TENDER FOR THE SUPPLY, INSTALLATION AND COMMISSIONING OF A RADIOLOGY INFORMATION SYSTEM - PICTURE ARCHIVING &COMMUNICATION SYSTEM (RIS-PACS) FOR KUANTAN MEDICAL CENTREl;.

Kuantan Medical Center, part of healthcare division of TDM Berhad (KMI), is planning to implement RIS-PACS system to enable online viewing of images and streamlining the radiology workflows. The aim is to achieve filmless operations in the very near future. The RIS-PACS system shall be interfaced with the Hospital Information System (HIS) to ensure that the patient demographics is consistent between the two systems.

The Hospital is looking for a turnkey solution where the vendor needs to propose end to end solution ie. hardware, software and the support after the warranty period.

The hospital will bear the cost of system integrations between RIS/PACS and HIS, as well as between RIS/PACS and the imaging modalities.

System ArchitectureThe proposed solution shall consist of RIS/PACS systems. It is the vendor choice to offer RIS & PACS as two separate systems OR to offer as one integrated system, with single database.

Below is the reference solution architecture:

a) SUMMARY PACS - Kuantan Medical Centre

i) Annual Workload:

No. Procedure Daily Workload Monthly Workload

Annual Workload(cases)

1 General X-ray - - 13,0002 Fluoroscopy - - 1203 CT Scan - - 3,2004 MRI - - 3,2505 Ultrasound - - 4,3006 Mammography - - 5007 Cardiac Angiography - - 3608 DEXA - - 1209 C-Arm (OT) - - 900

Total Workload 25,750

ii) Modality List:

No. Modality Type Manufacturer Model QuantityDICOM Option

Available(Worklist & Storage)

1 General X-ray Shimadzu Radspeed MC 2 Yes2 Fluoroscopy Shimadzu Flaxvision 1 yes3 CT Scan Siemens Definition AS 1 Yes4 MRI GE Signa Explorer 1 Yes5 Ultrasound GE & Mindray GE Logiq 6; Mindray DC8 2 Yes6 Mammography Philips MammoDiagnost AR 1 No7 Cardiac angiography Shimadzu Bransist Alexa C12 1 Yes8 DEXA Hologic Discovery WI 1 Yes9 Mobile C-Arm (OT) GE Brivo OEC 785; OEC 9900 Ekite 2 Yes

10 CR Konica Minolta Regius 3 yes

iii) Solutions & Version Offered

iv) Storage Type & Capacity

v) Country of Origin

vi) Country of First Release

vii) Warranty

viii) Total Price (RM)ix) PPM Contract (Post-Warranty)

b) PPM Contract Quotation (Post Warranty)

i) Comprehensive

YearYear 1 Year 2 Year 3 Year 4 Year 5 Total (RM)

Cost (RM)

ii) Non-comprehensive

Year Year 1 Year 2 Year 3 Year 4 Year 5 Total (RM)Cost (RM)

No. Specifications Comply(Yes/No)

Remarks

1.00 Vendor Qualification1.01 Vendor should have a minimum 3 PACS implementations in the

country.Please provide the user certificate from end users.Please provide a list of installed bases in Malaysia & Singapore, giving names of sites and year of installation.

1.02 Vendor should have the experience of implementing Enterprise PACS (connecting multiple sites).Please provide details of such implementations with number of sites, individual bed strength and year of go life.

1.03 The vendor shall have Malaysian MDA certification.Please produce the certificate.

1.04 The proposed solution shall be FDA and CE compliant.Please produce certificates.

2.00 Technical Specifications 2.01 The solution shall include a Radiology Information System (RIS)

& Picture Archival & Communication System (PACS).

2.02 The solution shall be multi-modality capable (i.e. CR, CT, MRI, US, etc.).

2.03 The solution shall support remote viewing/reporting of exams when required.

2.04 The solution shall include unlimited viewing licenses. 2.05 The solution shall support HL7 compatibility. 2.06 The solution offered shall be fully integrated with Hospital

information System (HIS), for ordering & results notification.

2.07 The solution shall support reporting capabilities. 2.08 Server Database should be based on reputable & proven

vendors (i.e. Oracle or Microsoft).2.09 Proposed architecture should be completely virtualized

(including database), using VMWare virtualization for scalability.

2.10 Proposed solution should be certified to run on VMWare virtualization platform (i.e. performance tests).

2.11 Vendor to provide the following:i) DICOM Conformance Statementii) IHE Certificationiii) FDA Certificationiv) EC Certificationv) ISO Certificationvi) HIPAA Statement

2.12 The solution provided should be inclusive of hardware & software.

2.13 For tele-radiology environment with multiple sites connected, the system should provide user access to multiple data sources (i.e. exam location) whilst logged on a single workstation

2.14 For tele-radiology environment with multiple sites connected, the system should be able to consolidate exams belonging to a single patient but done on different sites. This information should be presented in a single session to allow users to view the imaging history of that particular patient.

2.15 Feature stated in 2.14 should support configuration to match exams belonging to a certain patient based on common demographics (i.e. name, birth date, gender, etc.). The likelihood of exam match results should be displayed in percentage '%’, with matching criteria & percentage values configurable.

2.16 Feature stated in 2.14 should also support integration with other data sources (PACS from a different vendor), where data could be accessed.

2.17 The solution should support image compression. Compression algorithms should be configurable based on modality, AE Title & Body Part.

2.18 Ratio of image compression stated in 2.17 should be JPEG Lossless (up to 3:1) or Wavelet Lossy compressed (upwards of 100:1).

2.19 The solution should support subscription feature, where users could create an exam folder based on specific requirements. Notification in the form of message alerts or system sounds should be available whenever a new content is added to the folder.

2.20 Users should be able to reserve an exam to prevent the same exam from being read/reported twice.

2.21 Mobile Access: Mobile App for both iOS and Google platform available.

2.22 Non-DICOM image support: System shall allow attaching non-DICOM images and these images shall be available for online viewing on any physician terminal.

3.00 Application Specifications - RIS 3.01 The system should be entirely web-based solution, accessible

via web browser.

3.02 The following modules should be available:

● Appointment & Scheduling● Statistics● Transcription● Tele-Radiology● Reporting● Voice Recognition● SMS & Email Notifications● PACS Integration● HIS Integration

3.03 Availability of Home/Dashboard view, displaying the following information via visual format, such as graph bar or pie chart on Imaging Department:

● Outstanding Examinations● Daily Workload● Key Performance Indicator (i.e. turnaround time)● Activity Report

3.04 Using a single mouse-click, information displayed on Home/Dashboard view should be able to:

● Send a print request to printer● Download in JPEG or Bitmap● Export data in Excel (CSV) format

3.05 Scheduling should provide a systematic list of exams scheduled, with the ability to display the following:

● Statistics daily/monthly/annually● Examination room occupancy rate (high/low)● Latest appointments/schedules● Pending/scheduled appointments● Notification of downtime (i.e. equipment/system maintenance)

3.06 When assigning a procedure to the order, users should be able to either:● Filter available procedures using procedure code/modality type, or,● From an anatomy diagram, selecting a specific body part to display list of procedures available

3.07 Availability of Arrival view, with options to display & filter:● Entire schedule● Examination based

3.08 For ad-hoc requests, users should also be able to create new arrivals (i.e. emergency cases).

3.09 Examination worklist, displaying the list of exams per patient. The priority for each exam based on waiting time should be displayed in the form of color code.

3.10 Supports the execution/start of multiple exams concurrently. 3.11 Upon execution of exam, the system should generate modality

worklist specific to the modality, based on procedure type.

3.12 Reporting worklist is filtered automatically to assigned radiologist based on username. However, radiologist should also have the option to view exams assigned to other radiologists as well.

3.13 Transcriptionist workflow should be supported. Describe the workflow.

3.14 Voice dictation support: Radiologist should be able to record the report as voice file which is accessible to the transcriptionist.

3.15 The system shall support integration to provide voice recognition.

3.16 Customizable report templates, especially on the following:● Header/Footer● Patient & examination details● Templates based on exam types● Radiologist details (i.e. name, credentials, signature)● Printed by <username>

3.17 Radiologist should have the option to share their reporting templates or otherwise (private).

3.18 Radiologist should have the option to automatically load specific reporting templates with corresponding examinations.

3.19 Supports dual reading workflow, by 2 different radiologists (i.e. reported by & validated by).

3.20 Option to provide a single report for multiple procedures. 3.21 The system should have the ability to customize & generate

statistical reports such as:● Annual workload/Workload based on modality● Average turnaround time based on procedure/modality● Total reported exams● Audit Trail

3.22 Solution should be integrated with PACS & Hospital Information System (HIS).

3.23 When the hospital implements EMR, the RIS shall be integrated with the EMR so that with a single click, radiologist can view

other details of the patient.3.24 It should be possible to view the details of personnel involved in

the order, i.e. who created the order, who scheduled/rescheduled it, scanning radiographer, typist, sign-off radiologist

3.25 System shall be able to send SMS/Email to radiologists/physicians/patients.

3.26 Turn-Around-Time (TAT) Provisioning: System shall allow to specify the TAT for various modalities and exam types (normal/ASAP/stat). These TAT shall be displayed on the radiologist work list.

3.27 Provisioning of clinical documents: The system shall allow provisioning of standard document templates (e.g. consent form, check list, preparation guidelines etc).

3.28 Critical case reporting: The system shall support documentation of critical cases in the system and informing the same to physicians.

3.29 Embedded Rich Text Editor: Reporting module should have embedded rich text editor for reporting.

3.30 MS-Word Integration: Reporting editor can be configured with MS-WORD.

3.31 Ability to embed electronic signature.3.32 The patient demographics should appear in all pages of the

reports automatically.3.33 Reports should display the page numbers.3.34 Support for Medical Dictionary in the default embedded editor.3.35 Addendum work flow: Once report is completed, user can only

make changes via Addendum.3.36 Structured Report: The proposed solution shall be able to

process he structured reports being generated from equipment and make them available during reporting

4.00 Application Specifications - PACS 4.01 The system should be entirely web-based solution, accessible

via web browser.

4.02 The system should have a zero-footprint viewer. 4.03 The system should be based on server-rendering technology,

where no data is downloaded to the viewer.

4.04 The system will be a single solution, combining PACS with optional reporting capabilities.

4.05 The mouse device should be configurable with Mouse Button Down Operation (MBDO).

4.06 The system should support one-hand mouse operation for common tools such as: Window Levelling, Zoom & Pan.

4.07 Image processing presets should be configurable based on modality. These presets should be available through keypad shortcuts.

4.08 Image processing features should be available for CR, CT, MG & other general image types sent from modality, (vendor -neutral).

4.09 The system should support interactive region of interest with zoom, magnification & window levelling.

4.10 The system should provide manual DICOM image shuttering capabilities.

4.11 Users should be able to input information into the DICOM images through active overlays.

4.12 The system should provide spine labelling feature for CT and MR exams.

4.13 The system should provide store & display Tomosynthesis (Mammo) Exams, with dedicated viewing protocols.

4.14 The system should have toolbar icons for easy access. The toolbar should have pin/unpin feature depending on user's preference.

4.15 The system should have the following annotation & measurement capabilities:

o ROI with calculated area, perimeter as well as mean and standard deviation of densityo Free texto Line length and line ratio rulero Arrowso Curved line measuremento Density Values (Hounsfield Unit, Optical Density or Pixel Value depending on image type)o Elliptical, rectangular and freehando Label palette for spine labeling

4.16 The system should support viewing of cine images with supporting tools.

4.17 The system should support export of lossy JPEG images to desktop JPG or BMP file via drag & drop.

4.18 Users should be able to do image stacking via mouse control. 4.19 Users should be able to bookmark key images as required. 4.20 The system should support drag/drop for copy and paste to

external Windows Applications.

4.21 The system should support drag and drop to create shortcuts to a specific exam or exam folder, accessible via a desktop icon.

4.22 Users should be able to perform synchronized stack navigation

4.23 Users should be able to perform crosshair 3D navigation with support for MG & PT exams.

4.24 The system should be capable of linking between series or images belonging to the same exam for relative window levelling to reduce the number of clicks while reading an exam.

4.25 The system should include monitor calibration support for true size display.

4.26 Users should be able to select image compression version for initial loading/display of exam, and also changing the version after exam is loaded.

4.27 The system should include customizable modality specific overlays for patient, study & image information.

4.28 The system should include integrated MIP & MPR feature, launched within the same viewing window as PACS.

4.29 The following viewers in MIP/MPR should be available to the user:• MPR Viewer• Compare• Stereo Viewer• Fusion Viewer• PET-CT Fusion Compare

4.30 Users should be able to customize viewing protocols. 4.31 The system should provide a reading protocol editor based on

graphical user interface to create reading protocols based on modality, procedure, & MG specific stack reading protocols.

4.32 Users should be able to choose a different protocol via drop-down list.

4.33 Users should be able to reorder or delete reading protocol steps.

4.34 The system should support template reading protocols. Four levels should be available:o All studieso Specific modalityo Specific procedure code(s)o Specific series combination using the DICOM series description name to match the protocol

4.35 Users should be able to create own user level reading protocols. 4.36 System should provide series standardization feature with the

ability to normalize series names from different modalities.

4.37 MG images should be grouped at image level due to MG workflow requirements.

4.38 MG stack match protocol should be available for users to display a mixed set of exam images from various MG series in one viewport.

4.39 Users should be able to export or import reading protocol settings between similar systems.

4.40 Users should be able to customize context menu for most frequently used menu items.

4.41 Users should be able to create/customize folders based on image, demographic information & other HIS/RIS data.

4.42 The system should include a dashboard view to provide exam specific information to users.

4.43 A history folder containing exams previously viewed by users should be available.

4.44 Folder columns should be sorted (up to 3 sorts at once) and filtered using on screen query by example.

4.45 Folder columns should be configurable with color designation for individual or workstation based.

4.46 Users should be able to launch exam search within image view. 4.47 System should support auto-compare for relevant priors by one

of the criteria’s below:o Same modalityo Same procedure codeo Related procedure code across modalitieso Related procedure code and same modality

4.48 System should provide a single viewing/access screen for the following information:o Comparison examso Study informationo Reportso Noteso Documentso Series

4.49 Users should be able to add text or voice notes. 4.50 Users should be able to store non-DICOM objects via drag &

drop in the system screen.

4.51 Users should be able to add documents via direct scanning into the system.

4.52 The system should include series picker that is configurable. 4.53 The system should support roaming user profiles. 4.54 Auto-logoff feature should be available. 4.55 The system should support folder access based on user roles. 4.56 The system should support automated content deletion. 4.57 The system should include administrative folders for display of

system metrics and any possible anomalies.

4.58 The system should support drag & drop features for study,

series, image, patient merging and reallocating.4.59 The system should support ad-hoc deletion of exams for users

with appropriate roles/privileges. A safety mechanism to recover deleted data must also be included.

4.60 The system supports DICOM header export. 4.61 Users should be able to perform DICOM print via the system

using print composer feature, to configure desired print layout.

4.62 Users should be able to transfer exams into external media, i.e. external USB hard disk, CD, DVD, etc. Option to anonymize exams must be available.

4.63 A DICOM viewer must be embedded whenever an exam is transferred/burned to external media.

4.64 The system should support viewing/access via Apple Mac interface with vendor's own native viewer, if required.

4.65 The system shall support dose capture: Ability to capture radiation dose from the modality end.

5.00 Zero Foot Print (ZFP) ViewerPhysicians shall access the images using ZFP viewer

5.01 The ZFP viewer shall support viewing of DICOM and non-DICOM images.

5.02 The ZFP viewer shall support standard tools like zoom, pan, rotate

5.03 The ZFP viewer should support measurements e.g. linear, angular, area. For area measurements on CT images, it shall display the average Hounsfield values.

5.04 The ZFP viewer shall support WW/WL and the modality presets for CT.

5.05 The ZFP viewer shall support series synchronization.

5.06 The ZFP viewer shall be able to display images and reports side by side.

6.00 Architecture6.01 Solution proposed should have high availability for business

continuance; using auto-failover which doesn’t require any manual/user intervention.

6.02 Solution proposed should be inclusive of database and image backup solution.

6.03 Proposed solution should guarantee an uptime of 99.99%.6.04 Vendor to include a system design proposal.

7.00 Hardware Specifications 7.01 Server to meet the following requirements:

1. Quantity - 22. RAID 103. CPU – Intel Xeon (Dual CPU)4. RAM – 128GB5. HDD – 600GB 15K RPM SAS (x3 units)6. DVD ROM Drive 7. Windows Server 2016 Data centre Edition8. Redundant Power Supply

7.02 Main storage hardware to meet the following requirements:1. SAN storage with RAID 62. HDD – 600GB 15K RPM SAS (x6 units)3. - 4TB 7.2K RPM NLSAS (x12 units)4. Reduntant power supply

7.03 Backup storage to meet the following requirements:1. Quantity – 12. CPU – Intel Xeon (Dual CPU)3. RAM – 128GB4. HDD – 600GB 15K RPM SAS (x6 units)

- 4TB 7.2K RPM NLSAS (x12 units5. Redundant power supply

7.04 The following hard-wares to be included:1. Sever rack – 42U2. UPS for all servers (minimum 15 minutes)3. KVM & KMM

7.05 Diagnostic workstation (radiologist) to meet the following requirements:

1. Quantity – 22. Intel Core i7 / Xeon3. RAM – 16GB4. HDD – 512GB SSD5. Display – 24” LED6. DVD R / W Drive7. Windows 10 Professional 64 BIT, MS office 2019,

Home Business8. Keyboard & Mouse9. PCI slot for Barco monitor

Note: Vendor to exclude diagnostic monitors in tender submission.

7.06 Voice recognition software & microphone to meet following requirements:

1. Quantity - 22. Professional speech recognition with customized

radiology vocabulary (UK spelling system) and specially adapted to Asian accents

3. Philips Speech Mike Premium – compatible with voice recognition software

7.07 Disc Publisher to meet the following requirements:1. Quantity – 22. Estimated throughput – CD-R : 30 discs/hour

DVD-R: 15 discs/hour3. Total Drives – 24. License included5. Workstation included

8.00 System/Solution’s General Information8.01 Name & Version of Solution offered8.02 Country of origin and year of 1st release8.03 Year at which vendor accorded dealership in Malaysia8.04 Please provide Solution’s other differentiating features

(including recognitions, awards) not already covered, if any.

9.00 Support Requirements9.01 Vendor to provide a list of local system support personnel based

in the country.Please provide names, qualifications, training and experience.

9.02 Vendor to detail the levels of technical support for the system.9.03 Vendor to provide at least 10 days of user training by

application specialist.

9.04 Vendor to provide at least 7 days of post go-life on-site support.9.05 Vendor to provide 24 months of warranty with at least 2

preventive maintenance services per year inclusive of parts replacement, hardware and software update and software licensing.

9.06 Any future connectivity to new DICOM modalities shall not incur any connectivity fee.

9.07 For installation of VNA in the future, vendor shall assist in PACS-VNA connectivity works at no additional cost.

9.08 When the hospital implements EMR in future, vendor shall integrate system to EMR at no additional cost.

10.00

Quotation for PPM

10.01 Vendor to provide quotation for:1. Comprehensive ppm for 5 years, post warranty2. Non comprehensive ppm for 5 years, post warranty

10.02 Quotation shall include free life-long software update.