Inside Information-Assisted Imaging Workflow

 The link among quality, workflow and integration is strong. Integration builds efficient workflow processes, and the combination can boost quality in the healthcare enterprise. Alegent Health, a nine-hospital system in Omaha, Neb., has leveraged a wide array of integrated imaging and IT applications from Siemens Medical Solutions to optimize workflow and improve quality and patient care in its healthcare facilities. The relationship between Alegent Health and Siemens goes beyond imaging and IT equipment. They have built a strategic alliance, which helps guide the decision-making process at the healthcare organization.

The imaging and IT formula

Over the last several years, Alegent Health has embarked on a massive campaign to update its imaging and IT infrastructure and implement digital processes. The fully integrated digital imaging environment delivers a number of benefits, says Senior Vice President and CIO Ken Lawonn. Standardizing equipment, processes and technology helps the organization meet key goals including trimming costs, optimizing quality and increasing efficiency. Another critical benefit, says Lawonn, is the widespread availability of information to caregivers. Caregivers can access information not only at the point of care, but also at their offices and homes and across the hospital system.

PACS & People

Digital image management, is an IT solution, but a truly successful deployment hinges on people as well as technology. Alegent Health approached the human side of the PACS deployment with the same degree of commitment as the technical side. The healthcare organization considered relationships with outside vendors and staff as it entered the digital era.

On the equipment front, Alegent looked for a technology collaborator rather than a vendor. The organization selected Siemens Medical Solutions as its primary imaging and IT provider. The benefits of the single-source approach are significant, says Senior Vice President and CIO Ken Lawonn. For starters, the arrangement facilitates standardization and integration, which boosts efficiency among care providers. At the next level, the healthcare organization can develop a stronger relationship with one primary vendor. If there are multiple vendors, it is much more difficult to nurture relationships with each vendor. Alegent Health and Siemens have grown the relationship into a strategic alliance, and now the healthcare organization taps into Siemens’ expertise for input into the long-term strategic planning process.

The other human element of digital image management is the medical staff. “It’s important to engage medical staff in the evaluation and selection process as early as possible,” Lawonn says. This boosts buy-in among physicians and helps guide the enterprise toward an optimal solution from the clinical perspective.

Alegent Health also garnered significant support among clinical staff by ensuring that its technical infrastructure sufficed for the transition to digital image management. The organization invested in network upgrades, redundant servers and state-of the-art storage solutions like EMC Corporation’s CLARiiON networked storage to ensure optimal image and data transmission speeds.

The final element relates to sharing knowledge from other healthcare organizations. “There is no need to reinvent the wheel when deploying PACS,” says Jeff Broz, operations director, imaging applications. “Healthcare organizations can leverage the expertise of other sites,” continues Broz. He recommends that healthcare organizations locate allies and complete site visits to understand objectives and challenges associated with digital image management. This approach can save time, fine tune the project and uncover undetected roadblocks prior to implementation.

Alegent’s image management solutions include Siemens Cardiology and Radiology PACS platform and syngo Workflow RIS, which handles radiology workflow. Siemens also provides the lion’s share of the organization’s imaging modalities including SOMATOM Definition dual-source CT scanners, SOMATOM Sensation 64 CT scanners, SOMATOM Sensation 16-slice CT scanners, MAGNETOM Trio 3T, Espree and Symphony MRI systems. Other solutions across the enterprise include Siemens Soarian Clinical Access electronic medical record (EMR) on the inpatient side and a NextGen outpatient EMR.

The rationale for the primarily single vendor approach is simple, says Jeff Broz, operations director, imaging applications. “Alegent Health is a multi-entity enterprise, and many of our healthcare providers travel between our different sites. They need seamless access to images and information to provide optimal patient care.” Streamlined, universal access facilitates continuity of care and can lead to better patient outcomes.

The digital imaging project has re-invented image access. Before web-enabled PACS, an image was an island, says Broz. Images weren’t portable, and multiple providers could not view an image. Fast forward to the integrated era. Physicians can view patient images and information across the enterprise. Image viewing options include PACS workstations located throughout the enterprise or Soarian Clinical Access. Soarian is linked to the PACS web server for diagnostic images, so images are available with patient results. The integration delivers significant workflow and efficiency gains as physicians can view images from anywhere within the hospital network with a few mouse clicks.

The infrastructure component

Implementing digital image management requires a significant adjustment on the part of physicians. Prior to implementation, Lawonn realized that any technical barriers or glitches could interfere with adoption and the success of the project. “High availability and reliability are essential. If physicians can’t rely on digital solutions, the site will lose buy-in,” states Lawonn. Consequently, Alegent Health combed through its network and storage infrastructure prior to the PACS deployment.

“When we first looked at the situation, there were significant concerns about the availability and reliability of images and data. We realized the importance of image retrieval time and convinced leadership to remove barriers that might interfere with optimal image retrieval,” recalls Lawonn.

The healthcare system analyzed its network for potential bottlenecks and decided to upgrade to a robust network that would deliver maximum speed. Alegent Health installed a redundant gigabit network between its sites. The network resembles a daisy chain, so if one link goes down data can travel in the other direction. In addition, all facilities are wireless. The network infrastructure provides the foundation for a portal strategy; portals linked to Soarian and web-based PACS are dispersed throughout the various sites, providing convenient access to patient images and data.

The infrastructure commitment extended to other areas as well. Alegent Health opted to keep its imaging archive as near term as possible to circumvent any delays in retrieving images from deeper storage.

“We decided the best thing to do was to partner with a good organization, so we went to EMC to look at near-line, high performance and offline storage,” Lawonn says. “We wanted to develop a strategy to plan for and accommodate tremendous growth in storage. Perhaps the biggest challenge for any organization as you go into digital imaging is to really effectively plan your storage needs.”

Alegent Health also invested in a test server, a fairly unique decision in the medical IT arena. The organization uses the server to test upgrades and interface changes prior to deployment.

The integrated approach

Healthcare organizations can realize significant gains with the implementation of digital imaging modalities and digital image management. An integrated approach can boost efficiency and workflow and enhance patient quality. A true solution, however, extends beyond imaging modalities and requires a thorough analysis of the IT infrastructure.

Storing Cardiology Information Intelligently: The Benefits of Enterprise Storage

The capacity needed to store cardiology images presents a challenge for the healthcare enterprise. Alegent Health in Omaha, Neb., is grappling with exponential growth in the amount of patient information needing to be stored. “We’re using 2 terabytes (TB) a month just for PACS,” calculates Kirk Johnson, operations director, systems management at Alegent Health. Those growth rates translate into a significant challenge. Sites need to develop a proactive, future-oriented storage strategy.

That’s exactly the path Alegent Health selected when it deployed Siemens Medical Solutions Cardiology and Radiology PACS platform four years ago. “We wanted to be on the leading edge and leverage emerging technology — to move our information online for immediate access,” explains Alegent Health Senior Vice President and CIO Ken Lawonn. The alternative and standard option at that point relied on tape, but Alegent realized that route would have required an upgrade in the short-term.

The healthcare enterprise selected EMC and invested in a tiered, networked storage strategy with three distinct platforms. The storage configuration includes two EMC CLARiiON CX600 systems, two CLARiiON CX700 systems and two CLARiiON CX3-40 UltraScale systems. The CLARiiON storage area network (SAN) systems hold high availability applications like email. EMC Symmetrix is used for high-speed, real-time data like clinical systems and payroll. Finally, Alegent Health is migrating its imaging archives to a pair of EMC Centera systems.

The EMC Centera systems will deliver a number of benefits, says Johnson. “The biggest benefit associated with the Centera platform is ease of management.” As the Siemens PACS archive grows, management represents an ongoing challenge as the site must continue to add disks to the CLARiiON archive to keep up with PACS growth. The site’s CLARiiON systems relied on a tape-based back-up mechanism. Centera removes tape from the equation. “The difference between managing a tape library and Centera spinning disk archive is night and day,” says Jeff Broz, operations director, imaging applications.

For starters, tapes can break or go bad. When additional imaging storage is needed, Alegent Health plans to purchase an additional pair of 40 TB Centera cabinets. “Centera incorporates a self-healing architecture that detects problems and provides flexibility, stability and proactivity. We won’t need to dig and snoop to find problems as is required with tape,” notes Broz. After the Centera migration is complete, imaging data will be simultaneously written to both redundant archives, which streamlines the backup processes.

True collaboration

EMC Corporation has been a presence at Alegent Health for about four years. Since the initial deployment, the company has worked closely with the healthcare system to help it tap into cutting-edge information infrastructure; however, in the last year, EMC has stepped up to become a true technology ally, says Johnson.

The differences between a vendor and true technology collaborator are subtle but can have a lasting effect. “EMC helps us plan for the future and refines our strategic plan to achieve our objectives,” explains Johnson. This pre-sales work consists of regular meetings and white board sessions that don’t automatically translate into a sale, but do guide Alegent Health toward maximizing its storage investment. Recent sessions with EMC have focused on disaster recovery, data back up strategies and high-availability storage solutions.

The strategic alliance between Alegent Health and EMC provide a solid foundation for the future as well, says Broz. “Applications, particularly Radiology and Cardiology PACS, are going to fall under one umbrella in the not too distant future. Alegent Health is ready for consolidation on the back-end as the organization has deployed a common radiology and cardiology storage platform.”

The insider’s guide to storage

Developing and implementing an enterprise storage strategy is a significant undertaking. Johnson offers some advice for colleagues facing the storage issue.
  • Make sure that the storage platform can grow as the organization’s needs grow. “No matter how large the initial system is, site needs will grow by leaps and bounds.” The ideal base strategy revolves around additional storage. If the site opts for a lesser system, it is likely to require a replacement system sooner rather than later.
  • Discuss storage strategies with imaging and IT vendors, and find out which systems they support.
  • Storage is an essential ingredient. Maximize your storage investment by developing a robust, future-oriented platform.