Waukesha Memorial Hospital in Waukesha, Wis., like other growing healthcare enterprises nationwide, has expanded from a single hospital into an integrated, state-of-the-art healthcare system. The ProHealth Care system includes two hospitals, two diagnostic imaging centers, senior and assisted living complexes, nursing homes, home care and hospice services as well as an inpatient hospice facility, a fitness and wellness center and 16 primary-care clinics. The system completes 180,000 imaging studies annually and is equipped with state-of-the-art imaging equipment.
Waukesha deployed Agfa HealthCare IMPAX PACS in 1997, Agfa computed radiography (CR) systems and IMPAX WEB 1000 web image distribution in 2000, and EMC SMARTS technology for their IT resource management strategy, providing service visibility and control access across their information infrastructure. Today, IMPAX 5.2 serves as the primary PACS, and clinicians throughout the enterprise use Web 1000 and web distribution for image viewing.
Agfa’s enterprise model has continued to meet the hospital’s needs as they’ve evolved over time, reports PACS Administrator Mike Morateck. What’s more, the health system is firming up its relationship with Agfa HealthCare as it plans future enterprise imaging improvements.
A snapshot of the enterprise reveals a sound digital imaging deployment. Waukesha Memorial Hospital is 85 to 90 percent filmless with orthopedic templating as one of the final film bastions. The healthcare system’s needs are similar to other digital sites, says Morateck, with enterprise viewing near the top of the list.
The enterprise solution
Viewing images internally and externally across the enterprise and in the OR presented a major hurdle. The hospital began implementing web distribution in 2000 and completed the project by 2003. Today, a virtual private network (VPN) and web distribution provide enterprise image access and enable radiologists and clinicians to view studies from home. Implementation of PACS in the OR has improved workflow and virtually eliminated unnecessary printing. In the past, the hospital printed patients’ films prior to surgery, but more than half the films were never used. IMPAX WEB eliminated the process and provided surgeons the digital image review tools needed during operative cases.
Waukesha Memorial Hospital, like other digital enterprises, faces evolving challenges. “Integration of cardiology and radiology is a major challenge,” Morateck says. “We need to migrate to a single database while providing clinicians with the specific tools they need to perform their jobs.” The solution, continues Morateck, is a smart-client system that wraps cardiology, radiology and 3D imaging into a single image-review application from a single database. Morateck predicts that Agfa HealthCare will provide these capabilities through a fully functional web distributed image review application.
RIS/PACS integration also rears its familiar face at Waukesha Memorial Hospital. The health system uses a RIS from a different vendor, so integration is a work in progress. “RIS/PACS integration is improving,” notes Morateck. The HIS, however, is the missing link in the integration puzzle. That’s because items such as lab results and clinical notes reside in the HIS, which does not feed into the RIS, so radiologists can not readily access this data from the PACS. The health system is currently working on its portal strategy for staff, patients and physicians.
“A portal solution that preserves the patient context in the PACS application could run on the third PACS monitor and provide HIS and RIS information to the physician at the same point of service. A web-enabled or Citrix version of the HIS and other potential systems would be necessary for the portal to work. This would provide a dashboard view of patient data without the extensive HIS/RIS/PACS integration that is needed natively between the applications in the current state,” explains Morateck. The portal strategy does carry prerequisites. Specifically, the HIS must have a web framework and be able to manage context.
Managing continuous availability of digital images
IMPAX has proven its scalability at Waukesha Memorial Hospital and has accommodated the growing hospital system at all stages. Digital image transmission and storage present an ongoing challenge. “With its large file sizes, radiology is the elephant on the hospital network. We are working to implement best practices with respect to IT and storage,” notes Morateck. Many of the hospital’s IT decisions reflect its commitment.
“We’ve been judicious about what is saved from large datasets and we are allocating storage based on predetermined service standards,” explains Morateck. That is, the health system is creating a budget for storage based on the service standards of the study availability to its customers. Imaging data are saved according to these standards. Older studies that are less likely to be recalled and do not require instant availability are migrated from spinning disk architecture to less expensive storage.
Waukesha Memorial Hosptial has deployed EMC Smarts to ensure continuous image availability and to shift the burden of managing IT complexity from the clinical and IT staff to the actual system. It provides complete visibility and control from Agfa HealthCare IMPAX applications, through server and network management, to storage management. Service standards are essential to managing an information management strategy. “Take time to develop and analyze the business model,” recommends Morateck. Determine how fast images need to be available to whom, where and when and the costs associated with the various standards.
Another prerequisite for data nimbleness, says Morateck, is a non-proprietary storage format. That is, the storage infrastructure should facilitate adjustments. “Healthcare systems should own their data and be able to move or transfer data without significant costs or a large amount of vendor intervention,” opines Morateck.
As the health system has grown, it has solidified its relationship with Agfa HealthCare and EMC, an arrangement that better meets the site’s needs. “Storage decisions like efficacy of tiering and implementing a SAN vs. NAS require information from the imaging vendor. We expect to add a dedicated architect resource from Agfa, which will provide a direct line into Agfa HealthCare’s service organization and facilitate sound decision-making,” says Morateck.
Partnership pays dividends
Developing and implementing an enterprise imaging strategy is a complex, long-term project that requires constant attention. As radiology and enterprise needs grow, PACS continues to evolve to meet those needs. Health systems can minimize their growing pains and maximize their investment in digital solutions by forming a strong relationship with an enterprise imaging vendor.