide role and preferred method—email, meeting, or workshop)?
- Are there any documents, architecture diagrams, contract excerpts, or logs you can share that would speed up our assessment? If so, please list.
- Finally—on a scale of 1–10, how ready does your organization feel to pursue a platform replacement or major migration right now?
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Solution Experience
Translate findings into scenario-based experiences showing how the platform achieves fast viewer performance, subspecialty routing, EHR integration, and secure migration.
Experience Meetings
- Solution Experience Kickoff — Current State, Consequence & Future State
- Viewer Performance Experience — Diagnosis, Proof & Validation
- Workflow & Subspecialty Routing Experience — Real Scenarios
- EHR Integration & Contextual Access Experience
- Secure Migration Experience — Dry Run & Acceptance Gates
- Agree on interface list, test endpoints, and an integration test schedule.
- Seller: If targets missed, schedule remediation test and list configuration changes to be applied.
- One‑sentence routing problem recap
- Validate that routing rules produce the expected assignment and escalation behavior in real clinical scenarios.
- Confirm throughput and failover behavior meets the operational needs for peak volume and staff absences.
- Agree the rule-set and pilot configuration for a runway test in production or a sandbox.
- Customer: Share canonical routing rules, on-call schedules, and escalation definitions for pilot configuration.
- Seller: Build the routing rule-set in a sandbox and provide a walkthrough document showing expected assignments and audit trails.
- Both: Schedule a short pilot window to run live routing with defined success metrics and owner for each metric.
- Confirm EHR use-cases to validate
- Show that clinicians can access the correct studies/reports from the EHR with preserved context and acceptable latency.
- Validate report/order flows and identify any data mapping gaps that must be resolved.
- Introductions & Meeting Objectives
- Customer: Provide EHR test endpoints, sample ADT/ORM/ORU messages, and expected field mappings.
- Seller: Deliver an integration checklist and a timeline for connectivity tests including necessary test accounts.
- Both: Schedule a dedicated EHR integration test window and assign an integration owner from each side.
- Recap Archive Constraints & Migration Goals
- Prove the migration method preserves study integrity and metadata for the sample set.
- Agree on explicit acceptance gates, rollback conditions, and owner responsibilities for the production migration.
- Define the pilot migration scope and schedule to validate at scale.
- Customer: Provide archive inventory and confirm sample set selected for dry-run.
- Seller: Run full verification report (checksums, UID mapping, access tests) and deliver findings within 48 hours.
- Both: Sign the migration pilot statement of scope, acceptance criteria, and designate migration owners.
- Achieve signed agreement on a single-sentence current-state describing the pain to be solved.
- Quantify the business/clinical consequence so scenarios target urgency, not curiosity.
- Define a measurable future-state outcome for each scenario that will be proven and validated.
- Agree the scenario list, required customer artifacts, and schedule for the experience sessions.
- Customer: Provide one-sentence current-state, top 3 consequence metrics, anonymized sample cases, worklists, and network baseline within 3 business days.
- Seller: Prepare scenario plan and test checklist mapped to each agreed acceptance metric.
- Both: Confirm secure data exchange method and sign any required NDAs for sample transfer.
- Recap Agreed Current/Future State & Metrics
- Produce measured viewer performance data using the customer's sample cases under agreed network conditions.
- Customer explicitly validates that the measured performance will materially reduce the stated consequence.
- Identify any configuration or environment changes required to meet acceptance targets.
- Seller: Deliver a performance test report with timestamps, configurations used, and recommendations within 48 hours.
- Customer: Confirm if reported performance meets internal SLA targets or provide revised acceptance thresholds.
- One‑Sentence Current State (Diagnosis)
- Migration Approach & Risk Controls
- Live Scenario — Context Launch from EHR
- Scenario 1 — Urgent Stroke CT Routing
- Environment Setup & Baseline Capture
- Scenario 2 — Subspecialty Read & Peer‑Review
- Live Scenario — Report & Order Flow
- Live Dry Run — Migrate Sample Studies
- Baseline vs Platform Tests (Live)
- Quantify Consequences
- Rollback, Verification & Acceptance Gates
- Define One‑Sentence Future State (Outcome)
- Throughput & Failover Test
- Show Proof Mechanisms — Streaming, Prefetch & Caching
- Security, Audit & Identity Mapping
- Select & Prioritize Scenarios to Validate
- Tie Results to Consequence
- Map Back to Consequence & Validate
- Agree Migration SLA, Owners & Pilot Scope
- Validation & Interface Scope Agreement
- Force Validation
- Pre‑work & Data Exchange Checklist
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Solution Scope
Define modules (PACS, RIS, VNA), migration scope and approach, integrations, SLAs, responsibilities, and measurable acceptance criteria.
Scope Configuration
- Modality DICOM Connectivity
- DICOM Routing and Study Distribution
- Vendor-Neutral Archive Provisioning
- Legacy PACS Bulk Study Migration
- Enterprise Zero-Footprint Viewer Deployment
- Worklist Engine and Reading Pools
- Structured Reporting and Voice Integration
- EHR Integration (HL7/FHIR) for Results
- High-Availability and Failover Setup
- Lifecycle Management and Tiered Storage
- Audit Logging and Audit Trail Enablement
- Disaster Recovery Replication and Restore
- Role-Based Access Control Provisioning
- Peer Review and Quality Tracking Module
Scope Questions
Modality DICOM Connectivity
- How many unique modalities and modality types (CT, MR, XR, US, NM, etc.) need DICOM connectivity?
- Which modality vendors and models require configuration (list vendor/model pairs or upload list)?
- Are modalities on the same network segment as the PACS or behind separate VLANs/firewalls?
- Do you require DICOM TLS or certificate-based authentication for modalities?
- Will modalities send via Push (C-STORE) only or do you also need modality query/retrieve and modality worklist (MWL)?
- Are there bandwidth constraints or expected peak studies/hour per modality that should influence connectivity planning? Please provide numbers if known.
DICOM Routing and Study Distribution
- Do you require per-modality or per-study routing rules (e.g., by modality type, accession, body part, or DICOM tag)?
- List target destinations for routed studies (e.g., local PACS, external reading centers, vendor archive, cloud endpoints).
- Should routing include transformations (anonymization, tag normalization, SOP Class conversion)?
- Do you need conditional routing (e.g., route to subspecialty reader for certain body parts or accession numbers)?
- Are duplicate copies to multiple endpoints required for redundancy or DR purposes?
- What SLAs or performance expectations exist for distribution (e.g., <30s delivery, <2 min for large CT/MR)?
Vendor-Neutral Archive Provisioning
- What is the current and projected archive size (TB) and study count to be supported initially and at 3 years?
- What retention policies are required (e.g., clinical retention 7 years, oncology 20 years, pediatrics lifetime)?
- Are de-duplication, compression, or multi-instance storage requirements desired for storage optimization?
- Do you require encryption at rest and key management (managed keys vs customer-managed keys)?
- Do you need archive indexing/search SLA targets (e.g., retrieve study in <30s for recent studies, <2 min for deep archive)?
- Is replication across sites or geographic regions required for compliance or resiliency?
Legacy PACS Bulk Study Migration
- Approximately how many studies and total TB need to be migrated from legacy PACS?
- Do you require full-fidelity migration (images + all tags + reports) or a subset (images only, images + key tags)?
- What migration approach do you prefer or require: bulk offline export/import, streaming migration with cutover, or staged/rolling migration?
- Will migrations be performed during a maintenance window with read-only mode or must reads continue during migration?
- What verification and acceptance criteria should be used to validate migrated studies (sample checks, checksum, count reconciliation)?
- Are there contractual or regulatory requirements for data retention or chain-of-custody during migration?
Enterprise Zero-Footprint Viewer Deployment
- How many concurrent users (typical and peak) need access to the zero-footprint viewer?
- Which user types need diagnostic-grade access vs clinical review (radiologists, referring MDs, technologists)?
- Is EHR-context launch or single sign-on integration required for the viewer (e.g., CCOW, SMART on FHIR, SSO)?
- What performance acceptance criteria are required (e.g., first image <2s on WAN, full study load <8s for 50-series CT)?
- Which browsers, devices (desktop/tablet), and network conditions must be supported?
- Do you require integrations with measurement/calculation toolsets, hanging protocols, priors comparison, or advanced 3D tools?
Worklist Engine and Reading Pools
- How many reading pools or subspecialty groups do you plan to create (e.g., neuro, MSK, body, emergency)?
- Do you require rules-based routing into reading pools (by modality, accession, ICD code, or priority)?
- What SLA targets exist for study turnaround time or time-to-first-report by pool?
- Do you need shift-based scheduling, vacation overrides, and automatic redistribution for unread volumes?
- Should the worklist integrate with voice recognition/RIS statuses and support progress/state transitions (e.g., preliminary, final)?
- Are there rules for prioritization (e.g., STAT, inpatient, ED) that must be encoded in the engine?
Structured Reporting and Voice Integration
- Do you currently use a speech recognition vendor (Nuance, M*Modal, etc.) or need a recommendation?
- Do you require structured templates (CLINRAD, RSNA, custom) and discrete data capture for specific exam types?
- Should reporting integration include post-processing (structured results into EHR) via HL7 ORU or FHIR DiagnosticReport?
- Are voice macros, auto-text, or AI-assisted draft generation needed as part of the workflow?
- What acceptance criteria should be used for report transmission and finalization (e.g., <30s from sign-off to EHR visibility)?
- Do you require audit and QA workflows for report edits, peer review flags, or discrepancy tracking?
EHR Integration (HL7/FHIR) for Results
- Which EHR(s) must be integrated (vendor and version)?
- Do you prefer push (results pushed to EHR) or pull (EHR launches viewer with context) integration patterns, or both?
- How should patient matching be handled (exact MRN, probabilistic matching, use of enterprise MPI)?
- Are there specific FHIR resources or HL7 messages required (e.g., DiagnosticReport, ImagingStudy, ORU^R01)?
- What acceptance criteria or SLAs should be used for EHR visibility (e.g., results within 1 minute of sign-off)?
High-Availability and Failover Setup
- What are your RTO (recovery time objective) and RPO (recovery point objective) targets for imaging services?
- Do you require active-active, active-passive, or warm-standby architecture for core imaging services?
- Which components must be HA (viewer, archive, routing, RIS interfaces)?
- What maintenance windows and acceptable outage windows exist for failover testing?
- Do you require automated failover testing and periodic DR exercises included in scope?
- Are there monitoring/alerting integrations required (SNMP, Prometheus, PagerDuty, ServiceNow)?
Lifecycle Management and Tiered Storage
- What automated lifecycle policies do you require (move-to-cold after X days, archive-only after Y years)?
- Which storage tiers will you use or prefer (SSD/hot, HDD/warm, cloud-cold, tape)?
- Are cost-per-GB constraints or budget limits that should guide tiering decisions?
- Do you need automated lifecycle actions based on access patterns (auto-move/prioritized retrieval)?
- What retention deletion and legal hold workflows are required (e.g., legal hold cancel deletion for X studies)?
- Should lifecycle decisions be auditable and reportable for compliance reviews?
Audit Logging and Audit Trail Enablement
- What events must be logged (view/access, export, delete, modify, authentication, configuration changes)?
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Mutual Commit
Finalize commercial terms, SLA commitments, migration milestones, acceptance gates, and governance for go/no‑go decisions.
Agreement Modules
- Non-Disclosure Agreement (NDA)
- Master Services Agreement (MSA)
- Statement of Work (SOW)
- Service Level Agreement (SLA)
- Commercial Terms & Pricing Schedule
- Migration & Cutover Plan
- Acceptance Criteria & Go/No-Go Gates
- Governance & Steering Committee Charter
- Change Order & Scope Management
- Data Protection & Security Addendum (DPA)
- Integration & Interface Acceptance
- Support, Warranty & Maintenance
- Training & Knowledge Transfer Agreement
- Escrow & Intellectual Property Protection
- Termination, Exit & Archive Handover
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Deployment
Coordinate archive migration, modality connectivity, workflow configuration, cutover sequencing, and go‑live support with clear owners and timeline.
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Success
Validate acceptance criteria and performance targets, capture lessons learned, and maintain a shared channel for issues and enhancements.
Success Reviews
- Acceptance Criteria Validation Workshop
- Performance & SLA Review
- Lessons Learned & Continuous Improvement Retrospective
- Issue Triage & Enhancement Roadmap Sync
- Operational Handover: Support, Governance & Escalation Paths
Issues & Enhancements
- Align on release windows, expected impact, and communication plans.
- Document SLA outcomes and any agreed credits or contractual modifications.
- Project Timeline Recap
- Produce a documented lessons learned report mapping problems to root causes and preventive actions.
- Create a prioritized improvement backlog with owners and acceptance criteria.
- Establish a recurring cadence for retrospective follow-ups and process improvement tracking.
- Publish the lessons learned report and improvement backlog to the shared channel.
- Assign owners and target dates for top 5 improvement items and add to project tracker.
- Schedule the next retrospective/check-in meeting and invite cross-functional stakeholders.
- Open Issues Review
- Produce a prioritized and actionable issue/enhancement backlog visible to both customer and provider.
- Agree explicit acceptance criteria for top-priority enhancements to avoid scope ambiguity.
- Introductions & Objectives
- Create prioritized roadmap entries with detailed acceptance criteria and assigned PM/owner.
- Move agreed remediation items into the schedule with target release versions.
- Publish release and communication plan to the shared channel and notify affected user groups.
- Support Model Overview
- Complete handover of operational responsibilities with clear support contacts and SLAs.
- Establish a governance cadence and escalation matrix that both parties accept.
- Ensure operations team has access to runbooks and knows how to promote issues into the improvement backlog.
- Publish the finalized support contact list, escalation matrix, and governance calendar to the shared channel.
- Grant access to runbooks and confirm knowledge-transfer completion for primary support staff.
- Schedule the first operational governance meeting and include the improvement backlog review.
- Demonstrably validate each acceptance criterion with mapped evidence or live test results.
- Secure formal sign-off or documented remediation plan with owners and dates.
- Ensure all stakeholders share a single, unambiguous status for go/no‑go decisions.
- Publish acceptance validation report with artifacts and live test logs to the shared channel.
- Create remediation tickets for any unmet criteria with owners, completion dates, and verification steps.
- Schedule follow-up validation session for remediated items within agreed SLA timeframe.
- Monitoring Dashboard Walkthrough
- Verify whether performance targets and SLAs were met during the acceptance period.
- Agree on corrective actions and owners for any performance shortfalls.
- Confirm monitoring ownership, alert thresholds, and escalation paths to prevent recurrence.
- Adjust monitoring thresholds and create/assign alerts to agreed owners.
- Open remediation/change requests for capacity or performance fixes with target dates.
- Recap Acceptance Criteria
- Enhancement Requests & Prioritization
- What Went Well
- SLA Compliance Assessment
- Escalation Matrix & SLA Response Steps
- Governance Cadence & Stakeholder Meetings
- What Didn't Go Well
- Define Acceptance Criteria for Enhancements
- Incident & Performance Root Causes
- Evidence Presentation
- Live Validation Scenarios
- Release Cadence & Deployment Windows
- Capacity and Scalability Validation
- Knowledge Base, Runbooks & Access
- Root Cause Analysis
- Prioritized Improvement Backlog
- Feedback Loop & Continuous Improvement Mechanism
- Gap Review & Remediation Plan
- Remediation, SLA Credits & Monitoring Ownership
- Communication & User Impact Plan
- Sign-off Decision & Next Steps
- Recognition & Next Steps