The “CD factory” had to go. That was the consensus reached four years ago by all parties involved in the handling of diagnostic images at the University of Rochester Medical Center (URMC), the regional healthcare hub in Western New York anchored by 800-bed Strong Memorial Hospital.
The internal nickname for the seven-person operation reflected its assembly line processes as well as its often frenetic pace. CDs came in bearing imaging studies not only from inpatient departments but also far-flung outpatient sites. Most of the discs were readable, but many were problematic—glitching up over image viewers if not the images themselves. Radiology staff members would upload the good ones into the PACS each day and then, in a massive annual cleaning, weed out the dross. Taken as a whole, the labor was a cumbersome and inefficient means of medical-image management.
And “CD indigestion” was only one reason URMC decided to go looking for a better way.
“As a quaternary medical center, we have a hub-and-spoke model, with about 19 smaller healthcare facilities in the area feeding in to us,” explains Jim Forrester, URMC’s director of enterprise imaging informatics.
“Until the summer of 2012, the spoke facilities, mostly hospitals but also urgent-care centers and a mobile imaging unit, connected to us mainly by business-to-business VPN tunnels. That was a major challenge to manage, because VPN tunnels are fairly complex and many of the smaller facilities lack IT staffing, expertise or both.”
What changed three years ago? URMC implemented a greatly simplified, technically superior image-management solution. Led by David Waldman, MD, PhD, chair of the department of imaging sciences, the institution selected LifeIMAGE. Secure and HIPAA-compliant, the system only requires end-users to open a browser and sign in. It was out with the CD factory, in with the cloud.
“Last January we were at over 110 percent census in the hospital with the flu epidemic,” recalls Forrester, describing LifeIMAGE in action. “Our stroke team was able to make clinical decisions based on imaging studies performed at regional hospitals. ‘Is there anything that only our medical center can do for this patient, or can they be best treated right where they are?’ We don’t want to bring patients into a medical center that’s already over census if they don’t need quaternary care. LifeIMAGE allowed us to make those calls quickly and accurately.”
For URMC, one of LifeIMAGE’s most persuasive selling points was its ease of use, which was apparent immediately upon implementation. Forrester and his team are happy to talk tech, describing how, for many use cases, the solution’s local app called LILA deploys open extensions to handle business objects in SQL queries. Working in conjunction with PACS, dedicated LifeIMAGE sending apps at the spokes facilitate DICOM routing, transferring image data to the cloud so URMC specialists can view and download it.
But team members are quick to point out that all of this advanced cloud computing is invisible to end-users.
“In the grand scheme of things, this really is quite simple,” says Paul Soto, URMC’s technical lead for regional IT services. “The site just has to have a computer or a virtual machine. We set up time with LifeIMAGE to install the sending app, and the spoke facility can be up and running in about an hour.”
Meanwhile LifeIMAGE requires minor software installation and allows CD uploading anywhere in the hospital by anyone who has password privileges. Clinicians at the hub and all the spokes can share the images without first pushing them into the enterprise PACS, and they can easily nominate a study for the EMR as well as the PACS.
Physicians love the time savings, which is “huge” at URMC, says Soto. “Typically it used to take up to 45 minutes to send imaging,” he adds. “That’s now down to under five minutes.”
Forrester notes that all URMC departments dealing with diagnostic images—not just radiology, cardiology and neurology but also orthopedics, surgery, pediatric cardiology, stroke center, trauma center and others—are now using the system. Some use it for outbound as well as inbound image sharing. This includes the Rochester-based Finger Lakes Donor Recovery Network, which must work nimbly with URMC to send and receive images of donor organs in order to evaluate transplant appropriateness for do-or-die patients on wait lists locally, regionally and, occasionally, nationally.
‘Just good patient care’