University of Washington (UW) Medical Center in Seattle, Wash., is a PACS pioneer, first deploying digital image management a decade ago. Today, the hospital and its radiology department continue to stand at the leading edge of technology. The 450-bed hospital provides complete medical imaging services including 64-slice CT, digital mammography, 1.5T and 3T MRI, 4D ultrasound, nuclear medicine and PET/CT. Total annual imaging volume is approximately 250,000 exams. The medical center is affiliated with nine neighborhood clinics and more than 100 outpatient sites.
As an early PACS adopter, UW Medical Center has been filmless and paperless for about seven years. The center recently achieved a long-term goal, says William Shuman, MD, FACR, professor and vice chairman of the department of radiology and director of radiology, and tied its widely spread and diverse imaging facilities into a single network. The single network comprises an enterprise digital image management strategy that provides all radiologists and clinicians with anytime/anywhere access to images.
Growth and leading edge systems, however, can have downsides. UW Medical Center found that its initial self-managed, long-term archive strategy posed significant challenges in terms of management and costs. After a careful review of the market, the pioneer turned to its PACS vendor—GE Healthcare—and opted for an ASP (application service provider) solution to securely and redundantly manage its images offsite. The transition has simplified archive management, smoothed the budget and archive planning processes, and provided a robust disaster recovery strategy.
The large scale enterprise archive conundrum
As UW Medical Center extended PACS throughout the enterprise, its IT and radiology departments realized that the long-term archive strategy needed to be re-visited. During the initial PACS deployment, the academic medical center decided to locally manage its long-term archive. The local solution sufficed in the early days—but those were the days before 64-slice CT and enterprise digital image management. “We knew how to handle the archive locally,” says Andy Strickland, director of imaging informatics.
Several years ago, the hospital allocated 25 terabytes (TB) online for short-term storage and used an optical disk for backup disaster recovery. But the architecture was too limited for growth, says Strickland. So UW Medical Center upgraded to RAID technology to meet its size and performance needs. It still required a third tier of storage to meet disaster recovery requirements. “At that point,” recalls Strickland, “we were looking at $1 million in capital investment, so it made sense to look at all of the different possibilities.”
The long-term archive IT challenges also were fairly significant. “All of the other clinical systems in the UW Medical Center system comprise about 1 TB of storage. “The PACS currently sits at 30 TB and will reach 50 [TB] in a couple of years,” explains Strickland. The result was an IT management fiasco. Archive and storage technology continually change, says Shuman. “It was always painful and costly, and the IT group was becoming more involved in the upgrading and extending PACS into the enterprise, so it had less time to focus on the archive. The local archive arrangement was costing a lot of money and personnel time,” says Shuman. Strickland calculates that he spent approximately 100 hours every six months planning and implementing archive solutions.
Archives and options
The team at UW was clearly ready for a change. Late in 2005, UW Medical Center decided to evaluate all potential long-term archive solutions. GE, its Centricity PACS vendor, presented the ASP option Centricity ASP. Strickland says the facility also considered removable media such as optical disks and spinning RAID, as well as other ASP providers. A final category of options consisted of a hybrid approach that would combine various systems.
Ultimately, the medical center decided to partner with GE as it ASP provider. Multiple factors played into the decision, says Administrative Director of Radiology Gene Hoefling. “ASP is a single solution that addresses a number of needs. It provides a robust disaster recovery solution. It seamlessly handles storage requirements for escalating datasets. Finally, it offers stability both in terms of cost and storage platforms.”
The center pays for the long-term storage it uses through the operational budget rather than as a capital purchase. “With a traditional archive, the costs are primarily capital. The hospital must commit capital on an annual basis to maintain its archive,” explains Hoefling. And for any site facing increasing volumes in datasets, the writing seems to be on the wall. Budgeting for escalating datasets could become unmanageable. “With an ASP solution, the long-term archive becomes a stable operational cost that can be planned for over time just as a site predicts volume and revenue. At the same time, the hospital can commit capital to technologies that actually generate revenue rather than those that simply store datasets,” sums Hoefling.
A straightforward implementation + management ease
“Implementing ASP as a customer is simple,” says Strickland. The medical center provided a 150 megabit per second (mbs) VPN to GE’s ASP centers in Chicago and California.
The behind-the-scenes ASP process also is fairly simple. When an image is acquired, one copy is sent to an onsite RAID for short-term storage. At the same time, a second copy travels to Chicago via the VPN, and a third is sent to another offsite center in California. Image retrieval is seamless, as PACS reviews the daily schedule each night and pre-fetches exams likely to be of interest the following day, shifting them from the long-term archive to local online storage. When radiologists arrive each day and see new exams, they can view prior images in the same way as new studies.
The ASP model provides both disaster recovery and business continuity. “We have the ability to continue business even if our PACS or whole hospital were crushed. We could access the entire archive via a web page,” explains Strickland.
The ASP model also can free IT staff to focus on needs beyond the archive. “Managers never have enough time to do everything that could or should be done. Anytime there is a budget-neutral solution with the same benefits as another system that demands a lot of staff oversight, it should be considered. Getting out of archive management has been extremely valuable for the UW Medical Center IT group,” says Strickland. What’s more, the solution incorporates new storage technology as it arrives on the market, so the hospital no longer has to handle migrating from old technology to new technology.
Shuman points to further benefits of ASP. The radiology department prefers to employ an integrated approach to PACS, RIS, 3D and voice recognition. The single-vendor approach eliminates interfaces. In addition, it should facilitate PACS-native 3D. “Doing 3D on PACS requires source images in the PACS environment. This is a huge body of data going into PACS; it must be handled cost-effectively without constraining radiologists. If the storage system constrains what can be put into PACS, then PACS functionally is reduced. The GE ASP solution enables UW Medical Center to fully configure and optimize the PACS integration,” Shuman says.
Lessons learned
Onsite long-term archive management is becoming an increasingly difficult proposition. As datasets increase exponentially and technology changes, more and more staff intervention is required. Costs escalate, and a six or seven figure long-term archive can tax the capital budget.
ASP offers a different model. The benefits are comprehensive and address the enterprise’s operational, financial, IT and clinical needs, says Hoefling. ASP shifts the costs to the operating budget, allowing sites to pay for the archive as its uses it. At the same time, it shifts management responsibilities to the vendor, freeing local IT staff to focus on other critical enterprise needs. The impact on radiologists and other image consumers is non-existent as pre-fetching enables seamless review of historic images. Images are always available and always secure.