|Diagnostic Imaging Services (DIS), New Orleans|
Diagnostic Imaging Services (DIS) is a five-site freestanding imaging practice located in the greater New Orleans area. Unfortunately, the practice experienced disaster first-hand when Hurricane Katrina hit in August 2005. The storm devastated the region and greatly effected the practice, its patients and staff; however, the ASP model demonstrated its merit as every electronic image archived in long-term storage remained secure and available. The decision to implement ASP proved its value as it allowed DIS to ensure continuity of care for its patients when so much in the region was in such disarray.
DIS’ full service imaging portfolio includes digital mammography, MRI, CT, DEXA, ultrasound, nuclear medicine, digital radiography and fluoroscopy and collectively the five sites complete 115,000 to 120,000 studies annually. To manage that image load, the practice deployed GE Healthcare Centricity PACS in 2003 and opted too for ASP for long-term, off-site image archiving.
ASP presents an attractive arrangement from the upfront cost perspective, says CEO Anthony Gettys, who was CFO at the time the PACS/ASP solution was purchased. There is no upfront cost for ASP as long-term storage is funded through the operating budget, and the group pays only for the storage it uses. But the true benefit of ASP, particularly for DIS, is disaster recovery. The DIS experience demonstrates the safety, continuity and reliability of GE’s ASP offering.
“Disaster recovery is something we always planned for, but we never expected to have to use it. Hurricane Katrina proved the importance of ASP,” says Keith Robichaux, PACS administrator.
The DIS disaster recovery plan is elegantly simple. After images are acquired at any of the practice’s imaging centers, files are immediately saved in the long-term archives at two offsite data warehouses. That model facilitated a fairly straightforward disaster plan. In August 2005, once the practice realized that Hurricane Katrina would hit the area, the plan went into action.
In the days preceding Katrina, all imaging modalities performed according to regular protocols and sent data to PACS. After the last exam was acquired and the facility was closing to brace for the storm, Robichaux contacted GE, and the company helped the facility shut down the PACS—making sure all of the images had been safety sent to the offsite storage sites in Chicago and California. Robichaux, like other staff, left the area, taking the short-term backup data tape with him. “We were very confident of our offsite GE storage. The combination of the archives and a few backup tapes meant patient data would be secure,” explains Kathy Rabalais, director of clinical services & IT.
Three weeks passed before any staff was allowed to return to the area and the Imaging Centers. The hitch, as anyone in the healthcare business knows, is that patient care doesn’t wait.
Patients who had scattered to every corner of the U.S. needed access to their images. Even though the center was not sure of its future as an imaging facility, it needed to attend to previous patients. Robichaux and a colleague set up a PACS CD burning station on the second floor of the Metairie, La., facility—since the first floor had some water damage—and arranged for release of information and e-signing capabilities for radiologists. DIS established a central phone line to inform its 3,500 referring physicians of its status. “With proper credentials, our referring physicians could get the data they needed to maintain patient care. They were extremely grateful because many had patients left in limbo when Katrina hit. Oncology patients were able to get three years’ worth of CT or MRI data if they needed it, no matter where they were,” recalls Rabalais.
Centricity Web Portal also played a significant role in the continuity of care. Although the DIS imaging centers themselves were not open for business, referring physicians could access images and reports online. The CD burning station served physicians without web access.
The other at-risk patient population consisted of patients whose exams were acquired but not read in the days preceding the hurricane. DIS set up a second floor PACS reading station; a radiologist accessed those files on the archive to ensure that those studies were read and a report created.
Because of its ASP-enabled solid disaster recovery plan, DIS was able to provide patients with service after Katrina. The business outcome for the practice also was positive. “In September 2005, we weren’t sure that Diagnostic Imaging Services was going to come back as a business,” says Rabalais. Buildings had sustained some water damage, and the business anticipated that patient volume was going to be to substantially reduced after the hurricane. “The decisions about whether or not to open and how many facilities to open were major issues. But the one thing that was a constant was the fact that we had all historic patient imaging data stored in offsite databases; we knew physicians could easily retrieve imaging information and reports,” she says.
DIS did reopen, albeit slowly, after the storm. The practice opened one facility that sustained only minor roof damage within weeks and started seeing patients right away. People needed healthcare and diagnostic imaging, says Gettys. Over the next six months, DIS continued to open clinics slowly and by the spring of 2006 reached pre-Katrina numbers in terms of imaging study volumes.
“Disaster recovery is the No. 1 factor to consider when it comes to ASP. We know our data are maintained no matter what happens locally,” states Robichaux. In addition, the unfortunate reality of disaster is its democracy. New Orleans may run hurricane drills, and California may prep for earthquakes, but disaster can strike anywhere. “A water pipe break, fire or tornado is possible. With an ASP model, the imaging center does not have to worry about patient images or the core business being compromised because data are offsite and safe in two separate locations,” sums Rabalais.
And while disaster recovery is mission critical, imaging centers also need to make smart business decisions. Once again, the ASP model proves its value. “The very minimal upfront cost and ongoing operational costs are extremely beneficial from the business standpoint. The limited upfront investment allowed us to focus some of our capital on equipment and technology needed at the patient level,” notes Gettys.
|Maximizing Resources: IT & ASP|
|Facilities utilizing ASP are quick to point to its disaster recovery and cost benefits, but there are other important advantages associated with the ASP model. One example? ASP is an IT featherweight, minimizing IT infrastructure, staff burden and costs.|
Diagnostic Imaging Services (DIS) implemented GE Healthcare Centricity PACS with ASP in 2003. On the IT front, the model allows the five-center imaging practice to keep a very minimal IT department, says Kathy Rabalais, director of clinical services & IT. The practice relies on one in-house staffer to manage the PACS, PACS Administrator Keith Robichaux, and an IT Consultant, Andrew LeBlanc, to handle five digital imaging centers with annual imaging volume of 115,000 to 120,000. “If we did not have an ASP model, PACS would require a lot more resources both in terms of personnel and storage space,” continues Rabalais.
The long-term image archive is a very expensive capital item to maintain locally, says LeBlanc. For starters, an onsite archive requires regular server backup. Unlike other local clinical systems, PACS produces a massive amount of data, which creates a security challenge that can tax a local IT department. “DIS PACS data are stored remotely; the transfer is secure via a high-speed fiber optic connection,” explains LeBlanc.
ASP also offers flexibility. GE maintains the terabytes of backup files that can readily accommodate changing modalities and additional equipment or storage. In contrast, if the local site handles the long-term archive, the IT department is confronted with multiple vendors, increases in optical storage and tapes and additional maintenance. In addition, the local sites must manage other archive concerns such as power, an uninterruptible power source (UPS) and air conditioning. “Each component requires people. A typical site-based long-term PACS archive requires two or three FTEs to maintain the data and perform functions that could be handled by the ASP. Plus, people come and go, so there is retraining,” notes LeBlanc. ASP offers a low maintenance model; it is an offsite connection solution that does not require local support.
On top of the known issues—like upgrades and increasing the archive—there are IT unknowns such as media problems, says LeBlanc. Under the ASP model, the unknowns become the vendor’s headache, and GE can bring the resources and expertise to solve such issues.
LeBlanc sums, “ASP bypasses the need for a great amount of local IT support. Obsolescence is a non-issue as the vendor refreshes hardware and software. These are significant expenses that can be eliminated and consumed within the ASP model. ASP is the answer for long-term archiving and disaster recovery. Centers can handle the archive in other ways, or they can do it right [with ASP].”