Start Here: What’s Top of Mind in Imaging?

• What is the single biggest imaging-related priority for your team right now?
• How many distinct imaging sites or facilities are we talking about? Options: 1, 2–5, 6–15, 16–50, 51+
• Which core systems are currently in place across those sites (pick all that apply)? Options: Multiple PACS vendors, Single PACS vendor, Vendor-neutral archive, Separate RIS, EHR with embedded viewer, No centralized archive, Other
• Roughly how many studies does your enterprise handle monthly? Options: <10k, 10k–50k, 50k–200k, 200k–1M, 1M+
• Who should be in the room as we explore solutions (names and roles are ideal)?

If We Didn’t Fix This, What Would Break Next?

• When you look at your current imaging setup, what’s the one thing you silently worry will fail next?
• How often do those worries materialize into real incidents (downtime, lost access, migration failure, security event)? Options: Weekly, Monthly, Quarterly, Annually, Rarely
• Tell us about a recent incident that felt preventable—what happened and what was the impact?
• How long have you been operating under the risk or limitation you just described? Options: <6 months, 6–12 months, 1–3 years, 3–5 years, 5+ years
• What workaround do clinicians or IT use today to avoid that failure, and how does it affect their day?

Who Really Decides (And Who Gets Blamed)?

• If we needed a final signoff for a platform decision today, who would sign it and why?
• Which stakeholders influence budget, clinical adoption, and technical acceptance (select all that apply)? Options: Radiology Informatics Director, Department Chair/Physician Leader, Imaging IT Manager, CIO/VP IT, Finance/Procurement, Clinical End Users (radiologists/techs), Security/Compliance, Other
• Describe any decision-making tensions we should know about—e.g., finance wants lowest TCO while physicians insist on specific visualization tools.
• What budget owner or fund source would pay for consolidation, migration, or advanced visualization? Options: Department budget, System capital budget, IT budget, Grant/other, Undecided
• Are there procurement timelines, board reviews, or fiscal windows that constrain when a contract can be finalized? Options: Yes — specific date, Yes — within quarter, No strict timeline, Unsure

Where the Current Workflow Actually Slows You Down

• When radiologists and technologists talk about daily friction, what three things come up first?
• How much time per study are readers losing due to fragmented systems, slow loaders, or EHR context switching? Options: <1 minute, 1–3 minutes, 3–6 minutes, 6–10 minutes, 10+ minutes
• Which workflows are highest priority to optimize—consolidation/readers, EHR access, advanced Viz, AI triage, reporting, or something else? Options: Consolidation/readers, EHR access, Advanced visualization, AI integration, Structured reporting, Analytics/quality, Other
• Share a short example of a workflow breakdown that directly affected patient care or reporting turnaround.
• How do clinicians describe the emotional impact of current delays or friction—frustration, burnout, liability concern, or something else? Options: Frustration, Burnout, Worry about errors, Eroded trust in IT, Neutral

The Hard Numbers: Cost, Waste, and Opportunity

• What is your best estimate of annual spend to maintain current imaging systems (support, storage, licences, and hosting)? Options: <$100k, $100k–$500k, $500k–$2M, $2M–$5M, $5M+
• Beyond hard spend, where do you see hidden costs—overtime, lost productivity, duplicate studies, or penalties? Options: Overtime, Lost productivity, Duplicate studies, Delayed revenue, Compliance fines, Other
• If we could quantify one efficiency gain (e.g., 20% faster reads), how would that translate into FTE, patient throughput, or dollars for you?
• How does the cost of migration or consolidation compare in your mind to the ongoing cost of keeping the status quo? Options: Migration is clearly cheaper long-term, Migration cost is a barrier, Unsure — need analysis, Prefer incremental approach
• Who needs a clear ROI model to approve change, and what ROI horizon do they expect (months/years)? Options: 12 months, 18 months, 2–3 years, 3+ years, Unsure

Let’s Talk About Patient Safety and Data Risk

• If a security breach impacted imaging data tomorrow, how exposed do you feel the enterprise would be? Options: Highly exposed, Moderately exposed, Some exposure but contained, Low exposure, Unsure
• What are the biggest gaps you’ve identified in data protection, encryption, role-based access, or auditability?
• Do you have recent evidence of risk—penetration reports, audit findings, or security incidents—that we should consider? Options: Yes — incident reports available, Yes — audit findings, No documented evidence, Unsure
• Which compliance frameworks matter most for you (select all that apply)? Options: HIPAA/HITECH, SOC 2, ISO 27001, Local/state health regs, Other
• How would a material security improvement change the internal conversation about investing in a new platform?

What Would Success Actually Look Like (Not Just a Headline)?

• If this program is a clear success in 12 months, what three measurable outcomes would you point to?
• Which of these success signals matter most to you (pick up to three)? Options: Consolidation percent (archives/sites), Read turnaround time reduction, Cost reduction/TCO, Radiologist productivity gain, AI adoption rate, EHR access improvements, Security posture improvement
• How will clinical leaders and finance validate those outcomes—what dashboards or reports do they expect?
• Who needs to sign the final acceptance that these KPIs are met, and what evidence will satisfy them?
• If we miss one of the success signals, which one would be most tolerable and which would be a deal-breaker?

Integration Reality Check: EHR, AI, and Vendor Ecosystems

• What integration assumptions are you making today that could be dangerously optimistic?
• Which systems must integrate at cutover without exception (select all that apply)? Options: Primary EHR, Emergency Dept systems, RIS, Modality gateways, AI deployment platform, Vendor-specific viewers, Other
• What standards and protocols are mandatory for you—DICOM, FHIR, HL7, XDS, SMART on FHIR, or specific vendor APIs? Options: DICOM, FHIR, HL7 v2/v3, XDS, SMART on FHIR, Vendor APIs, Other
• Describe any past integration projects that took longer or cost more than expected—what surprised you?
• How important is a single-sign-on and unified workstation experience to radiologist adoption? Options: Critical, Important, Nice to have, Not important

Migration Appetite: Fast Cutover or Phased Confidence?

• Would you prefer a big-bang cutover, phased waves by facility/modality, or a hybrid approach—and why? Options: Big-bang, Phased waves, Hybrid, Undecided
• What’s the most realistic migration window—weekend cutover, nightly syncs, or multi-week migration windows? Options: Weekend cutover, Nightly syncs, Multi-week waves, Continuous coexistence
• What rollback, validation, and contingency plans do you require before a cutover is approved?
• Who will own migration tasks, validation, and sign-off on your side? Please name roles and responsibilities.
• What migration risks feel most terrifying to you—lost studies, indexing errors, performance degradation, or clinician disruption? Options: Lost studies, Indexing errors, Performance drop, Clinical workflow disruption, Security exposure, Other

Adoption and People: Will Clinicians Actually Use It?

• How do your radiologists typically respond to new tools—enthusiastic early adopters, cautious pragmatists, or resistors? Options: Early adopters, Cautious pragmatists, Resistors, Mixed
• What training and change management has worked for you in the past—and what failed?
• Which metrics will show us that clinicians are actually using and benefiting from the new platform? Options: Login/use rates, Read times, AI utilization, EHR access frequency, User satisfaction scores, Other
• If a subset of users refuses to adopt, what political or operational consequences should we anticipate?
• Would you consider a pilot with a small group of champions before broad roll-out, and what would success look like for that pilot? Options: Yes — pilot, No — full roll-out, Maybe — need details

Constraints, Must‑Haves, and Red Lines

• What are the non-negotiable requirements—technical, clinical, legal, or budgetary—that would stop a deal if unmet?
• Are there vendor or technology relationships you cannot replace (e.g., long-term contracts with a modality vendor)? Options: Yes — must keep vendor integration, No — open to replacement, Unsure
• Which commercial terms are deal-breakers: data ownership, indemnity, support SLAs, or pricing structure? Options: Data ownership, Indemnity, Support SLAs, Pricing model, Other
• What is your absolute latest go/no-go date to meet regulatory, surgical, or enterprise program deadlines?
• If we can’t meet one constraint, which is most negotiable and which is immutable?

Decision Rhythm: How Quickly Can You Move?

• If we present a recommended scope and price tomorrow, how quickly could your team evaluate and say yes or no? Options: Within 2 weeks, 2–6 weeks, 6–12 weeks, More than 12 weeks, Unsure
• What final approvals are required (legal, security, clinical governance, board), and how long do each typically take?
• Which internal stakeholders tend to extend timelines, and what information do they need to move faster?
• What would make you accelerate a decision—clear ROI, pilot success, executive sponsorship, or regulatory pressure? Options: Clear ROI, Pilot success, Executive sponsorship, Regulatory need, Other
• Realistically, how committed are you to exploring consolidation and modernization on a scale that impacts the entire enterprise? Options: Fully committed, Open but cautious, Piloting only, Not committed

Quick Snapshot: Your Imaging Footprint

• Which facility types and sites should we include when we talk about your imaging estate? Options: Single hospital, Multi-hospital system, Ambulatory imaging centers, Outpatient clinics, Teleradiology partners, Imaging joint ventures, Other
• Roughly how many studies does your organization generate per year (across the scope above)? Options: < 50,000, 50,000–150,000, 150,000–500,000, 500,000–1,000,000, > 1,000,000, Unknown / estimates vary by site
• Which imaging modalities are significant drivers of volume or complexity for you? Options: X-ray/DR, CT, MRI, Ultrasound, Nuclear medicine/PET, Mammography / DBT, Interventional radiology, Other
• Can you list the core imaging vendors and primary archive/PACS/VNA platforms in use today (vendor + approximate version or deployment year)?
• Which EHR(s) and RIS systems should we expect to integrate with or consider in scope?

Who's Actually Holding the Keys?

• If a single person could block or accelerate an imaging consolidation, who is that person and why?
• Which stakeholders need to sign off on architecture, clinical workflow, and budget respectively? Options: Radiology director(s), Imaging IT manager(s), CIO/VP IT, CMO/Chief Medical Informatics, Facility leadership, Procurement, Security/Compliance
• Who currently owns operational responsibility for archives vs who owns clinical application decisions (same team, separate, or split by site)? Options: Same team for both, Ops owns archives; clinicians decide apps, IT owns both, Split by site, Other
• How do governance and approval timelines typically unfold—weeks, months, quarters—and what common blockers slow decisions? Options: Weeks, 1–3 months, 3–6 months, 6–12 months, Longer / multi-year
• Who else should we include early in discovery to avoid late surprises (names/titles or roles)?

Where the Data Lives — and How Fragile It Is

• How confident are you that you could export and fully restore any imaging study without service-impact today? Options: Extremely confident, Mostly confident with caveats, Low confidence, We haven’t tested this
• What types of archives/storage are in use (select all that apply)? Options: Vendor PACS archive, Vendor VNA, On-prem object storage, Cloud object storage (vendor-managed), Tape / offsite cold storage, Hybrid mix
• What's your approximate imaging storage footprint and retention policy (TB and years)?
• Do you have studies in proprietary or legacy formats (non-standard DICOM, private tags, burned-in images) that complicate migration? Options: None / mostly standard, Some legacy/proprietary cases, Significant proportion, Unknown
• Have you experienced data integrity issues, silent corruption, or lost studies in the past 3 years? If yes, describe frequency and impact.

Integration Reality Check: Beyond the EHR Name

• Are images truly accessible inside the EHR for end users, or does access still route them to separate viewers and extra clicks? Options: Embedded viewer with full functionality, Embedded basic viewer / limited features, Links that open separate viewer, Separate viewer only, Varies by site/provider
• Which integration standards and paths are live today between imaging systems and clinical systems? Options: DICOM C-STORE, DICOMweb, WADO, HL7 orders/results, FHIR imagingStudy/DiagnosticReport, IHE profiles (XDS-I etc.), Custom APIs
• How mature is patient matching across systems (single MPI, probabilistic matching, manual reconciliation)? Options: Enterprise MPI / strong matching, Site-level MPI / imperfect, Probabilistic matching with manual corrections, Manual reconciliation common, Unknown
• Do clinicians reliably receive prior studies and structured reports in their workflow? Where do gaps show up most often?
• What integrations (EHR, ADT, RIS, AI gateways) are strategic priorities to fix or deepen in the next 12 months? Options: EHR image embedding, RIS workflow/order sync, ADT / patient identity hardening, AI integration pipeline, Reporting / analytics export, Other

Migration and Failure Modes — What Keeps You Up at Night?

• If you had to start a full archive migration tomorrow, what single technical or organizational failure would derail it?
• Which migration risks do you consider highest priority to mitigate? Options: Data loss/corruption, Index and metadata mismatch, Unacceptable downtime, Unsupported codec/format edge cases, EHR desynchronization, Contractual/vendor cooperation
• Have you performed migrations before? Describe one success and one painful lesson (who led it, timeline, outcome).
• What maximum service outage or degraded-function window is clinically acceptable for imaging services during migration? Options: No outage tolerated; zero downtime target, < 1 hour per system, 1–4 hours, Overnight windows only, Tolerate multi-day for non-critical services
• Do you have an internal rollback/fallback plan and named owners for migration activities? If so, who are they?

Security & Risk: Where Small Gaps Become Big Problems

• If a malicious actor targeted imaging systems tonight, how quickly could your team detect and limit exposure? Options: Immediate detection and containment, Within hours, Within days, Likely days to weeks, We don’t know
• Which of the following security controls are implemented for imaging systems? Options: Encryption at rest, Encryption in transit, Role-based access control / IAM, Network segmentation / VLANs, SIEM / centralized logging, MDR / SOC monitoring, Multi-factor authentication
• Do third-party vendors, reading services, or cloud partners have direct access to PHI in imaging systems, and how is that access governed? Options: Yes, governed by strict access controls and contracts, Yes, governed but with gaps, Limited third-party access, No third-party access
• When was the last tabletop or live exercise for imaging-specific incident response (ransomware, data breach)? What did it reveal? Options: < 6 months, 6–12 months, 1–2 years, Never / unknown
• Are there unresolved compliance or audit findings related to imaging (HIPAA, NIST, local policy)? If yes, summarize.

Workflows & Clinical Experience: Where Tech Meets Care

• Do your radiologists feel the current reading workflow increases productivity—or are they constantly working around system limits? Options: Significant productivity gains, Some gains with pain points, Neutral / mixed, Mostly working around limitations, Strong dissatisfaction
• Which advanced tools are in active use in reading workflows today (select all that apply)? Options: 3D advanced visualization, AI/algorithm integration, Structured reporting templates, Voice recognition / speech-to-text, Worklist orchestration/prioritization, Peer review/QC tools
• How much time do referring clinicians spend accessing images (embedded in EHR vs separate viewer)? Any known complaints about availability or user experience? Options: Mostly embedded and usable, Embedded but limited features, Mostly separate viewer, Significant clinician complaints
• What are the top three clinician or radiologist complaints today (be specific with examples and frequency)?
• How do you currently measure radiologist productivity and report TAT, and are those metrics shared with clinical leadership? Options: Yes, shared regularly, Measured but not shared, Ad hoc metrics only, Not measured

Cost, Contracts, and Hidden Complexity

• How often do renewal conversations reveal unexpected charges or constraints tied to imaging contracts? Options: Regularly, Sometimes, Rarely, Never / no renewals yet
• Which imaging cost categories are material today (select all that apply)? Options: Maintenance & support fees, Storage capacity costs, Cloud egress / bandwidth, Licensing for viewers/advanced tools, Third-party reading or hosting, Migration / professional services
• What are the typical contract end dates or renewal windows we should be aware of (vendor + timeframe)?
• Are there contractual barriers to moving data (eg, egress fees, proprietary formats, multi-year clauses)? If yes, please specify. Options: Yes, significant barriers, Some barriers but negotiable, No major barriers, Unknown / legal review needed
• Who in finance/procurement will need scope details to cost a consolidation effort, and what financial metrics matter most to them?

If Nothing Changes: The Likely Short-Term Outcome

• If you keep the current architecture and processes for the next 12 months, what is the single most likely negative outcome you expect?
• Which consequences worry you most if consolidation or remediation is delayed (select up to three)? Options: Rising storage and maintenance costs, Increased downtime and clinical disruption, Security breach / regulatory fines, Radiologist turnover due to poor UX, Inability to adopt AI/advanced tools, EHR integration failures
• How soon would you want a technical discovery workshop or deep inventory session to address these risks? Options: Immediately / within 2 weeks, 1 month, 1–3 months, 3–6 months, Undecided
• What artifacts would be most useful for our next session (examples: PACS/VNA inventory, DICOM sample sets, storage metrics, contract summaries)? Please list what you can provide.
• Who are the named owners we should invite to a technical deep-dive (role, name, and best contact)?

Quick Pulse: Where We Really Are Right Now

• Which phrase best describes your team's current deployment readiness? Options: Planning stage — no migrations started, Pilot migrations complete, Multiple waves planned, not started, Active cutovers underway, Post-cutover stabilization
• Tell us briefly about the last imaging migration your team ran and one thing that surprised you about it.
• Which systems and archives currently store production imaging that must be consolidated (select all that apply)? Options: Vendor A PACS, Vendor B PACS, Local modality archive, VNA / enterprise archive, Cloud archive, Point solution (advanced viz/AI), Other
• What is your typical monthly inbound DICOM study volume (approx)? Options: < 10k, 10k–50k, 50k–200k, 200k–500k, > 500k
• Who on your side will be the primary contact for scheduling and day‑of cutover decisions? (Name and role)

Are You Comfortable Leaving Data Mapping to Chance?

• Do you currently have a canonical data model or mapping specification that standardizes study metadata across sites? Options: Yes — formal spec exists, Partially — some mappings documented, No — mappings ad hoc per system, Unsure
• Which metadata fields do you consider non-negotiable to preserve exactly during migration? Options: Patient ID/MRN, Accession number, StudyInstanceUID, SeriesInstanceUID, Study date/time, Referring physician, Procedure codes (CPT), Radiologist report links, Other
• How heterogeneous are the DICOM tag implementations across your sites, and how long have you been managing that variability? Options: Highly heterogeneous — years, Moderately heterogeneous — months to years, Mostly consistent — recent minor differences, Not sure
• Describe a specific edge case (an exam type, modality, or vendor behavior) that you worry could break during mapping.
• Would you be open to a lightweight sample mapping run (small data set) to validate assumptions before full waves? Options: Yes — recommended, Maybe — need details, No — prefer full validation later

Who Really Has the Keys — Access, Accounts, and Security Controls

• If we gave a list of required service accounts and admin privileges today, would you be confident we could provision them within the proposed timeline? Options: Yes — provisioning process established, Partially — some approvals slow, No — approvals take too long, Unsure
• Which authentication and access models are in use for imaging tools at your sites? Options: Active Directory/LDAP, SAML/OAuth SSO, Local accounts only, Clinical single sign‑on (SSO), API keys/service accounts, Other
• How do you feel about the current level of visibility into privileged access (admins, service accounts) for imaging systems? Options: High visibility and logging, Partial visibility — gaps exist, Low visibility — concerning, Not sure
• Which encryption and network controls must be maintained or implemented for migration traffic? Options: TLS/DICOMweb (in transit), VPN/MPLS segmented network, Encryption at rest, IP allowlists, MFT with audit, Other
• Who is the security or compliance owner we should loop into migration planning (name and role)?

If Tests Fail, How Fast Can You Recover?

• Do you have a dedicated test environment that mirrors production for imaging systems and integrations? Options: Full mirror (recommended), Partial mirror (some systems), No — we test in a subset of prod or not at all, Unsure
• When you run validation tests today, which of these do you execute routinely? Options: Image integrity checks (pixel-level), EHR access/launch tests, AI call/response tests, Report linking and workflows, Performance/load tests, Security/authentication tests
• What are your acceptable Recovery Time Objective (RTO) and Recovery Point Objective (RPO) for the migration window? Options: RTO < 1 hour / RPO < 15 min, RTO 1–4 hours / RPO 15–60 min, RTO 4–24 hours / RPO hours, Longer windows acceptable / unspecific
• Describe your rollback decision process and who can call a stop or rollback during cutover.
• Have you performed a dry run of a cutover (end‑to‑end) in your environment before? If yes, what failed and what we learned. Options: Yes — multiple dry runs, Yes — one dry run, No — we rely on checklist testing, Not applicable

Who’s Actually Going To Own This — Naming Clear Accountability

• Which of the following roles will be accountable for migration and go‑live decisions on your side (select all that apply)? Options: Radiology Informatics Director, Imaging IT Manager/Director, PACS Administrator, Clinical IT/Infrastructure Lead, CISO or Security Officer, Clinical Operations/Dept Chair, EHR Integration Lead, Other
• For each role you selected, please list the named person and their preferred contact method.
• Do you have an established RACI or governance board for deployment decisions? Options: Formal RACI in place, Informal governance with known stakeholders, No RACI — decisions ad hoc, Unsure
• How do you prefer escalations be handled during migration windows (phone call, war room, ticketing priority, other)? Options: Dedicated war room + phone, Primary phone escalation then ticket, High-priority ticket with SLAs, Email only, Other
• What authority does your vendor partner have to make emergency config changes if critical issues arise during cutover? Options: Full admin with written approval, Admin with on-call approval, No admin — must route through our IT, Varies by environment

Does Integration Truly Work in Your EHR Workflow?

• How are clinicians expected to access images from the EHR after migration (select all that apply)? Options: Embedded zero-footprint viewer, Contextual launch to full viewer, Static links to external viewer, Thumbnail/preview only, CDS links or AI results in-chart, Other
• Do you require single sign‑on between EHR and imaging (SAML/OAuth) for all clinician groups? Options: Yes — mandatory, Preferred but not required, No — separate login acceptable, Unsure
• Which integration standards must be supported in your environment? Options: DICOM Q/R, DICOMweb, HL7v2, FHIR ImagingStudy/DiagnosticReport, XDS/XDS-I, Custom APIs, Other
• Share an example where imaging in the EHR caused a clinical workflow slowdown or patient care delay — what happened and why it mattered.
• What is the maximum acceptable time from clicking a study in the EHR to images rendering for clinicians? Options: < 5 seconds, 5–15 seconds, 15–30 seconds, > 30 seconds — problematic

What Would Success Look Like on Day One?

• Which of these acceptance criteria are mandatory for you on cutover day (select all that apply)? Options: All studies accessible with correct patient mapping, EHR launch and context preserved, No missing reports or broken links, AI integrations successfully calling and returning results, Performance within SLA thresholds, Security and audit logging enabled
• How will your team measure image integrity post-migration (pixel comparison, checksums, spot-check sampling, other)? Options: Pixel-level checks (automated), Checksums/hash validation, Sample spot-checks by modality, Report/sample reconciliation, Other
• Who needs to sign off on day‑one acceptance and what is the minimum set of signatories?
• If one acceptance criterion fails, what is your preferred remediation path (pause cutover, continue with exceptions, rollback, hybrid approach)? Options: Pause and remediate, Rollback to previous state, Proceed with exception tracking and quick fix, Other
• What monitoring or alerting must be in place immediately after cutover to feel confident the environment is stable? Options: Real-time ingestion dashboards, EHR access latency alerts, AI call failure alerts, Security audit logs monitored, User-reported issue queue with SLA

Signals of Risk You Might Be Ignoring

• Which potential risks keep you up at night about migration and why?
• Do you have legacy devices or modalities that are unsupported or end‑of‑life that must be handled specially? Options: Yes — many, Yes — a few known devices, No — devices supported, Unsure
• Are there contractual, regulatory, or data‑residency constraints we need to consider when moving or storing images? Options: Yes — strict constraints, Some constraints — manageable, No major constraints, Unsure
• How would you rank your top three migration risks from this list? Options: Data mapping errors, Authentication/SSO failures, Performance/latency, AI integration failures, Report linking loss, Security/compliance gaps, Rollback inability
• For each risk you selected, what mitigation or contingency is already in place?

Next Steps: Commitment, Timelines, and Small Bets

• Thinking realistically, when do you want the first migration wave to occur? Options: Within 30 days, 30–90 days, 3–6 months, 6+ months, Undecided
• Which of these preparatory steps would you prioritize in the next 30 days? Options: Sample data mapping run, Provision test environments, Security validation and penetration test, RACI finalization and sign-off, EHR integration smoke test, Other
• What would make you say 'we’re ready' in writing — a single-sentence criteria that commits your team?
• Who else on your executive or clinical team should we brief before we schedule a dry run? Options: CIO, CISO, Chief Medical Officer, Department Chair, Clinical Operations, Other
• Would you like us to prepare a one‑page readiness checklist and a proposed timeline based on your answers? Options: Yes — please prepare, Maybe — I need more info, No — we have our process

Setting the Table: Quick Context

• Which role are you answering these questions as? Options: Radiology Informatics Director, Imaging IT Manager, Department Chair, CIO/CISO, Technical Project Manager, Other
• How many facilities and distinct imaging sites does your organization operate today? Options: 1–3, 4–10, 11–25, 26–50, 51+
• What is your approximate monthly imaging study volume across all sites? Options: <10k, 10k–50k, 50k–150k, 150k–500k, 500k+
• Which imaging modalities and clinical applications are core to your operations right now? Options: CT, MR, X‑ray/DR, US, Nuclear/PET, Cardiac, Dental/CBCT, 3D/Advanced Viz
• Who is the primary budget owner for imaging infrastructure in your organization? Options: Radiology department, IT/Infrastructure, CIO office, Capital planning, Combination, Unsure
• If you had to name one immediate priority for imaging this year, what is it?

If This Were a Fire Alarm, Where Would It Ring First?

• What single failure or outcome would cause you to escalate this program to executive leadership right now? Options: Clinical downtime, Major migration data loss, Regulatory breach, Radiologist attrition/productivity loss, Large unexpected cost, Other
• Tell us about a recent incident that felt like a near miss or real failure—what happened and who felt the consequences most?
• How often do such incidents or near misses occur today? Options: Weekly, Monthly, Quarterly, Rarely, Never
• When those problems occur, what are the typical downstream effects on patient care, report turnaround, or revenue?
• Which stakeholders do you find are most vocal or most impacted when things break (pick all that apply)? Options: Radiologists, Referring physicians, Nursing/Clinicians, IT operations, Compliance/legal, Executive leadership

Are You Tolerating Complexity or Managing It?

• If you had to describe your current imaging estate in one sentence, what would it be?
• How many distinct PACS/archives/vendors are actively storing and serving studies today? Options: 1, 2–3, 4–6, 7–10, 11+
• Which of the following best represents your integration landscape? Options: Single EHR, few imaging integrations, Multiple EHRs, ad hoc imaging links, Enterprise EHR + formal embedded viewer, Mixed EHRs with centralized archive, Other
• What are the top three technical failure modes you worry about (e.g., migration loss, vendor lock-in, HL7/DICOM mismatch, performance)? Options: Migration data loss, Vendor lock‑in, Integration failures (EHR/AD), Performance/latency, Security gaps, AI integration failures
• How long have you been operating with the current level of complexity? Options: <1 year, 1–3 years, 3–6 years, 6+ years
• Who on your team currently owns day‑to‑day archive hygiene, integrations, and vendor escalations? Options: Imaging IT, Biomedical engineering, Vendor-managed service, Shared/Matrix team, We don't have a clear owner

What Would Winning Actually Feel Like for Your Team?

• If you woke up a year from now and this program had been a clear success, what would be different in the daily life of a radiologist?
• Which measurable outcomes matter most to you for a successful program (choose up to 4)? Options: Consolidation of archives, Report turnaround time (TAT), Total cost of ownership reduction, Radiologist productivity, EHR‑embedded access, AI adoption rate, Security/compliance improvement
• For the KPIs you selected, what are your current baselines (if known) and realistic target improvements?
• Which of these would be non‑negotiable for you to consider moving forward? Options: Zero critical downtime during cutover, No loss of studylevel metadata, EHR embedded viewer for referring MDs, Vendor‑neutral archive retention, Clear data ownership clause
• How would success be perceived differently by clinical leadership versus IT/finance in your organization?

What Would Block You From Saying Yes?

• What are the deal‑killers you cannot tolerate in a vendor or solution? Options: Opaque pricing, Unclear data ownership, Insufficient EHR integration, No proven migration methodology, Weak security posture, Poor radiologist UX
• Have you had prior vendor engagements that failed to deliver—what were the root causes and lessons learned?
• Which contractual or procurement constraints might slow or block a decision here? Options: Capital budget cycle timing, Consortium/IDN approvals, Legal/compliance reviews, Vendor pre‑qualification lists, Other
• How do you weigh technical capability versus commercial terms when choosing a partner? Options: Technical capability first, Commercial terms first, Balanced equally, Depends on program phase
• What are your expectations around data ownership, portability, and exit terms?

Imagine the Integration: Who, What, When?

• If this program starts tomorrow, who on your side would be the named owner of migration, integrations, and clinical adoption?
• What does your ideal timeline look like from vendor selection to first cutover (choose the nearest range)? Options: <3 months, 3–6 months, 6–9 months, 9–12 months, 12+ months
• Which of these deployment models aligns best with how you want to run the project? Options: Big‑bang enterprise cutover, Phased by facility/wave, Modular feature rollouts (archive first, then apps), Hybrid cutover
• What internal resources can you commit to the project (select all that apply)? Options: Dedicated project manager, Clinical champions (radiologists), Imaging IT engineers, Integration specialists, Vendor liaison, Limited internal time
• What would need to change in your organization to hit the timeline you just selected?

Where Does Patient Safety and Security Keep You Up at Night?

• If a single security or compliance gap were exposed tomorrow, which one would cause the most concern? Options: Unencrypted PHI at rest, Improper access controls, Incomplete audit trails, Third‑party AI data handling, Failed backups/DR
• Which of the following controls do you currently enforce across your imaging estate? Options: Encryption at rest, Encryption in transit, Role‑based access control, SAML/SSO, Logging and SIEM integration, None of the above
• Have you had any regulatory findings or security incidents related to imaging systems in the past 3 years? Options: Yes, No, Not sure
• How do you expect a vendor to demonstrate compliance and prove safe handling of AI calls and third‑party integrations? Options: Formal SOC/ISO reports, Penetration test results, Architecture whitepaper, Shared runbooks, Customer references
• Who on your security/compliance team must sign off before any migrations or integrations proceed?

How Much Risk Are You Willing To Accept On Cutover Day?

• What is the maximum acceptable downtime window for clinical users during any cutover? Options: Zero downtime required, <1 hour, 1–4 hours, 4–12 hours, 12+ hours
• What level of data re‑synchronization or replay would be acceptable if an issue occurs during migration? Options: Real‑time no loss, <1% replay, 1–5% replay, >5% replay unacceptable, Unsure
• Which rollback or contingency expectations do you have if a wave experiences unexpected issues? Options: Immediate rollback to old system, Pause and manual reconciliation, Partial rollback for affected sites, No rollback, fix forward
• What kinds of tests and gates must pass before you authorize a go/no‑go (select all that apply)? Options: Image integrity checks, EHR access verification, AI call validation, Performance/load tests, Security penetration tests
• Who must be present and who must sign off for a final go/no‑go decision? Options: Radiology lead, CIO/CISO, Project manager, Vendor PM, Clinical informatics, Other

Proof in the Pudding: How Will You Validate Success?

• Which acceptance tests will be required to consider the migration and integration complete? Options: Image integrity verification, EHR embedded viewer tests, AI result end‑to‑end calls, Reporting and analytics validation, Security and audit trails
• How will you sample studies for validation (e.g., percent, modality focus, random, targeted edge cases)? Options: Random sampling, Modality‑focused, High‑complexity cases only, Percent of total studies, Customer selects scenarios
• What specific pass/fail criteria do you expect for image integrity and metadata fidelity?
• Who signs the final acceptance and who owns the post‑go live backlog of issues? Options: Radiology director, IT director, Clinical informatics, Vendor acceptance lead, Joint signoff
• After go‑live, which KPIs do you want monitored and for how long before we call the program stable? Options: 30 days, 60 days, 90 days, 6 months, Other

Next Steps: What Would Make Us Earn Your Trust?

• What would a credible pilot look like to you (scope, duration, success criteria)?
• Which stakeholders should we invite to the next conversation to make progress? Options: Radiology leadership, Imaging IT, CIO/CISO, Clinical informatics, Procurement, Vendor technical lead
• What are your preferred decision checkpoints and when is your next procurement window? Options: Weekly review, Biweekly steering, Monthly decision, Quarterly procurement cycle, Ad hoc
• What evidence or deliverables would help you feel comfortable progressing to a commercial discussion? Options: Detailed migration plan, Reference site visit, Security/pen test reports, TCO model, Pilot results
• Is there anything else we should know that would change how we approach a proposal for you?