Pacs-Ris-Cr RFP

PACS/RIS/CR
Request for Proposal

DRAFT
CaldwellSomewhere Memorial Hospital
DRAFT 1-14-05
1 About CaldwellSomewhere Memorial Hospital……….
…………………….6
2 Project Overview……………………………………………….. 6
3 Proposal Preparation Instructions……………………………….7
4 Key Goals……………………………………………………….7
5 Clinical Operations and Functionality…………………………..
Patient Registration……………………………………………..
Exam Scheduling……………………………………………….
Exam Ordering………………………………………………….
Film Exams……………………………………………………...
Bone Densitometry……………………………………………..
Computed Radiography…………………………………………
C-Arm…………………………………………………………..
CT-NM-MRI……………………………………………………
US………………………………………………………………
Full Field Digital Mammography………………………………
STAT Exams……………………………………………………
Other Priority Exams……………………………………………
Film Printing……………………………………………………
Diagnostic Reporting……………………………………………
Wet Reads………………………………………………………
Clinical Review…………………………………………………
Archived Exam Retrieval……………………………………….
Interaction between HIS/RIS/PACS……………………………
Teleradiography…………………………………………………
6 System Components……………………………………………..
6.1 System……………………………………………………………
6.2 Network………………………………………………………….
6.3 Database………………………………………………………….
6.4 System Storage……………………………………………………
6.5 Archive System……………………………………………………
6.6 External Information System Interfaces……………………………
CaldwellSomewhere Memorial Hospital 2

6.7 Image Acquisition Systems……………………………………………...
6.7.1 DICOM……………………………………………………….
6.7.2 General Modalities……………………………………………..
6.7.3 Film Digitizer…………………………………………………..
6.7.4 Quality Control Workstation……………………………………
6.8 Image Display Workstation…………………………………………….
6.8.1 Configuration…………………………………………………..
6.8.2 Monitors……………………………………………………….
6.8.3 Monitor Calibration……………………………………………
6.8.4 Performance……………………………………………………
6.8.5 User Interface…………………………………………………..
6.8.6 Exams, Folders, Worklists, and Queries………………………..
6.8.7 Reports…………………………………………………………
6.8.8 Exam Display and Arrangement……………………………..
6.8.9 Image Display and paging……………………………………..
6.8.10 Grayscale Operations…………………………………………
6.8.11 Image Orientation, Zoom, Pan, and Magnify…………………
6.8.12 Region of Interest, Distance, and Angles……………………….
6.8.13 Image Annotation……………………………………………..
6.8.14 Image Identification…………………………………………….
6.8.15 Utility Functions………………………………………………
6.8.16 Control of Hard Copy…………………………………………
6.8.17 3D Tools……………………………………………………….

6.8.18 Cardiology Tools………………………………………………
6.8.19 Orthopedics Tools…………………………………………….
6.8.20 Mammography Tools…………………………………………
6.9 Film Printers…………………………………………………………….
6.10 Web Servers and Workstations…………………………………………
7 Radiology Information System…………………………………………
7.1 Scheduling…………………………………………………….
7.2 Registration…………………………………………………….
7.3 Patient Profile…………………………………………………
7.4 Order Entry……………………………………………………
7.5 Exam Management……………………………………………
7.6 Technologist Station/Procedure Tracking and Charging………
7.7 Film Library Management……………………………………...
7.8 Digital Reporting……………………………………………….
7.9 Mammography Reporting System…………………………….
7.10 Multi Facility Master Patient Index……………………………
7.11 Document Scanning……………………………………………
7.12 Inventory Control……………………………………………..
7.13 Management Reports and Forms………………………………
8 Computed Radiography System………………………………………..
8.2 System Requirements…………………………………………
8.3 Workstation Functionality……………………………………
8.4 Requested Vendor Information………………………………..

9 System Integration……………………………………………………….
9.1 Operations…………………………………………………….
9.2 Security………………………………………………………..
9.3 Reliability………………………………………………………
10 Purchased Components…………………………………………………
10.1 Configuration…………………………………………………
11 Installation and Emplementation………………………………………..
11.1 Hospital Furnished Equipment and services…………………..
11.2 Vendor Furnished Services……………………………………
12 System Acceptance………………………………………………………
13 Training…………………………………………………………………..
14 System Warranty and Maintenance …………………………………….
14.1 Warranty………………………………………………………
14.2 Maintenance……………………………………………………
15 Reference Information…………………………………………………..
16 Project Administration………………………………………………..
17 Proposal Structure………………………………………………………
18 Financing Options………………………………………………………..
Appendix A……………………………………………………………………….
Appendix B……………………………………………………………………….
Appendix C………………………………………………………………………
Appendix D………………………………………………………………………

1 About CaldwellSomewhere Memorial Hospital
CaldwellSomewhere Memorial Hospital is proud to bring the best in healthcare

close to home for the people of CaldwellSomewhere County. During our 54
years, we have continued to grow and change in order to better meet the needs
of the communities we serve. Our mission is to provide safe, effective,
compassionate care and to promote healthy lifestyles for our community.
Approximately 100 specialists and physicians, backed by more than 700 support
staff, comprise a medical community devoted to improving quality of life in our
county. Anchored by a 110-bed acute care facility with a fully staffed ER,
physician’s offices, diagnostic services, our outpatient surgery center and
wellness center are conveniently located throughout the community. Multiple
educational and counseling programs are available for interests ranging from
cancer and diabetes treatment to pre-natal and parenting skills.
2 Project Overview
2.1 This document requests a proposal for a Picture Archiving and

Communications System(PACS)/ Radiology Information System(RIS) and
Computed Radiography (CR) solution that shall make CaldwellSomewhere
Memorial Hospital’s Imaging department film-less and paperless.
CaldwellSomewhere Memorial Hospital requests that your solution provide all

the benefits of a digital environment such as, but not limited to, storage, fast
retrieval, data management and enterprise wide distribution of all images and
reports produced throughout our Imaging department on a daily basis.
Our Imaging Department is centrally located on the second floor of the hospital.
Directly adjacent to the department is the emergency room and operating room.
Our department has one (1) radiographic and fluoroscopic room, one (1)
stereotactic biopsy room, one (1) bone density room, three (3) plain
radiographic rooms, one (1) Nuclear Medicine room, one (1) four slice CT unit,
and three (3) ultrasound rooms. See Appendix D for department floor diagram.
The emergency room treats 26,000 patients a year utilizing thirteen (13)
treatment rooms. There is one (1) dedicated radiographic room within the
emergency department. Our surgical department consists of five (5) surgical

suites and two (2) colonoscopy suites. We have (2) full size c-arms and (1) mini
-c-arm operating in that area.
Our hospital also has an outpatient surgery center approximately one mile away
from the main campus that has four (4) surgical suites with one (1) full size c-
arm and one (1) mini-c-arm in operation. Our Center for Breast Health is
located adjacent to our outpatient surgery center. Plain film radiography, one
(1) room, and digital mammography, one (1) room, are performed at that center.
There are three (3) hospital owned physician practices. Two of them are within
a few hundred yards of the hospital on the same street. Those two clinics
perform plain radiographic studies that are brought to the hospital for
interpretation. CaldwellSomewhere Internal Medicine performs on average
twenty (20) images per day and CaldwellSomewhere Family Care produces on
average forty- (40) images per day. Hallmark Care is approximately five miles
from the hospital and performs an average of forty-eight (48) images per day.
Those films are brought to the hospital for interpretation also.
2.2 Please refer to the procedure volume analysis in Appendix A. Please see the
equipment list in Appendix B.
2.3 As soon as possible CMH wants to first implement an enterprise RIS/PACS

solution and a Computed Radiography system. The Radiology Information
System implementation will immediately follow a successful installation of
PACS and CR but all three systems will be implemented in succession as one
turnkey project.
3 Proposal Preparation Instructions
3.1 All your responses shall be preceded with the notation of “<Vendor Name>
Response:” Please have only one specific response per requirement.
3.2 Please submit three (3) hard copies and two (2) softcopies by February 15th,
2005.
4 Key Goals

4.1 Reduce or eliminate unread studies resulting from loss or confiscation of the
films related to those studies.
4.2 Reduction in labor in the production, handling and storing of film.
4.3 Elimination of film costs and all associated expenses of using film.
4.4 Increase accuracy and efficiency of capturing charges of exams and related
supplies.
4.5 To increase the efficiency and productivity of all imaging staff and radiologists
as related to workflow and turn around times of exam reports.
4.6 To make all studies available to all referring physicians at any place and at any
time where a computer with a proper connection is available.
4.7 To be able to measure, track, list, and report any captured data from both the
RIS and PACS for reasons of management and patient care. This would include
mammography information.
4.8 Reduce demographic errors and improve accuracy of identification of images

and all related information.
4.9 To use automated processes to assure HIPPA compliance is assured with all
information, image access, and storage.
4.10 To eliminate or greatly reduce paper usage with no storage of physical paper.
5 Clinical Operations and functionality
The following descriptions are not normative but intended to give the vendor a
vision of what CaldwellSomewhere Memorial Hospital envisions as desirable
functionality and workflow processes of an integrated RIS/PACS enterprise
solution.
 Patient registration: With the exception of emergency situations, all

patients will be registered through the Hospital Information System (HIS).
Registration is defined as placing the patient’s demographic and insurance
information into the HIS and assigning the patient an account number for that
occurrence.

The RIS/PACS system will allow acquisition and interpretation of “John Doe”
patients without compromising the patient’s timeliness of care and allowing for
an easy merge of the patients demographic information when obtained.
 Exam scheduling: All exams that require scheduling will be done so

through our current scheduling ASP, Scheduling.com. HL7 messages will be
sent from Sheduling.com to the scheduling component of the RIS for worklist
and ordering purposes.
 Exam Ordering: All ordering of exams will be done through the HIS and
RIS. HL7 messages containing required account information will be sent from
the HIS to the RIS for orders to be placed on specific accounts.
The RIS/PACS solution should allow for future functions like bar-coding to
verify patient identification. The RIS will send exam status updates back to the
HIS.
 Film exams: Non-digital film exams will be ordered though the RIS/PACS
and a flash card for that exam will print at a central location. A Patient
identification/order notification sheet will be printed and used to identify the
patient. The exam order will populate a worklist in the RIS/PACS system that
will allow the technologist to verify charges and complete the exam. On
completion of the exam the system will populate that exam on a worklist at the
radiologist diagnostic workstation that will allow him/her to dictate the report
into the PACS system without the use of a barcode or sheet of paper. The
radiologist should be able to differentiate non-digital exams from digital exams
in the worklist by seeing a visual marker or icon.
Non-digital film exams will be able to be tracked as to location and status.

These exams results will be available through PACS web distribution as if they
were the same as a digital exam.
There will be the ability to load outside non-digital images on to the PACS
system by using a film digitizer and to enter that exam on a worklist for the
radiologist to interpret without the requirement of creating an order on the
hospitals HIS or RIS. Even though no hospital charges will be processed, the
same report distribution should apply to that exam as if it was a digital exam
ordered and performed within the enterprise.
Ideally, a request for interpretation could be created in the RIS/PACS system
that would populate a worklist that could be accessed at all locations including
the location of the film digitizer making the process less prone to error and
consistent with other modality workflow processes.

 Bone Densitometry: DEXA scans will be ordered through the HIS and RIS.
The workflow will follow the same process as film exams as described. The
reports generated by the DEXA machine will be scanned in and sent to PACS
for interpretation.
 Computed Radiography Exams: CaldwellSomewhere Memorial Hospital

desires to be totally filmless. All general radiography will be performed using
the newly acquired CR system as part of the RIS/PACS/CR project.
Orders are placed for a general radiographic exam through the RIS/PACS or
HIS, that order should populate the worklist on both the RIS/PACS and the CR
units.
A Patient identification/order notification sheet will print at a central location or

locations. That form will be the source to identify the patient and exam to be
performed. On completion of the exam the technologist will QC the exam on
the CR workstation before final submission to the PACS system. The exam will
be removed from the CR workstation after transmission to PACS but remains
on the RIS/PACS workstation worklist until the exam is charged. This should be
without exception no matter the status of the exam to assure that the charges
will not be missed. The technologist will scan and attach any related documents
to that exam at the RIS/PACS workstation and then release the verified study to
the radiologist diagnostic workstation. The patient's demographic information
and all pertinent documents will then populate the radiologist worklist for the
exam to be interpreted.
Updates of status of that CR exam should be sent to the RIS/PACS system and
from there to the HIS.
 C-Arm: Orders for C-Arm exams will be placed from the RIS/PACS or the
HIS. That order will populate the worklist on both the RIS/PACS and the C-arm
unit. The C-arm will be “docked” at a central Ethernet hub to download the
worklist before the procedure. The exam will be performed then the images will
be transmitted to the RIS/PACS system through the same Ethernet connection.
After transmission of the images to the PACS, the exam will be removed form
the C-arm worklist. The technologists will then QC the exam on a RIS/PACS
workstation.
The exam will stay on the RIS/PACS workstation worklist until the exam is
charged. This should be without exception no matter the status of the exam to
assure that the charges will not be missed. The technologist will scan and attach
any related documents to that exam at the RIS/PACS workstation and then
release the verified study to the radiologist diagnostic workstation. The patient’s
demographic information and all pertinent documents will then populate the
radiologist worklist for the exam to be interpreted.
Updates of status of that specific modality exam should be sent to the
RIS/PACS system and from there to the HIS.

 CT-NM-MRI: Orders for each modality will be placed from the RIS/PACS or
the HIS. That order should populate the worklist on both the RIS/PACS and the
modality unit.
A Patient identification/order notification sheet will print at a central location or

locations that will be the source to identify the patient and exam to be
performed.
On completion of the exam the technologist will QC the exam on their specific
modality or RIS/PACS workstation before final submission to the PACS
system. The exam will be removed from the modality worklist at that time but
remain on the RIS/PACS workstation worklist until the exam is charged. This
should be without exception no matter the status of the exam to assure that the
charges will not be missed. The technologist will scan and attach any related
documents to that exam at the RIS/PACS workstation and then release the
verified study to the radiologist diagnostic workstation. The patient’s
demographic information and all pertinent documents will then populate the
radiologist worklist for the exam to be interpreted.

 US: None of three ultrasound units will be native DICOM. All three units are
scheduled for replacement in the next two years. We will however place “black
boxes” provided by the chosen vendor to incorporate ultrasound studies into our
RIS/PACS system.
Orders for ultrasound exams will be placed from the RIS/PACS or the HIS.
That order should populate the worklist on both the RIS/PACS and the
ultrasound unit or workstation.
A Patient identification/order notification sheet will print at a central location

that will be the source to identify the patient and exam to be performed.
On completion of the exam the technologist will QC the exam on the

workstation in the ultrasound area before final submission to the PACS system.
The exam will be removed from the modality worklist at that time but remain
on the RIS/PACS workstation worklist until the exam is charged. This should be
and all pertinent documents will then populate the radiologist worklist for the
exam to be interpreted.

 Full Field Digital Mammography: There will be one (1) digital
mammography in operation at our off-site Center for Breast health. The
system’s diagnostic viewstation will be located at the hospital’s main diagnostic
imaging department. Our PACS solution will be or will be in the process of
obtaining FDA approval for diagnostic mammography interpretation. There
will be one diagnostic PACS viewstation configured with the required hardware
and software to function as a second mammography read station in addition to
the digital mammogram unit’s native workstation.
Orders for mammography exams will be placed from the RIS/PACS. That order
will populate the worklist on both the RIS/PACS and the mammography unit’s
technologist workstation.
A Patient identification/order notification sheet will print at a central location

that will be the source to identify the patient and exam to be performed.
On completion of the exam the technologist will QC the exam on dedicated

FFDM workstation at the Breast Center before final submission to both the
PACS system and the dedicated diagnostic FFDM viewstation. The exam will
be removed from the modality worklist at that time but remain on the
RIS/PACS workstation worklist until the exam is charged. This should be
and all pertinent documents will then populate the radiologist worklist on PACS
and/or the FDDM diagnostic viewstation worklist for the exam to be
interpreted.

 STAT exams: All STAT exams regardless of modality or origination will

populate the appropriate worklist and present at the top of that list. That exam
will be differentiated by color and/or wording that will clearly identify it to the
technologist or radiologist that immediate attention is required for that exam.
 Other priority statuses: The RIS/PACS solution will provide the ability to
prioritize exams at different levels other than STAT. Those priority levels
should include, at the minimum, ASAP, routine, and timed orders.

ASAP orders will be given priority behind STAT but in front of all other
priority levels. An ASAP order will populate technologist and radiologist
worklists in a manner that places those exams at the top of the worklist without
superseding STAT exams. ASAP exams should be identifiable by color and/or
text so they can clearly be identified as a priority exam.
Routine exams need only to populate the worklists specific to the modality in
the order in which they were received.
Timed orders are orders that are place to be performed at a specific time. These
orders will populate the technologist worklist no matter the modality in a
manner that makes it clear through color and/or text that the exam is to be
performed at a specific time.
 Film Printing: There will be the ability to print an image from any QC, view,
or diagnostic workstation. There will be at least one printer centrally located
that will be able to print multiple formats ranging from 1:1 to 32:1 on demand.
 Diagnostic reporting: Radiologists and other authorized users will be able to

access worklists of unread exams for interpretation and dictation. The user shall
benefit from all functionality that integrated RIS/PACS offers with one log-on
and bi-directional workflow between both systems. The user will be able to
build or access specific worklists, assigned to his or her logon, based on but not
limited to modality or any demographic identifying information.
By simply clicking the exam on the worklist the system automatically displays
the images, all supporting demographic information from the RIS, and
supporting scanned documents. The images will be displayed in a customized
manner as defined by the specific user and initiated by their unique logon. Any
old studies that are in the archive will be automatically loaded based on prior
study retrieval protocols and either displayed or be readily available in the
background.
On the same mouse click the dictation queue loads. The interpreting user will
now be able to dictate a report into the dictation system. The demographic
information required for the dictation system is sent automatically and no other
steps are required for starting dictation.
The user has the option of using personalized “canned” text reports assigned to
their specific user logon or dictate a custom report for that exam. The ability to
sign a pre- typed report at that point will be an option.
The user can advance to the next study to be dictated in the worklist and close
the previous study by simply pressing the space bar. All the same actions occur
for the next study to be dictated as the initial one described above.

The dictating user will have the ability to reject a study for interpretation. The
user will be able to enter free text in a note section documenting the reason for
rejection and the study will repopulate the originating workstation work-list as a
study identified in some means to alert staff of required follow-up.
The dictating user will be able to electronically sign reports from the same
diagnostic workstation. Exams will have the ability to be identified for
introduction into a teaching file. The teaching file images should easily be
copied to an application such as PowerPoint or to external recordable media.
All performed steps of reporting and dictation on the diagnostic workstation will
update the status of the exam on all related systems, HIS, RIS, and PACS.
 Wet Reads: All clinicians will have the ability to attach a text note or voice
clip to an exam before being officially read by the radiologist.
Most importantly, the ER physician will have the ability to attach a text
message of their interpretation to the exam. This text message will be readily
apparent to the radiologist when the case is brought up for final interpretation.
At that point, there will be check boxes in a reply template that allows the
radiologist to check a box with the choices, “agree”, “disagree” and “need
consultation”. If one of the choices “disagree” or “need consultation” is
selected, the system will populate a worklist in the ER that the ER physician
will monitor for those types of alerts. His special follow up worklist will be
easily accessible and easy to manage. The ER physician will be able to mark
the exam or delete the exam from the worklist when the necessary follow up has
been completed.
 Clinical review: All authorized users will have the ability to view images and
corresponding reports from anywhere anytime using a web based distribution
system. This web distribution system will be the primary distribution system
throughout the enterprise and for at home access. There will be view stations in
key locations that utilize the web access but have larger screen sizes and higher
resolution monitors. There will be a view station in the ICU and one centrally
located on the third floor.
A more dedicated viewstation will be located in the emergency room that
includes access to the RIS/PACS archive. Emergency room physicians
perform the first “wet” read on all general radiography exams ordered in the
ED.
All authorized users will be able to customize their own worklists and viewing
preferences and those options will be unique to their password regardless to
location.

All viewstation and web assess users will have basic image manipulating tools
such as, but not limited to, pan, zoom, window leveling, rotate, flip, invert, cine
display, edge enhancement and print capabilities.
 Archived Exam Retrieval: The primary storage will be on a Storage Area

Network. (SAN) Disaster recovery data and longer-term storage will be on tape
back up or a DVD jukebox device. In the case that an old study is not on-line
and has been archived, the worklists will identify those studies with text or
visual marker. “Fetches” will be performed by the system from the back-up
archive if necessary and will be performed in a manner of established priority.
 Interaction between the HIS/RIS/PACS: The HIS is SMS Medseries 4 release

23.25 operating on an AS400 operating system level 5.2. Patient registration
will occur through the HIS with demographic information passing from the HIS
to RIS then to PACS. Order entry throughout the enterprise will be performed
through the HIS with HL7 messages being sent to the RIS. Order entry from
within the imaging department will be done through the RIS with order
messaging being sent to the HIS order communication system.
The RIS will be a truly integrated application purchased from the chosen
RIS/PACS vendor. The RIS will be broker-less with bi-directional workflow
functionality. The RIS and PACS will continuously update each system with
modality worklists and status of exams.
Charges for the exam will be performed through the RIS. The RIS will send the
charges real-time to the HIS order communications and then the HIS will
process the orders at midnight.
Dictation will be performed through the RIS at the diagnostic workstations. The
hospital currently uses Lanier MedQuest for dictation and transcription. The
RIS will be integrated with the Lanier system or CaldwellSomewhere Memorial
Hospital may choose to utilize a built in solution provided as a component of
the chosen RIS/PACS system. Regardless of choice, seamless functionality with
the best workflow will be a requirement.
Reports will be sent from the dictation system back to the diagnostic
workstation for review and electronic signature. On final signature, the report
will be distributed to the HIS, web distribution system and be readily available
on the RIS/PACS through the archive.
 Teleradiography: The web based distribution system will replace our current
teleradiography system. The RIS/PACS solution will allow, if desired, for at
home reading and dictation of all types of modality studies and general
radiography if the at home viewing station is hardware compliant for diagnostic
interpretation.

The PACS system will be able to send and receive DICOM images from other
PACS systems that might be used by Nighthawk services. The system must be
flexible in many ways of access, be it web or virtual private network, to
accommodate different choices of where and when studies can be viewed or
diagnostically read.
6 System Components
6.1 System
6.1.1 The proposal shall include a detailed description of the system architecture
documenting the system topology and components of the system.
6.1.2 The proposal shall include a description of the operation of the system,
including the data flow for:
 Image acquisition from CR

 Image acquisition from all DICOM modalities
 Bi-directional communication with the HIS and RIS
 Database access by a workstation
 Exam selection and image display
 Archiving
 Ad hoc dearchiving
6.1.3 The proposal shall clearly state whether the system relies on the routing of
images to fulfill performance requirements, and if so, document the routing
model.
6.1.4 If the system auto-routes, then it shall be based on a configurable algorithm

which constitutes combining a set of selection criteria according to a set of
rules.
6.1.5 Please document in the proposal any known limits of the architecture in respect
to storage capacity, network throughput, processing capacity, and future
scalability. The vendor shall document input/output throughput in all
appropriate areas of the proposal.
6.1.6 The system shall support system-wide authentication of users through the use of
a unique user-ID and password for each user and/or through an alternative
approach with equivalent result.

6.1.7 The system shall have a unified view of all exams known to the system with the
ability of the user to find and access the exam without knowing its location.
6.1.8 The PACS will integrate with the RIS allowing demographic information to be
viewed simultaneously and bi-directionally between the PACS and RIS user
interface. PACS shall have the ability to import demographics from the RIS in
case of RIS unavailability.
6.2 Network
The vendor will provide within the required network infrastructure to

implement the requirements of this RFP for diagnostic, review, and technologist
workstations for the complete RIS/PACS/CR solution.
Network management and monitoring shall be possible from a system
management application, which shall provide comprehensive functionality for
monitoring traffic patterns, loss packets/cells, network component failures, and
re-configuration etc.
6.2.1 The system network shall include a bridge from the RIS/PACS to the hospital’s
network to allow the corporate network to be used for web-based access.
6.2.2 The system network shall isolate its internal traffic from all other networks to
which it is connected.
6.2.3 The vendor shall insure that the existing corporate network can support any
necessary usage of that network for interfaced components and web distributed
viewing.
6.2.4 The Vendor shall comply with hospital IS requirements for security and
equipment standards across the enterprise.
6.2.5 The system shall provide secure web access to clinicians outside of the
enterprise. Such security shall include, but not be limited to, authentication of
users and encryption of the data transferred between server and clients.
6.3 Database

6.3.1 The system shall provide an access control mechanism that enables assignment
of unique access privileges to individual users and user groups to access or alter
system resources and data. Examples of such functions are:
• Displaying approved reports
• Displaying unapproved (unsigned) reports
• Displaying images
• Printing images
• Ad hoc queries of the system database (worklists, etc.)
• Dearchiving exams
• Quality control of exams
• Changing the status of images and exams
• Changing the display attributes of exams
• Approving reports
• Creating, modifying, or deleting academic and private folders
6.3.2 The system shall model all events, statuses, and status changes necessary for
proper synchronization as true integrated RIS/PACS and to support system-wide
worklists.
6.3.3 The system database shall have a capacity scalable to store seven years of exam
information based on the annual procedure volume specified in Appendix A,
plus 50%. The system database shall have the ability to identify exam history
that needs to be stored longer than seven years such as, but not limited to, minor
cases, mammograms and teaching files. Minor or pediatric exam history and
images have to be kept till the patient reaches the age of 21. Mammogram
exam history and images are kept indefinitely. Special cases or teaching exam
history will be kept until deemed not useful. This requirement is not to be
interpreted to imply that images are to be stored in the database, only that the
information which is required to be accessed in searching the database for an
exam is to be stored for seven years in the database.
6.3.4 The amount of storage proposed in fulfillment of 6.3.3, and the basis for its
calculation, shall be documented in the proposal.
6.3.5 The database shall enable workstation users to submit queries to the database to
obtain a list of references (worklists and folders) representing a subset of the
exams in the database.
6.3.6 The database shall be backed up and verified by a procedure that does not take
the database out of service or significantly impact database performance.
6.3.7 A system-wide administration function shall be provided to facilitate user and

group profile creation (as required in 6.1.6 and 6.3.2), worklist query creation,
system configuration management, data integrity checks and maintenance, and

any other administration functions as required by the implementation of the
product. A graphical user interface for this function is preferred.
6.3.8 The system shall support access to patient data across the hospital enterprise,
including other hospitals and clinics. This access shall be available regardless
of the number and type of RIS in use (either single or multiple disparate RIS).
6.3.9 Describe how the System Administrator is notified of “broken” records and
steps to avoid broken records.
6.4 Storage System
In this document, the term “storage system” refers to on-line storage for rapid
access to images. The assumption is made that in order to meet the performance
requirements of the system, the storage system will be separate from the archive
system and employ different technology, but none of the requirements in this
RFP are to be interpreted to force that architectural implementation.
6.4.1 A Storage Area Network (SAN) will be the chosen method of on-line storage.
The vendor shall propose a SAN for on-line storage of two (2) years of data
based on the imaging volume calculated from information in Appendix A. The
proposed San shall be included in the price quote as a line item.
The proposing vendor shall work in conjunction with CaldwellSomewhere

Memorial Hospital’s Information Systems (IS) department for the possibility of
a purchase of a (SAN) to be implemented before the actual RIS/PACS
installation. The hospital is in the process of acquiring a Full Field Digital
Mammography machine that will be operational before RIS/PACS
implementation. The hospital reserves the right to purchase the SAN
independently if timing is an issue but will work with the awarded RIS/PACS
vendor to assure compatibility and performance requirements of the SAN are
meet. It is the intention of the hospital for the awarded RIS/PACS vendor to
assume warranty and service for the SAN as part of the purchase agreement if
purchased independently.
6.4.2 The basic element of storage and retrieval for the storage system shall be the
exam.
6.4.3 The system shall not store any image in the storage system with non-reversible
compression before the diagnosis of the exam, of which the image is a part, is
complete.
6.4.4 The system shall make exams available for retrieval by workstations within
thirty (30) seconds of their receipt in the storage system.

6.4.5 The system shall not automatically delete from the storage system any exam
until space for new exams is required. “Is required” can be interpreted to mean,
“is expected to be required in the near future”.
6.4.6 The vendor shall describe how exams if any are selected for automatic deletion
from the storage system .
6.4.7 The policy for automatic deletion of exams from the storage system, as
specified in 6.4.6, shall be reconfigurable by the system administrator.
6.4.8 The storage system shall monitor usage and provide real-time display of usage
patterns and statistics.
6.4.9 The storage system shall tolerate the failure of a single disk drive without loss
of data.
6.4.10 The storage system shall remain operational in the event of the failure of a
single disk drive.
6.4.11 A description of the consequences of a disk failure (both transient at the onset of
a failure, and any effects lasting until the failure has been corrected) on the
operation, performance, or vital functions of the storage system shall be
documented in the proposal.
6.4.12 The storage system shall remain operational during the service required to
correct a failed disk drive.
6.4.13 The storage system shall provide means for notifying the system administrator
in the event of a failure in the storage system.
6.5 Archive System
In this document, the term “archive” refers to storage for long-term access to
images. The SAN shall serve as two (2) years of on-line storage with archival
storage purpose being for storage of exams older than two (2) years and data
disaster recovery.
6.5.1 The system shall include sufficient on-line archival storage to provide access to
at least five (5) years’ of general image production, ten (10) years of
mammography production, pediatric images till the age of twenty one (21) and
infinite storage for special cases based on volumes as defined in Appendix A,
without intervention by a human operator.

6.5.2 The amount of storage proposed in fulfillment of 6.5.1, and the basis for its
calculation, shall be documented in the proposal.
6.5.3 The vendor shall describe the type of storage and configuration for the proposed
RIS/PACS and rationale. The archive solution shall be listed as a line item in
the price quote.
6.5.4 The vendor shall describe its experience implementing different types of
archival storage and the proposed configurations.
6.5.5 Exams older than the limit in 6.5.1 shall be accessible. Requiring a human
operator to insert storage media into the system can satisfy accessibility.
6.5.6 If a human operator is required to intervene as in 6.5.5, the archive system shall
automatically provide instructions, identifying the location of the media
involved and the action to be performed.
6.5.7 The archive system shall automatically archive exams when they are received
into the storage system. This requirement can be interpreted to mean that an
exam is entered into a queue for archiving as soon as all the images for the
exam have been received and, if required by the implementation, the exam has
been verified, provided that in normal operation the queue is always actively
being served.
6.5.8 In response to the ordering of a new exam, the archive system shall
automatically dearchive related exams according to a prefetching algorithm if
the exam is not resident on the SAN.
6.5.9 The vendor shall include in the proposal a detailed description of the
prefetching algorithm, including those parts, if any, which are configurable by
the system administrator.
6.5.10 The archive system shall dearchive exams in response to ad hoc requests from
users at workstations.
6.5.11 The archive system shall support priority queuing of dearchival requests.
6.5.12 The archive system shall monitor usage and provide real-time display of usage
patterns and statistics.
6.5.13 The archive system shall be able to service an archive/dearchive request load
defined by the daily image production as defined in Appendix A, multiplied by
6, within a 16-hour period.
6.5.14 The vendor shall provide a description of the reversible compression algorithm
available for use during archiving.

6.5.15 The vendor shall provide a description of the irreversible compression algorithm
available for use during archiving.
6.5.16 Where irreversible compression is used in archiving, any diagnostic

interpretation must be performed on a lossless image.
6.5.17 The archive system shall store exams for five years without loss. This
requirement is not intended to imply “with reversible compression,” only that
the exams, in whatever form they are archived, remain accessible for five years.
6.5.18 The vendor shall describe options available for disaster recovery of the archive,
including associated costs.
6.5.19 The vendor shall describe the process of recovering the archive after a disaster.
6.6 External Information System Interfaces
CaldwellSomewhere Memorial Hospital will be acquiring the RIS and PACS

from the same vendor. All assumptions and requirements made in this RFP are
made with the fact that the RIS and PACS will be from the same vendor.
The hospital currently has SMS Medseries 4 release 2.25 HIS and RIS. There
are no immediate plans to replace the HIS. Our current RIS will be replaced
with your proposed system.
The HIS and RIS will be the primary sites of data entry. The RIS/PACS will be
expected to update information between both systems and the RIS will be
expected to update certain types of data to the HIS. The HIS/RIS/ and PACS
system will be required to exchange information about schedules exams, patient
demographics, charges and final reports. There will also be reports passed
between the transcription system and the RIS and HIS. The HIS/RIS and PACS
will also perform mutual data integrity such as patient and exam merge, exam
cancellation, status tracking and synchronization.
The hospital wishes to interface in a limited manner with Carolina Orthopedics
own PACS. The interface would allow sharing of images between both sites.
See Appendix C for all required interface systems.
6.6.1 The vendor shall co-operate with the hospital and the HIS vendor to define a
fully functional, bi-directional interface between the system and the HIS based
on the HL7 standard.

6.6.2 The interface of 6.6.1 shall support:
• Exam order entry transfer from the HIS to the RIS/PACS to support
prefetching and transfer of patient demographic information
• Bi-directional transfer of demographic and status change information
• Transfer of radiographic report text from the HIS to the RIS/PACS and bi-
directional transfer of status information to provide synchronization of the
two systems with changes
• Exam status information transfer from the RIS/PACS to the HIS to inform
the HIS of the completion of an exam.
This requirement should not be interpreted to disallow bi-directional transfer of

report text.
6.6.3 The proposal shall include a description of the vendor’s experience with HIS-
RIS/PACS interface implementations and specifically with interfaces to the
hospitals HIS.
6.6.4 The HIS-RIS/PACS interface shall be upgraded to maintain, at a minimum, its

initial functionality or extend its functionality when either the RIS/PACS or the
HIS system software is upgraded. To meet this requirement, the vendor will be
required to coordinate upgrade plans and schedules with the hospital and the
HIS vendors, and prove through regression testing that upgrades do not have a
negative impact on the interface.
6.6.5 Speech Recognition: the vendor shall describe how its system can interface with
speech recognition software.
6.6.6 The vendor shall describe the speech recognition products with whom you can
provide generation and editing of radiology reports from the PACS workstation.
6.6.7 Electronic Patient Record portal: the vendor shall describe how its system can
interface with Electronic Patient Record software.
6.6.9 The vendor shall describe if it can provide an integrated RIS-Speech-PACS

solution.
6.6.10 The vendor shall describe their ability to import data and images directly from
another PACS system.

6.6.11 The vendor shall propose a solution to import and export images with Carolina
Orthopedics. Storage of images from Carolina Orthopedics would be done on an
as needed basis. The main goal is the ability to view Carolina Orthopedic
exams on our PACS in the operating suite. See Appendix C for integration
information.r
6.6.12 The vendor shall be IHE compliant. Please include supporting documentation.
6.7 Image Acquisition Systems
6.7.1 DICOM
6.7.1.1 The system shall provide a DICOM interface to which DICOM-compliant

external devices may connect. External devices are devices not supplied with
the system and include but are not limited to image review workstations, image
printers and modalities.
6.7.1.2 The system shall include one or more DICOM Storage SCPs which support all
necessary storage SOP classes required to support the DICOM Storage SCUs
implemented on the image acquisition systems listed in Appendix B.
6.7.1.3 The system shall include a DICOM Query/Retrieve SCP which supports Study
Root queries at the Study Level and which provides query responses for all
studies, series, and images stored in either the Storage System or the Archive
System.
6.7.1.4 The system shall include a DICOM Modality Worklist Management SCP which
provides worklists that include all studies stored in the Storage System.
6.7.1.5 The system shall include a DICOM Storage Commitment Push Model SCP
which accepts storage commitment by either the Storage System or the Archive
System.
6.7.1.6 The system shall include a DICOM Performed Procedure Step SCP which
facilitates the transmission of information related to a Performed Procedure Step
from a Modality to an Information System (IS) and from the IS to other systems
(typically workstations).

6.7.1.7 The vendor shall provide with the proposal one or more Conformance
Statements covering all DICOM functions of the system.
6.7.1.8 The system shall be capable of creating and storing in electronic DICOM format
paper documents that can be stored with the exam.
6.7.2 General Modalities
6.7.2.1 The system shall support integration of the image acquisition equipment listed
in Appendix B. The integration is to be based on the requirements of Section
6.7.1.
6.7.2.2 For each image acquisition system where integration is achieved by means other
than the one described in 6.7.2.1, a thorough description of the method shall be
supplied. The description shall include the method used to obtain correct
patient ID and study UID and how DICOM objects such as Image Series, Study
Components, and Study IODs are supported.
6.7.2.3 The interface between a modality and the system shall not decrease the patient
throughput of the modality.
6.7.2.4 The system shall accept, store, and display the full, original image dataset
transmitted from each modality.
6.7.2.5 In situations where a procedure is performed on a patient without prior

registration in the RIS, no patient information and study UID is available for the
modality to use for the store operation. In these cases the modality will allow
the operator to enter the patient information manually, and allocate a study UID
of its own. The system shall include a mechanism to remap this UID when the
RIS order has been performed and communicated to the system and thereby
correctly associate the acquired images with the appropriate RIS ordered exam.
6.7.2.6 If bypassing RIS patient identification procedures is unavailable, the bidder

shall provide a complete description of the acquisition process when RIS is
unavailable.
6.7.2.7 If bypassing RIS patient identification procedures, the bidder shall provide a
complete description of the process required to synchronize RIS and PACS
patient identification data.
6.7.2.8 The RIS/PACS shall provide the means for technologists at any modality to
enter special designations for exams, configurable by the PACS administrator,
such as STAT, Urgent, ER.

6.7.3 Film Digitizer (FD)
6.7.3.1 The FD shall accept all radiographic film sizes
6.7.3.2 If an exam digitization has been pre-ordered through the PACS or the RIS, the
FD shall allow the operator to acquire the exam and patient identification
information necessary for digitizing one exam with a simple action. Such an
action may be a keystroke, mouse click, barcode acquisition or the equivalent.
6.7.3.3 The FD shall also provide an option for the operator to enter exam and patient
identification information manually for unscheduled exams.
6.7.3.4 The FD shall automatically associate the exam and patient identification
information with all the acquired images for the exam.
6.7.3.5 The FD shall possess scanning capabilities in order to meet diagnostic quality
images as close to original quality as possible. The vendor shall make their
recommendations for a FD with example images.
6.7.3.6 The FD shall be capable of reasonable throughput to maintain efficient

workflow processes without loss of quality images.
6.7.3.7 The vendor shall supply FDs for three (3) outside physician practices and one to
be centrally located within the department. Total of four (4).
6.7.3.8 The vendor shall propose a data entry solution for the three (3) outside
physician practices in 6.7.3.7.
6.7.4 Quality Control Workstation
The hospital desires QC stations (or access through existing PCs) at each
modality that is specifically designed to provide an ideal RIS/PACS/Archive
communication model where:
 The DICOM Modality Worklist service permits RIS/PACS-modality
communication by providing a mechanism for transferring patient and
procedure information from the RIS to the modality.

 The DICOM Modality Performed Procedure Step service permits modality-
RIS communication by providing a mechanism for transferring augmented
information from the modality back to the RIS/PACS during the procedure and
at completion.
 Full implementation of these services by a modality would mean that images

sent onward to the PACS archive were fully validated with respect to the RIS,
and fully aligned with the RIS data model. A truly integrated and bidirectional
communication of the RIS/PACS is required.
6.7.4.1 The vendor shall describe how its QC station facilitates complete integration
with modalities.
6.7.4.2 The QC station shall be capable of routing directly from the modality to the
review station.
6.7.4.3 The QC station shall support restructuring (split, segment, merge) of multi-
organ studies such as CT for distribution.
6.8 Image Display Workstations
Two categories of PACS workstations are required:

• a diagnostic workstation (DWS) primarily located in the radiology
department and used for primary interpretation, and
• a review workstation (RWS) primarily for use in the clinical departments.
Whenever the phrase “workstation” or “user interface” is used in a requirement

without specifically mentioning the type of workstation, the requirement is
applicable to the diagnostic workstation.
A third workstation type (WWS) is required to provide access to PACS data via
a web server. This section does not apply to the WWS. The requirements for
this workstation are documented in Section 6.10.
6.8.1 Configuration
6.8.1.1 Two classes of workstation monitors shall be available:
Class A: Spatial Resolution approximately 2MP

Class B: Spatial Resolution approximately 3MP
Class C: Spatial Resolution and brand of monitor to meet FDA
requirements for diagnostic mammography interpretation.

Class D: Spatial Resolution of approximately 1MP –Color. This monitor
will be used for RIS/PACS demographic information and any study where color
imaging is used for diagnosis.
6.8.1.2 DWS shall support 1, 2,3 ,4 or 5 monitors of Class B , Class C, and/or Class D.
6.8.1.3 RWS shall support 1 or 2 monitors of Class A.
6.8.1.4 The RWS workstations shall support Windows operating system.

6.8.1.5 There shall be workstations in the following locations:
 One DWS with two (2) class C monitors and one (1) class D monitor in
the diagnostic imaging department. Please quote as an optional line item a third
class C monitor.
 One DWS with two (2) class B monitors and one (1) class D in the
diagnostic imaging department. Please quote as an optional line item a third
class B monitor.
 One RWS with two (2) Class A monitors and one (1) class D monitor to
be located in the physician area of the Emergency Department.
 One RWS with one (1) class A monitor to be located at a Doctors dictation
area on the third floor.
 One RWS with one (1) class A monitor to be located at a Doctors dictation
area in the ICU area.
 Three mobile RWS with one (1) class A monitor. Two of these mobile
RWS will be used in the Hospital’s main operating room and the third will be
used at the outpatient surgery center.
6.8.2 Monitors
6.8.2.1 Workstation monitors (color and black/white) shall display what are industry
standard gray scales and color depth levels for optimal diagnostic and viewing
requirements. The vendor shall propose their recommendations and options.
6.8.3 Monitor Calibration
6.8.3.1 It shall be possible to assure calibration of all monitors with respect to contrast,
intensity and spatial resolution.

6.8.3.2 The vendor shall supply a QC procedure and any required images and
calibration equipment to assure that the test and calibration requirements in this
Section are met.
6.8.3.3 Before the beginning of the acceptance test, a preventive and corrective
maintenance program shall be provided and hospital personnel trained to ensure
that monitor specifications are within acceptable limits.
6.8.4 Performance
6.8.4.1 Please provide sample benchmark data for image retrieval times.
6.8.4.2 The proposal shall include a description of how the number of concurrent
workstation users affects system performance.
6.8.5 User Interface
6.8.5.1 The cursor shall move within and between monitors in a smooth and continuous
manner under the control of a mouse or trackball-pointing device with the
cursor remaining visible during its movement. Only one keyboard will be
required to type any text or to execute any function on all monitors.
6.8.5.2 The system shall enable all workstations to share a common user profile for
each user that specifies at a minimum:
• window width and level presets
• default display protocols
• access rights and privileges
6.8.6 Exams, Folders, Worklists, and Queries
6.8.6.1 The system shall allow dynamically updated worklists to be created by the
system administrator for a specific user or class of users. For the purpose of this
RFP, a worklist is any database query that returns a list of exams or patients
either in the RIS or PACS. Dynamically updated means that as exams change
status in such a way as to change the contents of a worklist, the worklist is
automatically refreshed in both the RIS and PACS. Periodic polling of the
database can satisfy the requirement for dynamic updating with a frequency
defined by a parameter, which is configurable by the system administrator.

6.8.6.2 The worklists available to a user shall be those assigned to the user, plus those
assigned to the group of which the user is a member.
6.8.6.3 The system shall support manual and automated methods of exam selection.
6.8.6.4 New worklists shall be definable at any time by the on-site system administrator
and/or by the user.
6.8.6.5 A worklist entry for an exam shall include at least the patient name and ID,
examination procedure, exam date and time and priority level.
6.8.6.6 The database shall support ad hoc queries using search criteria based on the
values, or range of values, of the data items of the table below, combined using
logical operators (e.g. “AND”, “OR”, “NOT”) and with the ability to sort results
in ascending or descending order. Functionality equivalent to an SQL Select
statement is intended. The purpose of this requirement is to assure worklist
queries and administrative report queries can be constructed to support a range
of needs. This requirement is not to be interpreted to require that all users be
able to initiate queries using SQL directly.
· Accession Number
· Acquisition Location
· Age
· Body Part
· Branch of Service
· Department
· Department Visit ID
· Global patient ID
· Institution
· Keywords
· Modality
· Operator
· Other Patient ID
· Patient DOB
· Patient ID
· Patient Location - Current (within hospital)
· Patient Location - Original (within hospital)
· Patient Name
· Performing Physician
· Priority ID
· Physician Reading Study (Radiologist)
· Rank

· Referring Physician
· Requested Procedure
· Requesting Physician
· Requesting Service
· Specialty
· Station Alias
· Study Status
· Study Comments
· Study Date (and date range)
· Study Description
· Study Location (within the PACS cluster or clusters)
6.8.6.7 The system shall support queries via wildcards with the following criteria:
 accession number
 operator
 Patient ID
 Patient Name
 Requested Procedure
6.8.6.8 Describe the number of simultaneous criteria supported for a given query.
6.8.6.9 All exams shall be accessible from every workstation, limited only by security
mechanisms.
6.8.6.10 It shall be possible to request old exams from the storage system and archive.
6.8.6.11 A mechanism shall be provided to notify a member of the Radiologist Group

when he opens an unread exam, which is already open by another member of
the Radiologist Group. There shall be a mechanism to assure that there are no
double read studies.
6.8.6.12 Users with proper privileges shall be able to attach to an exam and display for
review comments made by other users with proper privileges. The intent is to
allow preliminary findings or comments from radiology technologists, and
clinical care providers, to be saved with an exam and available to radiologists at
the time of professional interpretation.
6.8.6.13 Emergency room physicians shall have a “wet read” function that they can
attach free text or a voice clip that will display when the radiologist opens the
exam for final interpretation.

6.8.6.14 When an exam with a wet read (as described in 6.8.6.13) is attached has its final
interpretation the reading radiologist shall have options within the wet reading
display box to check boxes that communicate that he agrees, disagrees, or needs
to consult with the initial interpreting physician.
6.8.6.15 The system shall send a communication through any method (special worklist,
email, or alert message) to the emergency room physician on duty that alerts
him/her that the over reading radiologist has disagreed or needs further
consultation about an initial interpretation done by an emergency physician.
6.8.6.16 The user interface shall organize images for exams using the metaphor of a
folder.
6.8.6.17 A mechanism shall be provided to permit a user with proper privileges to select
images or exams for inclusion into one or more manually created folders for
teaching and research purposes.
6.8.6.18 The user shall be able to anonymize images or exams used for teaching and
research purposes.
6.8.6.19 A user with the proper privileges shall be able to add or delete selected images
to or from the clinical folder.
6.8.6.20 The user shall be able to create a summary sampling of images that is saved
with the original series.
6.8.6.21 The user shall be able to create a single independent summary series from
multiple studies.
6.8.6.22 The user shall be able to copy images to clipboard for use in presentations and
word processing applications.
6.8.6.23 The user shall be able to export images in JPEG format.
6.8.6.24 The user shall be able to export cine files in AVI format.
6.8.7 Reports

6.8.7.1 The workstation shall allow a user with the proper privileges to display the
report for any reported exam without requiring the display of its associated
images.
6.8.7.2 The administrative status of any report (e.g., approved or not approved) shall be
indicated when the report is displayed.
6.8.8 Exam Display and Arrangement
6.8.8.1 The workstation shall support the display of multiple images from one exam on
one or more monitors.
6.8.8.2 It shall be possible to choose among multiple image display formats for the
monitors of a workstation, for example: 1:1, 2:1, 4:1, 9:1, 12:1, 15:1 and 20:1.
6.8.8.3 The workstation shall support manually rearranging the sequence of images in
an exam.
6.8.8.4 The system shall provide user-selectable, user-definable protocols for display of
the images of an exam where the protocols are specific to the type of exam. The
intent of this requirement is to allow physicians’ preferences for display to be
satisfied.
6.8.8.5 If no display protocol exists for a specific user and examination type, the system
shall provide a default protocol.
6.8.8.6 Images shall be automatically presented in an upright as well as correct

right/left orientation whenever the image orientation is known to the system and
the orientation is not overridden by a display protocol.
6.8.8.7 The workstation shall allow a user with the proper privileges to save the
information that controls the display of the images of an exam, including
window width and level, display sequence, orientation, magnification, pan
position, and any annotations.
6.8.8.8 Only the most recent copy of the display state shall be saved.
6.8.8.9 If one or more presentation states are stored with at least one image in a study, it
shall be possible to select and apply it to all eligible images.
6.8.8.10 If an exam is displayed which has had its display state saved, that display state
shall be used.

6.8.8.11 The workstation shall support the display of multiple exams simultaneously.
6.8.8.12 The system shall provide user-selectable, user-definable protocols for display of
multiple exams where the protocols are specific to the types of exams being
displayed together. The intent of this requirement is to support the presentation
of historical studies along with a new study for diagnosis.
6.8.8.13 The system shall support rapidly moving to the next or previous exam in a
worklist. The intent of this requirement is to allow the radiologist to close a
currently open exam and open the next one in a worklist with the equivalent of
one keystroke or mouse click or verbal command.
6.8.9 Image Display and Paging
6.8.9.1 Rapid sequential paging through images of an exam displayable on a single

monitor shall be provided.
6.8.9.2 Both forward and backward paging shall be supported.
6.8.9.3 If multiple image series are viewed, it shall be possible to page through the
series independently.
6.8.9.4 The workstation shall support arranging groups of related images into a stack
(with only the top image visible) and displaying them sequentially forward or
backward, coupled to the movement of the workstation’s pointing device.
6.8.9.5 The workstation shall support linking multiple image stacks and moving
through them synchronously so that the image sequence is maintained in each
stack.
6.8.9.6 A cine function with a user selectable, variable frame rate of at least 10 frames
per second for 512x512 images shall be provided.
6.8.9.7 The cine viewer shall support advanced tools such as:
 update changes while playing
 start at DICOM frame rate
 frames/second calculator
 image zoom calculator

6.8.10 Grayscale Operations
6.8.10.1 The workstation shall provide dynamic window width and level through the
entire image grayscale dataset.
6.8.10.2 The window width and level function shall be applicable to a single image,
selected images, all images, or to a specified region of interest on a single
monitor. Satisfaction of the region of interest requirement may be
accomplished through, for example, the magnifying glass function.
6.8.10.3 Window width and level values shall be displayed in the converted units
provided by the DICOM image header information.
6.8.10.4 The user interface shall support both the window width and level approach and
the top/bottom approach, based on modality, with user-configurable
assignments.
6.8.10.5 Display of the inverse grayscale of any selected region of interest shall be
supported. Satisfaction of this requirement may be accomplished through, for
example, the magnifying glass function.
6.8.10.6 The system shall provide at least ten user-configurable window width and level
defaults.
6.8.10.7 It shall be possible to auto window/level a Region of Interest.
6.8.10.8 Window width and level defaults shall be user-, modality- and organ-specific.
6.8.10.9 A rapid method to select among default window width and level values shall be
provided. The intent of this requirement is to allow the user to jump between,
for example, bone windows and soft tissue windows in CT using function keys.
6.8.10.10 If an image is received from a modality along with a window width and level
for viewing, the window width and level parameters shall be used for the initial
display on the workstation.
6.8.10.11 If an image is displayed for which no window width and level is available, the
workstation shall select a set of values which at least make the image visible as
a starting point for subsequent manual changes.
6.8.10.12 It shall be possible to preset and to easily change window width and level
defaults for each user.

6.8.11 Image Orientation, Zoom, Pan, and Magnifying Glass
6.8.11.1 The workstation shall allow sequential 90 degree clockwise and counter-
clockwise rotation of any image as well as flip in the horizontal and vertical
axes.
6.8.11.2 It shall be possible to reorient a single image, selected images, or all images in
one operation.
6.8.11.3 The workstation shall be capable of enlarging an image up to at least 4x by

replication of pixel values.
6.8.11.4 The workstation shall be capable of enlarging an image up to at least 4x by

interpolation of pixel values.
6.8.11.5 It shall be possible to zoom a single image, selected images, or all images in one
operation.
6.8.11.6 It shall be possible to zoom an image to true size.
6.8.11.7 Zoomed images shall be repositionable by panning (roaming) the image within
the area allocated for display of the image.
6.8.11.8 When the actual image size is greater than the monitor resolution or the
resolution of the available display window, it shall be possible to reposition
(roam) the image in the window dynamically and interactively.
6.8.11.9 When zooming an image, the original image dataset shall be used. The intent of
this requirement is to assure that zooming a minified image will provide
additional resolution up to that of the originally acquired image.
6.8.11.10 The workstation shall include a user-sizeable magnifying glass function which
supports the options of variable magnification up to at least 4x, internal window
width and level, and grayscale inversion.
6.8.11.11 When applying the magnifying glass to an image, the original image dataset
shall be used. The intent of this requirement is to assure that magnifications of
a minified image will provide additional resolution up to that of the originally
acquired image.

6.8.12 Region of Interest, Distance, and Angle Measurements
6.8.12.1 The workstation shall compute point-to-point measurements with automatically

calibrated, user-selectable scales (mm, cm, or pixels).
6.8.12.2 The workstation shall support angle measurement.
6.8.12.3 The workstation shall support region of interest mean (in image units, e.g.,
Hounsfield units for CT), standard deviation, number of pixels, and area
measurement based on ellipses.
6.8.12.4 The workstation shall compute and display region of interest statistics and
distance/angle values for at least four regions simultaneously.
6.8.13 Image Annotation
6.8.13.1 The workstation shall provide tools allowing the user to position and orient
multiple instances of text and graphics (lines, arrowheads, and circles) for image
annotation.
6.8.13.2 It shall be possible to toggle the display of image annotation on and off.
6.8.14 Image Identification

6.8.14.1 The workstation shall display along with each image at least the following
patient data, where appropriate for the image and modality:
• patient name
• patient ID
• exam date and time
• image orientation
• kVp
• mAs
• pulse sequence
• slice position
• image or slice number

6.8.14.2 The workstation shall allow the user to toggle the display of image
identification text on and off.
6.8.14.3 The workstation shall allow the user to turn off all image identification text
except image or slice number.
6.8.14.4 The workstation shall provide a function to display the entire contents of the
DICOM header for a selected image.
6.8.15 Utility Functions
6.8.15.1 The workstation shall be capable of reversing the last executed command, or,
for those commands which are not reversible, the non-reversible commands
shall warn the user in advance.
6.8.15.2 During the execution of a time-consuming function, the workstation shall

indicate that the system is working.
6.8.15.3 The workstation shall provide an indicator with information on the progress of a
retrieval request (i.e. time remaining).
6.8.15.4 The workstation shall include automatic screen blanking and power saving with
a selectable time limit.
6.8.15.5 When a user’s viewing session needs to be interrupted, the workstation software
shall save the exact image (in a multi-image study) and the exact viewing
settings (e.g., number of images per screen, magnification level, window/level,
etc) so that when the user returns, they will be able to return to the images
exactly as they were left.
6.8.16 Control of Hard Copy Printing
6.8.16.1 The workstation shall allow users with the proper privileges to print exams on
any image printer connected to the network.

6.8.16.2 Requests for printing shall not compromise workstation operation or
performance.
6.8.16.3 The workstation shall allow the user to choose from multiple image formats:
1:1, 2:1, 4:1, 9:1, 12:1, 15:1 and 20:1.
6.8.16.4 The workstation shall allow the user to arrange the images of the examination
within the selected image format.
6.8.16.5 The workstation shall provide a function which displays the status of image
printers on the network, including the print queue and the status (e.g., on-line,
off-line, out-of-film, etc.).
6.8.16.6 The workstation shall allow the user to produce multiple copies of the same
image with one request, up to a maximum limit specific to the user.
6.8.16.7 The workstation shall allow the user to cancel a print request that he has
previously entered.
6.8.16.8 The system shall enable logging of print jobs for accounting purposes, including
at least the requester’s name, the number of films, the exam identification, the
date and time the exam was printed, and the printer which was used.
6.8.16.9 Date, time, and number of the film sheet shall be printed on the border of the
film.
6.8.16.10 The workstation shall support “what you see is what you get” (WYSIWYG)
printing mode that allows users to drag and drop images to create a custom print
layout based on site-specific templates. This utility shall be used to generate
multimedia reports for distribution via e-mail.
6.8.16.11 Vendor shall provide a CD-burner to enable the burning of image CDs from
multiple clients within the PACS domain to a single centrally located CD-
burner station.
6.8.16.12 CD-burner shall include a DICOM Viewer that is self-bootable on Windows

PCs.
6.8.16.13 CD-burner system shall include a black and white printer to facilitate the
creation of a customizable black and white CD label.

6.8.17 3D Tools
CaldwellSomewhere Memorial Hospital has decided after many PACS
demonstrations that the third party application Voxar is the desired 3D tool. If
your system does not support Voxar, the following minimum requirements
listed in 6.8.17.1 shall be met.
6.8.17.1 The workstation shall support the following tools:

 MIP/MPR display
 Batch MPR
 3D volume display (grayscale, color)
 support for multiple display formats
 shaded surface display
 presets & annotations
 The vendor shall indicate if integration with a third party application is
required in order to access the tools required in section 6.8.17.1 above.
6.8.18 Cardiology Tools

 digital subtraction angiography (DSA)
 QCA/LVA
 multi-modality image review
 cardiology-specific reporting templates
 remote viewing capability
 integration of Echo, Nuclear Cardiology, and the ability for future
integration with Cardiac MRI and CT modalities.
 integration with EMR, EKG, HIS
6.8.18.2 The vendor shall indicate if integration with a third party application is required
in order to access the tools required in section 6.8.18.1 above.
6.8.18.3 The vendor shall on request, perform a demonstration of available Cardiology

tools and/or applications for on staff cardiology physicians.

6.8.19 Orthopedics Tools
 Hip and knee templates and templating protocols

 Osteotomy planning module
 Coxometry module
 Biometry module
 Trauma planning
 shoulder, elbow, hand, and ankle templates
 image calibration
 multi-modality image review
 DICOM output
6.8.17.2 The vendor shall indicate the manufacturer(s), type(s) and number of templates
available.
6.8.17.4 The vendor shall on request, perform a demonstration of available Orthopedic

tools and/or applications for on staff orthopedic surgeons.
6.8.20 Mammography Tools
CaldwellSomewhere Memorial Hospital requests that the vendor shall be FDA

approved or officially applied and in the process for approval for diagnostic
reading of mammograms on their workstation. The vendor shall include
documentation with their response supporting approval or process of approval.

 Multi-modality image review
 Configurable comparative review mode (current and prior mammograms)
that supports the 4 standard screening view projections (RCC, LCC,
RMLO, LMLO)
 Pan

 Automatic chest wall alignment
 Active patient worklist
6.8.20.3 Vendor shall describe any plans for support of Mammography CAD.
The workstation shall support integration to a proposed Mammography

reporting system or CaldwellSomewhere Memorial Hospital’s existing
Mammography system with the RIS in order to use template reporting and
signature. Refer to Appendix C for application information.
6.9 Film Printers

6.9.1 The vendor shall interface with CaldwellSomewhere Memorial Hospital’s three
(3) existing DICOM dry laser printers. See Appendix B.
6.9.2 The vendor shall list as a line item on the price quote an optional multisize film
dry laser printer that is compatible with their RIS/PACS/CR solution.
6.9.3 The system shall allow printing to any printer from any workstation at any time.
6.10 Web Servers and Web Workstations
The hospital intends to provide access to PACS information in locations where

PC workstations are already installed. The preferred implementation is to use
World Wide Web technology to provide access through the hospital’s local area
network to hospital-supplied workstations running standard web browsers. The
web workstation will be referred to as WWS in this document. Remote web
workstations at non-imaging sites, e.g. physicians’ homes, will access exams
and images using telecommunications access to be provided as part of the
hospital’s communications system.
6.10.1 The system shall include at least one web server and web pages (and applets, if
required) which provide access to all PACS information through the PACS local
area network or through the hospital’s local area network.
6.10.2 The system shall include as many web servers as are required to support the
image review load specified in Appendix A assuming 25% of the total load is to
be retrieved through the web.
6.10.3 The system shall allow a PC supplied by the hospital to access the web pages
(and applets, if required) using Microsoft Internet Explorer.

6.10.4 The proposal shall describe the sizing rules for web servers, e.g., the number of
active WWS, which may be supported by one web server.
6.10.5 The proposal shall include a specification of the minimum hardware

configuration for a WWS, which provides the functionality required in this
section.
6.10.6 The WWS shall allow a user to log into and log off from the system.
6.10.7 The WWS shall support all worklists supported by the diagnostic and review
workstations.
6.10.8 The WWS shall allow selection of an exam from a worklist.
6.10.9 The WWS shall allow display of the report for the selected exam.
6.10.10 The WWS shall display images for the selected exam using the window width
and level, magnification, center, orientation, and annotation information stored
for each image.
6.10.11 The WWS shall support changing the window width and level on individual
images as well as on groups of selected images.
6.10.12 The WWS shall support magnification and panning (roaming) of individual
images.
6.10.13 The WWS shall support reorientation (flip and rotate) of individual images.
6.10.14 The WWS shall support real-time interactive conferencing mode with other web
workstations (including those at remote locations).
6.10.15 The WWS shall support, now or in the future, real-time text messaging (i.e.
“chat mode”) in conjunction with the conferencing mode described in item
6.10.14.
6.10.16 The WWS shall support query/retrieve of the archive.
6.10.17 The WWS shall support split screen viewing (i.e. 2 studies or a study and a
report).
6.10.18 The WWS shall support query/retrieve by the following criteria:

 referring physician
 study location
 study date
 modality

 patient ID
 patient name
 accession number
 department
 body part
 patient gender
 patient location
 date
 date range
 status
6.10.19 The WWS shall support User Preferences.
6.10.20 The WWS shall support the creation of W/L presets.
6.10.21 The WWS shall support the display of multi-frame cardiology images (e.g.
MPEG).
6.10.22 The WWS shall support SSL security.
6.10.23 It shall be possible to limit a user to viewing only those studies for which they
are the referring physician.
6.10.24 The WWS shall support region of interest mean (in image units, e.g.,
Hounsfield units for CT), number of pixels, and area measurement.
6.10.25 The WWS shall permit users to choose to download images to their local hard
drive to speed up the transfer of images.
6.10.26 The WWS user interface should be the same as the DWS and RWS.
6.10.27 The WWS shall allow access to pertinent patient information that may and will
be populated or accessed through the RIS.
7 Radiology Information System
CaldwellSomewhere Memorial Hospital desires a tightly integrated RIS driven

RIS/PACS solution with bi-directional workflow functionality. All
requirements in this section and all other sections of this RFP are to be applied
to a turnkey, tightly integrated RIS/PACS/CR solution.

7.1 Scheduling
7.1.1 The RIS shall integrate with CaldwellSomewhere Memorial Hospital’s current
enterprise scheduling ASP Scheduling.com.
7.1.2 The RIS shall receive HL7 messages from Scheduling.com to populate as much
of the RIS scheduling component as possible. The vendor shall list the fields
that will be populated with the integration requested in 7.1.1.
7.1.3 The vendor shall describe the usable functionality from their scheduling
component by being integrated with our current scheduler.
7.2 Registration
7.2.1 The RIS shall import ADT and patient demographics information from the HIS.
All patients are registered prior to arriving at radiology. No registration occurs
in any radiology departments.
7.2.2 RIS shall except updates from the HIS registration information and update all
corresponding patient records in the RIS and PACS.
7.2.3 The RIS shall auto merge patient information.
7.2.4 The RIS shall allow manual merge and unmerge by authorized personnel.
7.2.5 The RIS shall except updates from the HIS and auto update patient’s locations.
Examples: Emergency patient to inpatient to outpatient and all possible
combinations.
7.3 Patient Profile
7.3.1 The RIS shall include the following information per patient profile:
 Complete patient name

 Date of birth
 Current address
 Home and work phone numbers
 Gender

 Aliases
 Race
 Medical record number
 Social security number
 Current account number
 Patient status (inpatient, outpatient, emergency)
 Known allergies
 Weight
 Room number and admission date if currently admitted
 Attending physician with phone and fax numbers
 Referring physician with phone and fax numbers
 Field for free text for permanent medical history comments such as
surgeries and medical implants and devices
7.3.2 The user shall have the ability to search for a patient in the RIS by:
 Partial spelling of name

 Uncertain spelling of name (soundex)
 Medical record number
 Pre-existing radiology index number
 Scrolling through names listed on screen
 Account number
7.4 Order Entry
CaldwellSomewhere Memorial Hospital requests that orders can be placed

through the HIS and the RIS. Due to some potential limitations of the HIS, not
all HIS placed order entry requirements may be possible. For this reason, the
following requested functionality of order entry is desired for the RIS with the
understanding that not all fields and functionality may be possible from the HIS.
The vendor shall describe and identify what functions will be possible through
the proposed integration with the HIS.
7.4.1 The system shall allow order entry from all designated RIS terminals by
authorized users.
7.4.2 The RIS shall integrate with the HIS in a manner that orders can be entered in
the HIS and sent to the RIS. Orders status updates shall automatically update
between the HIS and RIS/PACS.

7.4.3 The RIS shall allow multiple orders to be placed on one patient within the same
order encounter.
7.4.4 The RIS shall have mandatory reason for cancelled exam field with audit trail of
whom, when and where the exam was cancelled.
7.4.5 Exam cancel notifications should update all worklists within the RIS and PACS
and notify the HIS of cancellation.
7.4.6 Procedure descriptions shall be linked to CPT codes.
7.4.7 The order should allow for display and entry of ICD-9 codes and descriptions
per exam.
7.4.8 The RIS shall allow for a completely customizable order requisition to include
at the minimum:
 Patient name
 Patient type
 Patient diagnosis
 Reason for exam
 Exam requested
 Date of birth
 Day requested for exam to be performed
 Time for exam to be performed
 Location of patient
 Exam Priority
 Transportation mode
 Portable indicator
 Isolation and/or special precautions
 Free text comments field
 Pregnancy field
 ICD-9 Codes and description field
7.4.9 The order shall allow admitting, attending and ordering MD fields.
7.4.10 The RIS shall allow for multiple physicians in the order.
7.4.11 The order shall allow a field to request extra copies of reports to be sent to
different physicians.
7.4.12 The RIS shall have the ability to add a non-staff physician to the ordering
physician field.

7.4.13 The RIS shall allow for changes of the order without the re-entry of all order
information.
7.4.14 When an order is placed an patient identification/ order notification sheet will
print at designated areas according to customizable routing.
7.4.15 Al cancelled exams will print cancel notifications at the appropriate location.
This function too will be customizable.
7.4.16 All orders will automatically populate worklist in the appropriate work areas.
7.4.17 The RIS shall allow orders for non digital exams such as the interpretation of
outside film or plain film exams performed within the hospital.
7.5 Exam Management
7.5.1 The RIS shall have the ability to log and track the start and completion of an
exam.
7.5.2 The RIS shall record the technologist performing the exam with start and
completion times.
7.5.3 The system shall allow for barcode capabilities to start and end exams.
7.5.4 The system shall allow for tracking of all entered steps with audit trails to who
accesses that tracking information.
7.5.5 The RIS shall allow the creation completely customizable worklists per user,
area, and modality regardless of location.
7.5.6 The system shall allow for the creation of completely customizable worklists
that sort work in reference to modality, exam status, exam priority, and report
status.
7.5.7 The RIS shall monitor the times between patient arrival and exam start and
differentiate those exam based on pre-defined time limits using different text or
column color and/or alert symbols to notify staff of delayed exam starts.
7.5.8 The RIS shall print, email, and or fax prep instructions on demand without the
need of a scheduled or ordered exam.
7.6 Technologist Station/ Procedure Tracking and Charging

7.6.1 Authorized staff will have the ability to modify or add multiple CPT codes and
modifiers using pull down windows to the order and/or charge.
7.6.2 The Technologist shall be able to create sortable worklists specific to their
needs and have the ability to click on an exam in that list and have access to all
pertinent information.
7.6.3 The technologist shall be able to track all required steps from that station and
that screen pertaining to that specific exam mentioned in 7.6.2 using a mouse,
keyboard, and/or barcode.
7.6.4 The technologist shall have the ability to view the entire electronic requisition
for a chosen exam.
7.6.5 The technologist shall have the ability to QC the exam at the station prior to
sending the images to PACS.
7.6.6 The technologist will charge the exam at the workstation. The RIS will allow
for charges to be assigned to the order with the added ability to add or delete
charges using drop down charge lists that include surgical procedure charges
and supplies.
7.6.7 The RIS charges will automatically be updated with the HIS charge master.
7.6.8 The technologist shall have the ability to add non published exam notes to the
exam that can be accessed and viewed only by authorized users.
7.6.9 Charges will be sent to the billing component of the HIS either as a batch or
real-time. This is an option that will be determined by integration and hospital
policy.
7.6.10 The technologist shall be able to change and edit an order without re-ordering
and re-entering all the order information.
7.6.11 When a charge cancel or modification is made an update, credit or additional

charge, will be automatically logged to be sent to the HIS billing component
either as a batch file or real-time.
7.6.12 The technologist shall have the ability to add or edit pertinent demographic to
the patient profile such as but not limited to allergy and surgical history.
7.7 Film Library Management

During the transition to a filmless environment there will be need for a robust
Film Library Management System within the RIS. CaldwellSomewhere
Memorial Hospital requests that the status of all images, film and digital, be
easily managed and identified throughout the entire RIS/PACS solution.
7.7.1 The system shall use bar-coding technology to monitor the location of main
patient folder and sub-folder.
7.7.2 The system shall allow tracking of the main patient folder and sub-folder by
using location options within a patient’s exam history with the use of a
keyboard or mouse.
7.7.3 The system shall create folder pull lists created by imported scheduling
information.
7.7.4 The system shall have a loan database that can be easily be added to and
updated real-time during the folder check out process.
7.7.5 The RIS shall create a “mass move” list for film purging that will be
customizable as to what folders to purge.
7.7.6 The RIS shall have the ability to flag special case, legal cases and other
designated qualifying statuses that alert the user that permission from authorized
personnel will be required to release or purge those folders.
7.7.7 The RIS will have the ability to log and track outside exams and folders. The
system will produce a barcode for this purpose.
7.7.8 The RIS will produce overdue letters when prompted or automatically by using
completely customizable criteria and instructions.
7.7.9 The RIS shall have the ability to merge folders.
7.7.10 The system will create and log detailed audit trails for all images film and
digital.
7.7.11 The RIS shall log all downloads, film prints, CD copy and electronic transfer of
all digital images with detailed audit trails.
7.8 Diagnostic Reporting
CaldwellSomewhere Memorial Hospital requests the vendor to integrate with

our current dictation and transcription system, Lanier Medquist to obtain full
dictation and transcription functionality through the RIS/PACS.

7.8.1 The vendor shall tightly integrate their RIS/PACS solution with our current
dictation and transcription system.
7.8.2 The user shall be able to choose between voice, standardized reports or digital
dictation and have the ability to switch from one to the other per dictation.
7.8.3 The user shall have the ability to use standardized reports initiated by voice
and/or chosen through a drop down menu.
7.8.4 The dictation component shall have the ability to allow the creation of and the
ability to tag exam specific standardized reports to all exams.
7.8.5 The RIS shall allow edit and electronic signature of reports.
7.8.6 The RIS shall allow for signature at the end of dictation without sending the
dictation to the transcription side.
7.8.7 The RIS shall allow for the capability, if desired, to self edit a VR (voice
recognition) created report and then sign the same report without being sent to
the transcription side.
7.8.7 The interpreting physician shall have the ability to review the images related to
the report with one mouse click.
7.8.8 The user shall have the ability to associate multiple exams to one report.
7.8.9 The user shall have the ability to identify a report and associated images as a
special case for a teaching file.
7.8.10 The user shall have the ability to add an addendum to an report without leaving
the report signing screen.
7.8.11 The RIS and integrated transcription and dictation system shall create audit
trails that log all stages of reporting. Dictation, transcription, edits, addendums,
and signature.
7.8.12 The system shall create a fax/email audit trail.
7.8.13 The RIS shall allow seamless advancement to the next exam to be interpreted in
the worklist by keystroke or verbal command and automatically bring up all
data including exam information, patient demographics, and old reports at the
same time the images are displayed.

7.8.14 The RWS as described in 6.8.1.5 shall permit easy free text wet read capability
for all exams ordered in the emergency department with a desired workflow as
described in 7.8.13 while being compliant to requests 6.8.6.13 , 6.8.6.14, and
6.8.6.15 .
7.8.15 The system shall allow the interpreting physician to reject an exam sending it
back to an unverified status to the originating workstation, repopulating the
worklist. The physician shall have the ability to attach a "tech" note for reason
for rejection that will not be globally visible.
7.8.16 The RIS/PACS shall allow at home interpretation and signature through the
WWS if the Lanier transcription/dictation product is capable.
7.8.17 The RIS/PACS shall allow on demand printing of reports with the main
responsibility of paper report remaining with the Lanier product and the
transcription department.
7.9 Mammography Reporting System
CaldwellSomewhere Memorial Hospital requests that a mammography

reporting system be tightly integrated within the RIS/PACS solution.
Mammography reporting and tracking capabilities should be accessible and
functional on technologist and DWSs.
7.9.1 The vendor shall propose and demonstrate functionality of their own
mammography system and as a line item in the quote or provide an integration
with out existing mammography reporting system. See Appendix C.
7.9.2 A proposed system should include but not be limited to:
 ACR BI-RADS Lexicon supplied and maintained by the vendor.

 Fully integrated module with the same database as the RIS.
 Graphical mammo representation capability.
 Mammo medical history.
 Pathology capture and reporting
 ACFR statistical reporting
 Standard quality assurance audit logs, i.g., referral, detection, interpretation
and recommendation profiles.
 User defined patient report letter in layman terms.

 Pateint report customization based on patient demographics, medical history
and risk factors.
 Mammo patient demographics report.
 Mammo compliance follow-up report.
 Mammo activity report.
 Unresolved mammo follow-up listing report.
 Mammo category "0" follow-up statistics.
 Biopsy statistic report.
 Cancer statistic report.
 Patient history and risk factor report.
 Radiologist interpretive statistic report.
 Findings data form. Paper or electronic.
 Pathology data form. Paper or electronic
 Patient data form. Paper or electronic
 Patient follow-up compliance report.
 Forms-letters tracking and auditing reports.
 Create and print user customized work sheets and forms.
 User defined follow-up notification letters.
 Automatic ACR Lexicon report generation.
7.10 Multi Facility Master Patient Index
CaldwellSomewhere Memorial Hospital does not have the current need for
Multi-Facility master indexing. However with our quickly changing and
growing environment we request your RIS/PACS solution to have that
functionality.
7.10.1 The system shall have the capability to define unlimited ID types and names.
7.10.2 The system shall maintain a master patient index.
7.10.3 The RIS/PACS shall auto-generate Ids by facility with user-defined criteria.
7.10.4 The system shall allow for facility configuration specifics.
7.10.5 The system shall allow for facility specific management reports.
7.10.6 The system shall allow for tight security control in relation to allowable access
to system wide information that will be defined by configurable user rights.
7.10.7 The system shall create and store complete access audit trails to maintain
HIPPA compliance.

7.11 Document Scanning
CaldwellSomewhere Memorial Hospital desires to be a paperless facility.

However, some paper will be necessary no matter which solution is chosen. For
example a patient identification/order notification form is a requirement to meet
JACHO requirements for patient safety.
We request that the proposing vendors eliminate paper storage with either
document scanning and/or the use of electronic forms when feasible. The
vendor shall include options in their response to achieve this goal.
7.11.1 The RIS/PACS system shall allow document scanning or electronic form
completion at any designated workstation regardless to type and location.
7.11.2 The system shall allow document scanning or electronic form completion to
occur at order entry, start of exam, verification of exam, and any time at a
common patient demographic or exam history screen.
7.11.3 The system shall allow standard customizable pre-set titles or free text titles to
be attached to the document image to allow for easy and constant identification
of those documents.
7.11.4 The system shall log a time and location of the document scan or completion of
electronic form to be included in the patient’s exam history.
7.11.5 The system shall allow access to scanned or electronic documents at any point
in the normal workflow of an exam. The document shall be assessable at any
workstation and including WWS.
7.12 Inventory Control
7.12.1 The system shall link inventory supplies to procedures with automatic inventory
adjustments as procedures are recorded at a users defined racking point.
7.12.2 The system shall use standard bar code for supply utilization and inventory
maintenance.
7.12.3 The system shall have an on-line supply status inquiry.
7.12.4 The system shall create at the minimum the following inventory reports:
 Stock status
 Vendor master list

 Supply use history
 Supply reorder notification
 Usage by procedure
 Current inventory level
7.13 Management Reports and Forms
7.13.1 The system shall have the ability to report, in some manner, a completely
customizable report of any tracked information or performed function that
occurs within RIS/PACS and if available CR.
7.13.2 The system shall create at the minimum the following reports:
 Patient merges
 Patient registration change
 Patient deletions
 Canceled order
 Daily transportation
 Daily preparation instruction distribution
 Daily exam log sorted by status
 No show reports
 Incomplete exam report
 Exam code change
 Completed exam report
 Radiologist report status (need to be signed and has been signed)
 Reports status
 Overdue reports
 Fax audit
 Addendum audit
 Pull folders report
 Transferred folders report
 Loan folder report
 Interesting case report and break downs
 Daily final charge report
 ICD-9 coding queue audit report
 Customizable exam statistics
 Technologist productivity report
 Customizable time flow studies
 Exam status milestone reports
 Waiting and delay reports

7.13.3 The system shall allow for the ability to create and store the following, but not
limited to, forms and labels:
 Physician mailing labels

 Diagnostic report templates
 Pull folders request form
 Overdue letter
 Order Requisition
 Flashcard
 Patient Identification/order notification
 Transportation notices
 Various barcodes
7.13.4 The system shall generate the mammography reporting as listed in 7.9.2.
8 Computed Radiography System
As stated earlier in section 2, CaldwellSomewhere Memorial Hospital desires a

turnkey RIS/PACS and CR proposal. The decision to select a CR product
purchased through the awarded vendor will be decided on vendor
recommendation, pricing and product evaluation.
8.1 The vendor shall include in this proposal, price quotes from available vendor
partners for two (2) multi-plate loaders with all associated networking and
integration components. One reader will be located in the main department and
the other will be located in the emergency department.
8.2 System Requirements
8.2.1 System shall support a minimum of 10 remote exam terminals to each CR

reader.
8.2.2 CR supports Gray Scale Display Function (GSDF)
8.2.3 CR supports Modality Performed Procedure Step (MPPS)
8.2.4 CR shall provide redundancy within defined areas.

8.2.5 System must include advanced processing features including exam tag
customization. Define.
8.2.6 UPS provided for all CR readers.
8.2.7 System shall be capable of auto exam selection at the CR reader and allow
automatic selection of specific views that are included within a study.
8.2.8 All cassettes shall be compatible with both single and multi-plate CR readers.
8.2.9 System shall provide for and comply with all HIPAA regulations including
privacy, security and transmission rules, and audit log-in and password security.
8.2.10 Scoliosis imaging software and associated accessories shall be provided for one
multi-plate CR reader and its workstation.
8.2.11 CR system shall print to existing imagers on demand.
8.2.12 System shall support a secure access log-in for each user.
8.2.13 In the event of TCP/IP network failure, a means shall be provided to produce
hard copy output from CR.
8.2.14 A server to network remote operators consoles and readers should not be
necessary.
8.2.15 The CR workstation shall provide a mechanism to support quality review of CR

images and permit a technologist to take remedial actions to include: image flip,
image rotation, window width and level, image rejection (deletion from the
exam) and image reprocessing.
8.2.16 The CR reader shall have automatic and user selectable image processing
capabilities that are selected in accordance with the anatomical region of a given
examination. The system shall allow the user to manually override the
automatic setting and to enter new image processing parameters.
8.2.17 The system shall allow for remote cassette identification and remote image
Quality Control (QC) by means of a remote operated console.
8.2.18 All CR models shall allow technologist to review an image, apply any
necessary image processing techniques before finalizing the examination.
These image processing techniques shall be available at all workstations and
remote operated panels regardless of where the cassette was originally
identified.

8.2.19 The CR system shall have the capability to route the image either by default or
requested location.
8.2.20 The system shall interface with the RIS and PACS systems via modality work
list, DICOM print / retrieve/query/store, and performed procedure step.
8.2.21 Workstation shall offer management reports to include repeat/reject auditing

and analysis, relative doses, and film utilization.
8.2.22 CR system shall not require the change of the grids in the existing imaging
equipment in the Radiology Department to insure excellent image quality.
8.2.23 The system shall allow image availability at multiple locations, to enable patient
relocation during procedures.
8.2.24 The system shall be able to store images for over a 24-hour period worth of
procedures.
8.3 Workstation Functionality
8.3.1 The system shall use graphic user interface (GUI) with keyboard, mouse, touch
sensitive screen, bar code reader, desktop CPU with a minimum 40 GB hard
drive to prevent loss of data and interruption of operation in the event of TCP/IP
network failure.
8.3.2 All stations designated as QC stations shall have high resolution monitors with a
display matrix of at least 1024 x 1024 with same user interface as the other
remote operations panels.
8.3.3 User shall have the option to annotate images with free-text comments, apply
digital image position markers and relocate as necessary, adjust collimation on
final images, contrast and brightness before print or sent to PACS.
8.3.4 Allows image ID via modality worklist, image review, QC and print that can be
shared between all CR readers and remote panels on the network for
redundancy purposes.
8.4 Requested Vendor Information
8.4.1 The vendor shall submit to CaldwellSomewhere Memorial Hospital in an easily

comparable format the following information per CR vendor:

 Cycle time for standard resolution 14x17 plate.
 Image preview time for standard resolution plate.
 Recommended resolution per body part
 14x17 plates processed per hour using standard resolution.
 Typical plate cycle lifespan.
 Available plate sizes and resolutions.
 System capable of true size DICOM print.
 Cassette capacity of loader.
 Grayscale depth.
 Compatible printers.
 Reader physical dimensions.
 Spatial resolution.
 Multiple exposures per plate capable.
 Latent image time before degradation.
 Required special cassettes for certain exams.
 Recommended grid ratios.
 Exposure technique difference between film and proposed system.
 Available algorithms
 Customizable algorithms
8.4.2 The vendor shall evaluate the number and sizes of cassettes needed to handle
general radiography volume using Appendix A as a guide.
9 System Integration
9.1 Operations
9.1.1 The proposal shall include a description of the staff required to operate the
system, their necessary qualifications, and the tasks the staff will perform.
9.1.2 Describe Process Re-engineering Services provided by the vendor.
9.1.3 Vendor shall provide the option for a full-time Dedicated Service Engineer
following installation for a set period of time. Please list as line item in proposal
and price quote.

9.2 Security
All the following requirements are too applied to the security of RIS and PACS
and CR.
9.2.1 Users shall be required to change their passwords following initial setup or
resetting of the password.
9.2.2 User passwords shall automatically be changed after a user-defined period has
passed.
9.2.3 Users shall be notified when their password is about to expire.
9.2.4 Users shall be provided with the capability to change their own passwords.
9.2.5 The system shall automatically log users off after a specified period.
9.2.6 Passwords shall be entered in a non-display field.
9.2.7 Passwords shall be encrypted when routed over a network.
9.2.8 Passwords shall be encrypted when stored in the database.
9.2.9 System shall log unauthorized access attempts by date, time, user id and
location.
9.2.10 The system shall lock out a user after a configurable number of unsuccessful
login attempts.
9.2.11 System shall maintain an audit trail of all security maintenance performed by
date, time, user id, and location and be easily accessible.
9.2.12 System shall provide security reports of users and access levels.
9.2.13 System shall provide varying levels of access within the security application
(i.e. access to only password reset functions or access to password reset and
access to add and update users).
9.2.14 System shall provide varying levels of access within the application.
9.2.15 System shall use groups to define levels of access.
9.2.15 System shall log all accesses (including inquiry, which is a proposed HIPAA
standard)

9.3 Reliability
9.3.1 The RIS/PACS system shall be designed with reasonable redundancy so that no
single point of failure can cause a major breakdown of radiology service.
9.3.2 The system shall protect against the loss of acquired images and data.
9.3.3 If a failure interrupts or disables image acquisition, the system shall provide a
means to enter the missed images from the imaging equipment at a later time.
9.3.4 Where appropriate to guarantee against loss of image or exam information

during acquisition or storage in the PACS in the event of a power failure, the
vendor shall supply an Uninterruptible Power Supply (UPS) with sufficient
capacity to support the necessary equipment during the operation. This
requirement is not intended to require UPS at all locations, only at those
locations where a power failure would cause a loss of patient images or
information. This requirement is also not intended to require that the system
continue to operate for additional acquisitions during the power outage.
9.3.5 The proposal shall include a list of all routine activities, such as, database
backup, routine service and maintenance, and routine software and hardware
upgrades, that result in loss or decrease in service.
9.3.6 The proposal shall include a description of the back-up and failure recovery
process for each major PACS module and the amount of customer in-house
personnel support required.
9.3.7 Please define critical components and uptime definition and associated costs.
9.3.8 Please identify options available for the proposed configuration for maximizing
uptime and associated costs.
9.3.9 Please describe any available system monitoring services and associated costs.
9.3.10 Please describe any available on-site service and associated costs.
9.3.11 The proposal shall identify all components, the failure of which can cause
significant loss of system functionality, e.g., inability to acquire, display,
archive, or fetch exams.
9.3.12 The vendor shall describe the failover strategies to be employed when each
system component fails, including interfaces to external information systems.
9.3.13 Each failover strategy shall include detailed descriptions of:

• how the failure will be detected

• how much of the system will remain operational during the failure
• how the function of the failed component will be performed during the
failure
• how the system will be restored after the failure has been corrected.
9.3.14 The system shall require minimal IT intervention/maintenance. Describe.
9.3.15 The vendor shall describe professional services available to assist us in

analyzing the balance between the costs of a high availability solution versus
uptime (e.g. availability audit).
9.3.16 The system shall have self monitoring capabilities and alerts through paging
and/or e-mail to the PACS administrator of problems.
10 Purchased Components
10.1 Configuration
10.1.1 The vendor shall supply and install the equipment in the proposal.
10.1.2 The vendor shall supply and install the communication network within the main
RIS/PACS/CR intranet to support the project including hubs, routers, viewing
stations wiring, and associated software.
10.1.3 The vendor shall supply all necessary media for the on-line portion of the
archive system necessary to support 90 days’ operation of the system at the
capacity indicated in Appendix A.
10.1.4 Vendor shall provide equipment cabinetry, racks, UPS and other items
necessary to suitably house the PACS equipment. These items should be listed
as line items on the price quote.
11 Installation and Implementation
CaldwellSomewhere Memorial Hospital requests to install PACS and CR first.

After completed successful acceptance of those two systems, RIS will be
installed.

11.1 Hospital-Furnished Equipment and Services
11.1.1 The hospital intends to centralize the core components of PACS to provide
maximum security and to facilitate the task of system administration. The
hospital will renovate the space required to provide the computer room.
11.1.2 The proposal shall specify those core system components, which are appropriate
to centralize in a computer room with limited access for system administration
and maintenance personnel.
11.1.3 The vendor shall describe steps that the hospital can take in order the facilitate a
smooth installation as well as reduce project costs.
11.1.4 The vendor shall describe hospital responsibilities during project
implementation.
11.2 Vendor Furnished Services
11.2.1 Vendor shall describe its PACS implementation and project management
process. Vendor shall include in this a description of the project management
team.
11.2.2 Vendor shall provide a sample project plan (e.g. Gantt chart) of a typical
installation. This should include:
11.2.3 Project milestones and estimated completion times
11.2.4 Detailed tasks including duration, effort, resource
11.2.5 Vendor shall describe interface specification and testing.
11.2.6 The vendor shall be responsible for network installation as noted in section
10.1.2.
11.2.7 Vendor shall describe how it can assist the hospital in calculating projected ROI
for PACS.
11.2.8 The vendor shall assist in creating downtime procedures for the RIS/PACS.
12 System Acceptance
12.1 Verification that the required equipment and services meet the RFP
requirements shall be accomplished through an Acceptance Test.

12.2 The vendor shall submit with the proposal a complete draft acceptance test plan
including time lines. The hospital and the vendor will negotiate a final version
of the acceptance test before the contract is awarded.
13 Training
13.1 An operator’s manual in softcopy format shall be provided for each delivered
system component.
13.2 QC procedures required to maintain operation within the requirements of this

RFP shall be supplied for each component.
13.3 All manuals shall be updated appropriately to reflect each new software release
and implementation phase.
13.4 The proposal shall include a comprehensive training plan that includes:
 on-site vendor training staff
 Courses offered
 Summary of course content
 Frequency of course offerings
 Training programs for: technologists, Radiologists, administrative
personnel, ICU staff, ED staff, IT staff and a RIS/ PACS administrator
 Continuous, computer based training materials and programs.
13.5 Vendor shall indicate if training qualifies as “continuing education.”
13.6 Vendor shall indicate if follow-up training is available and/or necessary.
14 System Warranty and Maintenance
14.1 Warranty
14.1.1 The warranty period shall start on the date of successful completion of the
acceptance test for each system as agreed on by the vendor and the hospital.
14.1.2 The vendor shall specify options and terms related to warranty of both
software and hardware, including length of warranty period.

14.2 Maintenance
14.2.1 The vendor shall include in the proposal an offer of both a one-year and a multi-
year maintenance contract with the characteristics described in the rest of this
section, specifying the ordering and payment terms.
14.2.2 In order to meet the functionality and reliability requirements of this RFP, the
vendor will state the number of hours and the qualifications of staff who will be
needed for maintenance of the RIS/PACS. This personnel support will be
supplied by the vendor during the maintenance period and will be supplemented
with staff from the hospital.
14.2.3 The proposal shall include a schedule of downtime required for routine system
maintenance, including frequency, duration and time of day. The preferred
implementation will have a minimum of scheduled downtime.
14.2.4 Timely maintenance and support response time is critical. It is expected that a
page to the field engineer on call will result in a return call within 1 hour. The
severity of the problem can be assessed by phone with a triage approach.
Complete system failure, or complete modality failure including CR, will
received the highest priority with a service person on-site, actively working on
the problem within 2 hours between the hours of 900 and 1700 . Lesser
problems will be attended to promptly as the severity of the problem dictates.
All problems will be aggressively handled with timely progress communication
with department staff. The vendor will describe the method and time frame of
problem resolution.
14.2.5 Vendor shall describe availability of support services, hours of operation and
any applicable costs for RIS/PACS and CR. (i.e. for after hours service).
14.2.6 Review all aspects of your technical support structure.
14.2.7 Vendor shall outline its service support process.
14.2.8 Vendor shall describe its escalation procedure.
14.2.9 Vendor shall describe the process for software maintenance releases and
updates.
14.2.10 The vendor shall handle all support calls through one phone call for RIS/PACS
and CR.
14.2.10 The system shall be designed such that major system components can be
upgraded without the need for any significant scheduled downtime. Describe
hardware replacement scenarios that would require the system to either stop
acquiring images or stop displaying images on user workstations.

14.2.11 Vendor shall describe any available technology refresh program.
14.2.12 The vendor shall describe how CR service and repair will be handled.
14.2.13 All hardware (RIS/PACS/CR) shall be listed by one of the following agencies,
UL, CSA, ETL, MET or Entella.
14.2.14 All hardware shall be labeled by one of the agencies listed in 14.2.13 in a visible
and secure manner.
15 Reference Information
15.1 The vendor shall supply a list of at least five (5) current hospital radiology
department users of the PACS system proposed for implementation at
CaldwellSomewhere Memorial Hospital. The reference sites PACS must be
“live” for at least six months. Hospitals of similar size and complexity are
preferred.
CaldwellSomewhere Memorial Hospital understands the fast changing
environment of RIS/PACS and CR systems. For that reason, the requirement of
15.1 may be meet using installations of a system that is not proposed in your
response to this RFP.
However, we will require this information to evaluate the vendors capabilities
concerning but not limited to, support, uptime, implementation and problem
solving.
15.2 In addition, vendor shall provide a site diagram of the hospital installations,
including core components (servers, archives) and peripherals (workstations,
DICOM gateways).
15.3 Identify the greatest benefits that your PACS system has over other systems?
15.4 How long has your proposed PACS system been commercially available?
15.5 Do you own your PACS software?
15.6 Do you have a PACS User Group?
15.7 What is your largest installation?
15.8 What is your smallest installation?

15.9 Describe your experience with multiple-department PACS (e.g. radiology,
cardiology,etc.)
15.10 Describe your experience with multiple-facility PACS (hospital(s),

clinic(s),etc.)
15.11 Describe future product plans/direction.
16 Project Administration
16.1 The administrative points of contact at the hospital for all contractual matters
are:
Tim Harris - Diagnostic Imaging Director

321 MulberryHuckleberry Street SW
LenoirHomeTown, NC 2864510101
828555-757-5218 Office
828555-757-5206 Fax
[email protected]
Paul LeonhardtHomeboy - Asst. Director Diagnostic Imaging/ PACS

Administrator
321 MulberryHuckleberry Street SW
LenoirHomeTown, NC 2864510101
828555-757-6152 Office
828555-757-5206 Fax
[email protected]
16.2 The vendor’s proposal shall identify a single administrative point of contact for
future negotiations and project planning.
17 Proposal Structure
17.1 The proposal shall include:
• system pricing
• technical description of the product offering and the specific
configuration for the hospital
• individual responses to each requirement using the requirement
identification numbers in this RFP; preferred format is to insert the

response into the document immediately following each numbered
statement
• specification sheets for all components
• technical reports and documentation necessary to validate the
vendor’s claims
• installation time line and staging plan
• information as required by other requirements in this RFP.
17.2 Three (3) printed copy of the proposal shall be submitted.

17.3 The proposal shall also be submitted as a Microsoft Word and/or Excel files on
CD. Copies of the specification sheets and technical reports and documentation
need not be included on the diskettes.
17.4 The proposal shall explicitly identify every requirement of this RFP, which is
not met by the vendor’s offering. If a requirement will be met in the future, the
vendor may provide a schedule of commercial availability for future
enhancements, which will provide the necessary functionality, along with the
price. If a requirement will not be met by a planned enhancement of the system,
the vendor may explain the impact of the deficit on overall system functionality.
18 Financing Options
18.1 The vendor shall include in the price quote all available vendor financing and
leasing options.

Appendix A
October 2003- September 2004

Volume
Department Volume
Diagnostic 30,959
Nuclear Medicine 3,832
Ultrasound 7,895
CT 6,476
Breast Center 4,546
MRI 1,979
Total= 55,687

Appendix B
Modality Proc. Per Avg. images per Annual % DICOM

year study growth READY
CT 6476 120 3 Y*
NM 3832 30 3 Y*
MRI 1979 100 3 Y
R&F 1660 25 2 Y*
FFDM** 4546 5 2 Y
C-ARMS x 157 2 2 Y*
3
US X 3 7895 24 3 N
CR 30959 5 3 Y
* Modality is DICOM capable and will be native DICOM ready by start of

installation.
** Based on current mammograms performed on analog unit. FFDM pending.
# of Modality Manufacture Description Current software

Modality Type version
1 CT GE Lightspeed 4 3.x
1 Fluoro GE DRS 3.2
1 NM GE/SMV DST-XL 2.1
3 US Toshiba Powervision 2.1
6000
1 MRI GE Signa LX 9.1
3 C-arm GE/OEC 9800 9.0.1
2 CR TBD TBD TBD
Multiloader
1 FFDM TBD TBD TBD
Existing Dry Laser Printers

1- Linx Contact 400
2- AGFA Drystar 3000
APPENDIX C
INTEGRATIONS
Scheduling: ASP Scheduling.com version-26
Transcription/Dictation: Lanier Medquist
Transcription- Cquence MT version - 3101p

Dictation- Cquence VXP version- 7.30.8
HIS: SMS Medseries 4 release- 23.30 operating on AS400 OS 5.2
RIS: SMS Medseries RIS release 23.30 operating on AS400 OS 5.2
Mammography Reporting System: Insight version-6.0
Carolina Orthopedics PACS: Merge E version-1.9.3 build 18

APPENDIX D
DIAGNOSTIC IMAGING DIAGRAM

APPENDIX D
EMERGENCY DEPARTMENT

APPENDIX D
OR DEPARTMENT

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Request for Proposal

3 Proposal Preparation Instructions……………………………….7

5 Clinical Operations and Functionality…………………………..

6.4 System Storage……………………………………………………

6.5 Archive System……………………………………………………

6.6 External Information System Interfaces……………………………

CaldwellSomewhere Memorial Hospital 2

6.7.2 General Modalities……………………………………………..

6.7.3 Film Digitizer…………………………………………………..

6.7.4 Quality Control Workstation……………………………………

6.8 Image Display Workstation…………………………………………….

6.8.3 Monitor Calibration……………………………………………

6.8.5 User Interface…………………………………………………..

6.8.6 Exams, Folders, Worklists, and Queries………………………..

6.8.8 Exam Display and Arrangement……………………………..

6.8.9 Image Display and paging……………………………………..

6.8.10 Grayscale Operations…………………………………………

6.8.11 Image Orientation, Zoom, Pan, and Magnify…………………

6.8.12 Region of Interest, Distance, and Angles……………………….

6.8.13 Image Annotation……………………………………………..

6.8.14 Image Identification…………………………………………….

6.8.15 Utility Functions………………………………………………

6.8.16 Control of Hard Copy…………………………………………

CaldwellSomewhere Memorial Hospital 3

6.8.19 Orthopedics Tools…………………………………………….

6.8.20 Mammography Tools…………………………………………

6.9 Film Printers…………………………………………………………….

6.10 Web Servers and Workstations…………………………………………

7 Radiology Information System…………………………………………

7.3 Patient Profile…………………………………………………

7.4 Order Entry……………………………………………………

7.5 Exam Management……………………………………………

7.6 Technologist Station/Procedure Tracking and Charging………

7.7 Film Library Management……………………………………...

7.8 Digital Reporting……………………………………………….

7.9 Mammography Reporting System…………………………….

7.10 Multi Facility Master Patient Index……………………………

7.11 Document Scanning……………………………………………

7.12 Inventory Control……………………………………………..

7.13 Management Reports and Forms………………………………

8 Computed Radiography System………………………………………..

8.2 System Requirements…………………………………………

8.3 Workstation Functionality……………………………………

8.4 Requested Vendor Information………………………………..

CaldwellSomewhere Memorial Hospital 4

11 Installation and Emplementation………………………………………..

11.1 Hospital Furnished Equipment and services…………………..

11.2 Vendor Furnished Services……………………………………

14 System Warranty and Maintenance …………………………………….

CaldwellSomewhere Memorial Hospital 5

CaldwellSomewhere Memorial Hospital is proud to bring the best in healthcare

2.1 This document requests a proposal for a Picture Archiving and

CaldwellSomewhere Memorial Hospital requests that your solution provide all

CaldwellSomewhere Memorial Hospital 6

2.3 As soon as possible CMH wants to first implement an enterprise RIS/PACS

3 Proposal Preparation Instructions