A Comprehensive Guide to Selecting and (Potentially) Replacing PACS: Navigating the Decision-Making Processes

Selecting a Picture Archiving and Communication System (PACS) is a strategic decision that impacts radiology workflow, communication, and operational efficiency. Despite its importance, there is limited guidance on structured approaches to PACS procurement. This study aims to describe a comprehensive, data-driven approach to evaluating and selecting a clinical PACS within a radiology department. A six-phase process was developed: team formation, expectation setting, background assessment, initial vendor assessment, virtual demonstrations, and final evaluation. A multidisciplinary committee identified key pillars and concepts for PACS functionality, which informed vendor evaluations through surveys, standardized demonstrations, and a detailed request for proposal. Quantitative and qualitative data were used at each phase to score vendors across multiple dimensions including usability, integration, performance, and cost. Eleven pillars and 236 concepts were defined and weighted to evaluate vendor solutions. Five vendors were shortlisted after an initial presentation. These vendors were invited to provide a virtual demonstration. Three vendors were then selected for onsite assessments using department-generated anonymized datasets. Comprehensive RFPs and cost analyses were incorporated into final evaluations. Ultimately, the incumbent vendor was selected with a recommendation for reevaluation in 3 years, guided by detailed assessment metrics and stakeholder feedback. This case study offers a potentially reproducible methodology for healthcare institutions evaluating PACS solutions. Emphasizing transparency, stakeholder engagement, and data-driven decision-making, the approach should be adaptable to other technology procurement efforts and scalable to smaller projects.