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20. Showdown in the Heart of Texas 203the CEOs. There is a high probability that if PACS fails at one institution, it could leadto a systemwide failure and loss of a huge investment.A failure on my part to get the systemwide implementation accomplished wouldseverely diminish my power and influence within DSHCS and could cost me my job.Mr. Hyde seems to be challenging me directly.”In summary, Mr. Yurit’s concerns are:1. A need to actualize the decisions of the board of directors and Mr. Ollie regardingthe implementation of PACS throughout DSHCS.2. Resistance from Mr. Hyde.3. Risk of loss of esteem and possibly the loss of his job if the PACS implementationfails.Mr. Hyde’s Perspective“For the past several years, the radiologists have been suggesting to me that the hospitalinstall a PACS in order to help reduce the turnaround time for radiology reporting,as well as to address the sparse radiology coverage of the regional hospitals byelectronically connecting them to HBO. PACS will greatly enhance the efficiency andthe perception of the radiology department to physicians and help improve the qualityof care for patients. Lost films or x-ray jackets will be much less of a problem. Imageswill be available to physicians in the radiology department, throughout the hospital, inthe operating rooms, and in the private physicians’ offices via a Web product. Radiologyreports will also be available more quickly, as they will be online as soon as theyare electronically signed. Physicians will no longer have to come to the radiologydepartment to view films. Looking for films and awaiting results are significant physicianissues.Why else do we need PACS? Our patient load has increased each year. Also, thenewer technologies (spiral CT, faster MRI software, etc.) allow us to perform examsmore quickly. The faster exam times have encouraged physicians to order radiologystudies more liberally. PACS seems to be one way to handle this increased workload.The other way to address this would be to hire more radiologists, but this is verydifficult in the current market.Critical issues still need to be addressed. I want to know if the technology is developedenough to ensure that this is not just a “fad” that the radiologists will not useafter 3 years. What I’ve read in the literature seems to support the idea that PACS isgoing to be the future of radiology. Why else would Kodak and Fuji, major players inthe film-based radiology arena, be putting so much R&D into PACS? Will the technologybe obsolete in a few months? Well, there will be improvements, just as thereare every 6 months in the PC area, but with a reliable company the systems should beback-compatible. What are the financial considerations in terms of cost, the timeto breakeven point, and the return on investment (ROI)? These variables dependon the institution, but from what I read, a facility like ours should break even in lessthan 5 years. We need to be sure to use a vendor that has a history of staying power inthe field and of excellent site support in order not to jeopardize patient care. I agreewith our radiologists’ assessment that it would be best for us to lease a system andinstall it using a phased-in approach. I don’t want to commit to something that maynot work for us and don’t want to disrupt the physicians’ work patterns too drasticallyall at once.We’re the largest facility in DSHCS, and Mr. Ollie hasn’t even asked our opinion ofwhat we need or want in terms of PACS. He sent Mr. Yurit down for only one day and