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| As a healthcare provider—the goal is to deliver patient care and achieve desired patient outcomes. This is done by striving for operational excellence. TNC’s company mission and strategic difference is to help you achieve this goal. Technological change is inevitable and ever increasing. Implementing change to achieve desired outcomes through improved workflow is a demand placed upon today’s healthcare administrators. Whether purchasing new equipment or integrating legacy equipment with new technology— True North Consulting and Associates Inc. will be the needed resource to help manage the risks associated with technological change and achieving strategic objectives. TNC takes a collaborative approach to change management initiatives and has developed consulting services with this methodology in mind. TNC offers comprehensive insightful thinking and creative problem solving from thought leaders who are focused on the challenges associated with DI. The TNC difference: We are an independent third-party. True North Consulting focuses solely on helping healthcare providers realize their key strategic goals and attain operational excellence while reducing cost structures across the entire healthcare enterprise. TNC offers DI consulting services in the following areas: Picture Archiving and Communication Systems (PACS) Networking |
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| Picture Archiving and Communication Systems: Infoway PACS Planning Canada Health Infoway (CHI) is in the process of changing Canada’s Healthcare landscape through the implementation of a Pan-Canadian Electronic Medical Record (EMR). Diagnostic Imaging is one of the largest contributors of data to the Patient EMR, therefore, numerous jurisdictions are now engaging with CHI as one of the partners to achieve this goal. Infoway has detailed a process for jurisdictions to complete as due diligence in preparation for their role in a jurisdictional Diagnostic Imaging repository (DI-r). Three key stages of work are recommended: • Phase 0 Deployment Planning; • Phase I Implementation Planning; and • Phase II Implementation. TNC is experienced in PACS implementation – over 25 to be exact. We understand PACS as perhaps few other consulting firms do. TNC understands the architectural, technical and change management requirements for implementing PACS successfully. Our clients achieve a higher level of integration and operational efficiencies resulting in increases in productivity and realized savings than others who simply accept the 70% of the benefits of PACS delivered out of the box. We are considered by many as Subject Matter Experts and have worked independently and collaboratively on numerous projects to achieve 90 – 95% of PACS benefits. This has prepared TNC to be one of the best resources to lead or have on the team for Infoway DI Planning Initiatives. We understand the Information Technology requirements of the DI enterprise and know how this needs to support the overall enterprise and jurisdictional EMR. PACS Vision and Mission Statement Development A sound Vision and Mission Statement is vital to all change management initiatives. TNC compiles essential data through a series of on-site interviews with all stakeholders and key management team members. The result is a Vision and Mission Statement that will direct a strategic initiative while offering guidelines for decision-making. The crystallization of these statements is completed collaboratively and presented enterprise-wide to provide direction and focus in the launch of a PACS. back to top PACS Strategic Plan Development Strategic Planning is critical in establishing how and when strategic initiatives will be attained. The PACS Strategic Plan will serve to bring champions on board by detailing the due diligence process being followed in the investigation and implementation of PACS. Key elements in a comprehensive strategic plan are: • Definition of Objectives • Definition of Desired Outcomes • Definition of Key Measurables • Definition of Scope of Project • Roles and Responsibilities • Due Diligence Process • Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis) • Required Resources – physical, personnel and financial • Policies and Strategic Guidelines • Quality of PACS Implementation • Timelines to Clinical Readiness • Requirements for Critical Path Plan back to top PACS Operational Review The PACS Operational Review is focused on two areas within DI departments and clinics. First is the collection of data to measure current operational efficiencies; and second is the documentation of existing workflows within the film-based environment. This PACS Operational Review compiles data on historical exam volume, projected growth rates, number of staff by role/modality, current supply costs, and current labour costs to give a snapshot in time of operational efficiencies. These measurements set the stage by providing a baseline for comparison with measurements taken after PACS has been implemented to validate achieved operational efficiencies. The measurements also provide fundamental data required in the construction of the PACS Business Case. The PACS Operational Review also takes the PACS Steering Committee through a process to document existing film-based workflows. Workflows are documented for inpatients and outpatients for each modality. This process is done to identify where process steps can be modified or eliminated through the integration and implementation of PACS with other Information Systems (IS). back to top PACS Connectivity and Interfacing Report Understanding the DICOM and Health Level 7 (HL-7) interfacing requirements is not trivial. Completing an inventory of existing DICOM Service Classes and Subject Object Pairs (SOP) Classes that are currently installed is the first step. Comparing this inventory against what is needed to achieve the desired integration outcomes requires a working knowledge of DICOM as a standard. This report identifies current inventory; required inventory; and projected costs to achieve desired integration between the RIS with modalities, modalities with PACS, and PACS with RIS. back to top PACS Needs Requirement Document The PACS Needs Requirement Document is one of the most pivotal stages in the seek, procure and implementation process for PACS. This document defines the final scope of project; objectives; quality of implementation; desired functional capabilities by PACS component; workflow scenarios and RFP questions; projected archive storage requirements; projected network demands; system fail-over, redundancy and disaster recovery strategies; integration requirements; and budgetary estimates for the desired configuration. The process to come to consensus across the healthcare enterprise is key to the success of the PACS initiative and provides defined requirements that the Request for Proposal (RFP) can be written from. back to top PACS Business Case Development TNC has developed a number of defensible Business Cases for the acquisition of a PACS for single and multi-site facilities in the Canadian healthcare environment. Our experience can be leveraged in determining areas for cost avoidance, cost containment, and increased productivity across numerous cost centers within an organization that may not have been previously considered. Hard costs and defensible soft cost benefits are developed and detailed for each Business Case. back to top Development of PACS RFI/RFP Developing a Request for Information (RFI) or RFP can be significantly accelerated through the use of a quality template that has been refined through reiterations on known questions and technical specifications. TNC has a library of numerous proposals designed to accelerate the time to market with proposals customized to reflect each facilities’ specific needs and requirements while protecting an institution from the numerous pitfalls resulting from missed details. Our third party, independent approach ensures specifications are written to meet clients’ needs as opposed to the needs of a specific vendor. Additionally, well-written RFP’s can be leveraged to define key technical specifications, performance criteria and integration requirements for vendor agreements, resulting in a more timely negotiation phase. TNC’s RFP templates cover implementations ranging from Tele-Radiology to Mini-PACS to Enterprise-wide filmless and paperless PACS implementations. back to top PACS RFI/RFP Technical Evaluations and Recommendations The technical evaluation of numerous RFI’s/RFP’s in an accelerated and accurate methodology will allow PACS Selection Committees to rapidly determine short-list candidates. Technical assessments using criteria such as best single source, lowest possible cost while meeting minimum specifications, or best integrated solutions, etc. can be issued to provide clear recommendations for acquisitions. The evaluation of responses will be significantly accelerated and is supported with a report indicating key differences and key negotiating terms. Management of vendor presentations and site visits can yield significant information in the acquisition process when clear objectives are established and shared with vendors of choice during the selection process. TNC will manage and participate in this process to ensure all appropriate information is collected to facilitate the best possible decision. back to top PACS Implementation/Critical Path Plan Development Due diligence on any initiative requires attention to detail and a logical step by step plan that accounts for all dependencies. The success of each well-developed strategic initiative is dependent on the quality of the Implementation Plan and Critical Path Plan. TNC has experience in numerous implementations and will provide a knowledge transfer to key decision makers on the process and timing required to meet deadlines. TNC offers the service of implementing the plan as well. Our consultants will accept project management responsibilities to ensure plans meet the defined quality of implementation and are delivered on time. back to top PACS Negotiation and Value Strategy Development Value is defined in many different ways, and economic value is just one measure. The lowest price is not always the law. TNC believes that finding the best value whilst meeting all parties’ needs is the law. Often, value is left on the negotiating table and not capitalized on by either party. Consideration on how to better access additional value propositions in the negotiating room can provide significant win/win results for both the healthcare provider and the vendor of choice. Defining partnerships that provide value to each group above and beyond the exchange of monies is an area our consultants are experienced in. Assessing these opportunities and developing a strategic approach that will lead to the greatest probability for success requires first-hand knowledge and expertise of current and future market trends in medical technology. Strategic negotiations lead by an experienced third party can uncover additional value for both parties and lead to realized win/win outcomes. back to top Acceptance Testing for PACS An Acceptance Test Plan (ATP) for a single modality or complex enterprise-wide PACS involving multiple phases installed over time is critical and requires a different approach to that of a DI modality. TNC suggests the development of an ATP that reflects hospital needs and objectives prior to negotiation of the PACS agreement. The ability to arrive at a common understanding between the hospital and the vendor for acceptance will resolve numerous issues after implementation. TNC has ATP’s that have been refined through use in numerous institutions and will provide the service of third party adjudication by independent professionals during the execution of the test plan. back to top Acceptance Testing with a Twist There are two stages in which an ATP is conducted: At the time of delivery to establish clinical readiness; and 30 days prior to warranty expiration. A mini-ATP at the second phase will establish strengths, weaknesses and discrepancies in the system and allow time for adjustment while still under warranty. This process can pay dividends in terms of long-term cost avoidance and risk management phases. back to top Additional PACS-Related Services Networking Access to a third party, independent network consultant can mean the difference between moving forward with confidence or risking a budget on too much or too little network bandwidth. Determining the proper scope of a project and alternatives to the approach can deliver solutions that otherwise may not have been considered. TNC works in collaboration with Solution Alternatives Inc. to provide IS departments with the information required to establish needs objectively and provide recommendations for bandwidth and upgrades to support IS and PACS initiatives. back to top Computed Radiography vs. Digital Radiography The debate continues over choosing Computed Radiography (CR) or Digital Radiography (DR). How does one determine the correct mix? What technology should be implemented for which application? What technology will be available over the long run? What is the correct choice for the application - selenium, amorphous silicone or CCD technology? Is this another Beta vs. VHS battle? TNC’s independent technical and economic consultation will provide counsel in ensuring all relevant factors have been considered and subsequent risks minimized. back to top CardioPACS The next trend in IS technology in healthcare is the deployment of PACS with Cardiology. Similar to PACS in the DI department yet significantly different due to size of exams, a multitude of formats for numerous exams and the specialized viewing applications to aid diagnosis. Navigating through these differences is not trivial and can offer many locations for risks. TNC is one of the few Canadian consulting firms able to offer assistance in the seek, procure and implementation of CardioPACS as a stand-alone or integrated system with an existing PACS environment. TNC offers a due diligence process for Cardiology that is similar in process yet different in its ability to seek and document the specific needs of Cardiology. Our consultant focused on Cardiology has more than twenty years of experience in Cardiology. Speaking the language, identifying the needs and driving to a successful implementation is the service offered. back to top Diagnostic Imaging Consulting Services Operational Reviews Mini Operational Review The Mini Operational Review focuses on one or two modalities, programs or segments within an organization to determine the level of performance that is being attained. The Mini-Ops Review examines existing operations, workflow, workload, potential growth rates, budget reviews and perceived problem areas. An analysis of the current situation will be submitted, along with relevant solutions, alternatives and recommendations. The Mini-Ops Review serves as a keystone in the development of a needs assessment for new or replacement modalities, changes in existing processes or Mini-PACS initiatives. back to top Full-Scale Operational Review A Full-Scale Operational Review provides an in-depth focus on the complete DI department(s) and clinics. This Review investigates the role of the DI department in both a healthcare enterprise, and if required, an entire region. It examines areas such as workflow and utilization of capacity, support functions, human resource issues, management planning, space issues, future planning, technological change and work/life quality. This comprehensive document clearly defines areas of success, and provides recommendations for improvement and implications when such recommendations are not implemented. back to top Functional Planning The Functional Plan is the logical next step beyond the Operational Review. With a thorough understanding of the DI department’s current performance, strengths and weaknesses, the high level Functional Plan positions institutions to address issues related to mid and long-term direction. The Functional Plan accounts for the DI department’s current and future needs, goals and objectives based on population demographics, political and technology trends. Assistance from an independent, third party consultant offers risk management perspectives and will accelerate the planning process through a dedicated resource assigned with development of the plan. back to top Architectural Review and Workflow The opportunity to begin with a clean sheet of paper to design a room, clinic, department or enterprise is an infrequent occurrence. The early stages of design and plan review are critical in averting significant and costly changes in the future. Logic in design and workflow must be considered as healthcare facilities evolve from film-based systems to electronic environments. TNC will accelerate this process and ensure all avenues have been evaluated before final drawings are approved. A specialized program to support an institution, architect, contractor or project manager can be completed after a single consultation. back to top Equipment Inventory and Condition Analysis Documenting the inventory of equipment across an enterprise or region is not a trivial task. Determining the condition, projected life expectancy and cost of replacement with equipment that will position the enterprise to take advantage of future technology trends is the benefit. TNC will inventory and develop an enterprise or regional report on existing equipment with current condition status. The report will also provide recommendations on projected dates for replacement and costs that will support short, mid and long-term functional planning for the enterprise or region. back to top Outcome Analysis Development of the Strategic Plan and the creation of a Business Plan are key steps in establishing criteria for PACS. Monitoring the project performance in relation to objectives, goals and financial outcomes will provide the feedback necessary in determining how to fine-tune the process. Realizing cost reductions, productivity gains, projected utilization levels and timely reporting are measurables that will indicate when economic goals have been achieved and physician satisfaction attained. TNC will establish pre and post implementation benchmarks in order to monitor and report on these key indicators. back to top Canadian Government Funding Program Partial and/or full government funding opportunities may be available to Canadian healthcare providers for Information Technology implementations within DI. Seeking and securing these funding opportunities requires a logical and well-executed approach, along with a considerable investment of time, resources and expertise. Assessing these programs and developing an approach that will lead to the greatest opportunity for success requires first-hand knowledge and expertise to evaluate each program’s applicability and likelihood for funding for the desired initiative. TNC offers a due diligence process that identifies steps and resources required in the seek, development and application with a strategic approach for the submission of government grant applications. As part of the program TNC will support the application with presentations and liaison with government officials, and provide the required support for the subsequent management of reporting funding of the desired initiative. back to top CT/MRI Application Compiling all the information and assembling this into the application for a CT or MRI application for the Ministry of Health and Long Term Care (MOHLTC) is not trivial. Completing this in a timely manner and communicating only the relevant data in a format that will gain acceptance is the challenge. TNC has experience in this sensitive and political arena. Our consultants offer a full process of collection of data, communication with MOHLTC, development of application submission and follow-up with MOHLTC staff on the application throughout the approval process. The value for the overworked management team is knowing an experienced individual is focused on doing what it takes to ensure a successful application is achieved. Modality Acquisition Modality Strategic Plan Development Strategic Planning is critical in establishing how and when strategic initiatives will be attained. The Modality Strategic Plan will survey internal resources to bring champions on board and will detail the due diligence process to be followed in the investigation and implementation of the new modality. Key elements in a comprehensive strategic plan are: • Definition of Objectives • Definition of Desired Outcomes • Definition of Key Measurables • Definition of Scope of Project • Roles and Responsibilities • Due Diligence Process • Strengths, Weaknesses, Opportunities and Threats (SWOT Analysis) • Required Resources – physical, personnel and financial • Policies and Strategic Guidelines • Quality of Modality Implementation • Timelines to Clinical Readiness • Requirements for Critical Path Plan back to top Modality Inventory and Condition Analysis Documenting the inventory of equipment across an enterprise or region is not a trivial task. Determining the condition, projected life expectancy and cost of replacement with equipment that will position the enterprise to take advantage of future technology trends is the benefit. TNC will inventory and develop an enterprise or regional report on existing equipment with current condition status. The report will also provide recommendations on projected dates for replacement and costs that will support short, mid and long-term functional planning for the enterprise or region. back to top Modality Workflow Documentation The documentation of modality workflows is the first requirement in achieving operational excellence with a new or replacement modality. Defining logical integration points for automation of process that results in efficiencies is best achieved through the review of past or projected workflows. TNC has numerous modality workflows to reference as benchmarks and to accelerate the development of a new modality’s workflow to ensure operational excellence. back to top Modality Connectivity and Interfacing Report Insertion of a new modality into an electronic environment requires planning and attention to detail. Understanding the DICOM and HL-7 interfacing requirements is not trivial. Development of DICOM Service Class and SOP Class requirements in advance of RFP release is critical to achieve the desired integration outcomes without additional surprise costs after the implementation. This report identifies required inventory, projected costs to achieve desired integration between the RIS with modalities and modalities with PACS. back to top Modality Needs Requirement Document The Modality Needs Requirement Document is a pivotal stage in the seek, procure and implementation process for modalities. This document defines the final objectives; scope of project; quality of modality implementation; desired functional capabilities; workflow scenario requirements; projected archive storage requirements; projected network demands; system fail-over and redundancy strategies; integration requirements; and budgetary estimates for the desired configuration. The Modality Needs Requirement Document ensures that key needs are identified and represented in a measurable method for use in the Modality RFP. Ultimately, the document identifies the defined requirements that the RFP can be written from. back to top Modality Business Case Development TNC will develop a defensible Business Case for the acquisition of any modality based on the healthcare enterprises’ geographical, political, staffing surpluses/shortages and medical needs. Our experience can be leveraged in determining areas for cost avoidance, cost containment, increased productivity and clinical viability. Hard costs and defensible soft cost benefits are developed and detailed for each Business Case. back to top Development of Modality RFP Developing a RFP can be significantly accelerated through the use of a quality proposal that has been refined through reiterations on known questions and technical specifications. TNC has a library of numerous proposals designed to accelerate the time to market with proposals customized to reflect specific needs and requirements while protecting an institution from the numerous pitfalls resulting from missed details. Our third party, independent approach will ensure specifications are written to meet clients’ needs as opposed to the needs of a specific vendor. In addition, a well-written RFP can be leveraged to define key specifications for vendor agreements, resulting in a more timely negotiation phase. TNC’s RFP proposals cover products ranging from Ultrasound, Nuclear Medicine, CT, MRI and Angiography to General Radiology and Fluorography. back to top Modality RFP Technical Evaluations and Recommendations The technical evaluation of numerous RFP’s in an accelerated and accurate methodology will allow the Modality Selection Committees to rapidly determine short-list candidates. Technical assessments using criteria such as best single source, lowest possible cost while meeting minimum specifications, or best integrated solutions, etc. can be issued to provide clear recommendations for acquisitions. The evaluation of responses will be significantly accelerated and is supported with a report indicating key differences and key negotiating terms. Management of vendor presentations and site visits can yield significant information in the acquisition process when clear objectives are established and shared with vendors of choice during the selection process. TNC will manage and participate in this process to ensure all appropriate information is collected to facilitate the best possible decision. back to top Modality Negotiation and Value Strategy Development Value is defined in many different ways, and economic value is just one measure. The lowest price is not always the law. TNC believes that finding the best value whilst meeting all parties’ needs is the law. Often, value is left on the negotiating table and not capitalized on by either party. Consideration on how to better access additional value propositions in the negotiating room can provide significant win/win results for both the healthcare provider and the vendor of choice. Defining partnerships that provide value to each group above and beyond the exchange of monies is an area our consultants are experienced in. Assessing these opportunities and developing a strategic approach that will lead to the greatest probability for success requires first-hand knowledge and expertise of current and future market trends in medical technology. Strategic negotiations lead by an experienced third party can uncover additional value for both parties and lead to realized win/win outcomes. back to top Modality Implementation/Critical Path Plan Development Due diligence on initiatives such as implementation of a new modality requires attention to detail and a logical step by step plan that accounts for all dependencies. The success of each well-developed strategic initiative is dependent on the quality of the Implementation Plan and Critical Path Plan. TNC has experience in numerous implementations and will provide a knowledge transfer to key decision makers on the process and timing required to meet deadlines. TNC offers the service of implementing the plan as well. Our consultants will accept project management responsibilities to ensure plans meet the defined quality of implementation and are delivered on time. back to top Acceptance Testing for Modalities The acceptance of any modality or system triggers the beginning of clinical use and the onset of warranty periods. The objective of most ATP’s is to establish the clinical readiness of a system and validation of the products against agreement specifications. A thorough ATP will validate the presence of all components at time of acceptance, the functionality and performance of each component as an independent component, and the functionality and performance of each component as an integrated system. The ability to have an independent third party adjudicate all executions of testing protocols ensures objectivity. TNC’s ATP template will accelerate the ability to present test criteria to vendors during the negotiation phase and include them as part of the vendor agreements. back to top Nuclear Medicine A thorough understanding of regulatory requirements for Nuclear Medicine is invaluable in the areas of Operational, Procedural, Information and Financial Reviews. Acquisition of radiopharmaceuticals and Nuclear Medicine capital equipment agreements can be accelerated through third party assistance and recommendations for a seamless process flow and integration into a DI department and PACS initiative. TNC’s independent, third party consultants will assist the evolution of the Nuclear Medicine department to operational excellence. back to top |
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